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Islam JY, Hurwitz E, Li D, Camacho-Rivera M, Sun J, Safo S, Ross JM, Wilkins K, Hassan S, Hill EL, Nosyk B, Varley C, Fadul N, Madlock-Brown C, Patel RC. Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C). AIDS Behav 2024:10.1007/s10461-024-04466-0. [PMID: 39292319 DOI: 10.1007/s10461-024-04466-0] [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] [Accepted: 08/12/2024] [Indexed: 09/19/2024]
Abstract
Individually, the COVID-19 and HIV pandemics have differentially impacted minoritized groups due to the role of social determinants of health (SDoH) in the U.S. Little is known how the collision of these two pandemics may have exacerbated adverse health outcomes. We evaluated county-level SDoH and associations with hospitalization after a COVID-19 diagnosis among people with (PWH) and without HIV (PWOH) by racial/ethnic groups. We used the U.S. National COVID Cohort Collaborative (January 2020-November 2023), a nationally-sampled electronic health record repository, to identify adults who were diagnosed with COVID-19 with HIV (n = 22,491) and without HIV (n = 2,220,660). We aggregated SDoH measures at the county-level and categorized racial/ethnic groups as Non-Hispanic (NH) White, NH-Black, Hispanic/Latinx, NH-Asian and Pacific Islander (AAPI), and NH-American Indian or Alaskan Native (AIAN). To estimate associations of county-level SDoH with hospitalization after a COVID-19 diagnosis, we used multilevel, multivariable logistic regressions, calculating adjusted relative risks (aRR) with 95% confidence intervals (95% CI). COVID-19 related hospitalization occurred among 11% of PWH and 7% of PWOH, with the highest proportion among NH-Black PWH (15%). In evaluating county-level SDoH among PWH, we found higher average household size was associated with lower risk of COVID-19 related hospitalization across racial/ethnic groups. Higher mean commute time (aRR: 1.76; 95% CI 1.10-2.62) and higher proportion of adults without health insurance (aRR: 1.40; 95% CI 1.04-1.84) was associated with a higher risk of COVID-19 hospitalization among NH-Black PWH, however, NH-Black PWOH did not demonstrate these associations. Differences by race and ethnicity exist in associations of adverse county-level SDoH with COVID-19 outcomes among people with and without HIV in the U.S.
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Affiliation(s)
- Jessica Y Islam
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, MRC - CANCONT, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
| | - Eric Hurwitz
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Virginia Commonwealth University, Richmond, VA, USA
| | - Dongmei Li
- Departments of Clinical and Translational Research, Obstetrics and Gynecology, and Public Health Sciences, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Sandra Safo
- Department of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer M Ross
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kenneth Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Shukri Hassan
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Elaine L Hill
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Cara Varley
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Nada Fadul
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charisse Madlock-Brown
- Department of Informatics, College of Nursing, The University of Iowa, Iowa City, IA, USA
| | - Rena C Patel
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Hao S, Quinn AW, Iasiello JA, Lea CS, Popowicz P, Fu Y, Irish W, Parikh AA, Snyder RA. Correlation of Patient-Reported Social Determinants of Health With Census Tract Measures of Socioeconomic Disadvantage in Patients With GI Cancers in Eastern North Carolina. JCO Oncol Pract 2024; 20:1280-1288. [PMID: 38759124 DOI: 10.1200/op.23.00703] [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: 10/29/2023] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Investigating the impact of social determinants of health (SDOHs) on cancer care in large populations relies on census estimates. Routine clinic SDOH screening provides timely patient-level information which could inform best practices. This study evaluated the correlation between patient-reported SDOH needs and population-level census tract measures. METHODS This was a retrospective cross-sectional study of a cohort of adult patients with GI malignancy screened for SDOHs such as financial insecurity, transportation, and food insecurity during initial outpatient evaluation at East Carolina University (formerly Vidant) Health Medical Center in Greenville, NC (November 2020-July 2021). Primary outcomes included number and severity of identified SDOH needs and area deprivation index (ADI) and census tract measures for each patient. Spearman rank correlations were calculated among patient-level needs and between patient-level needs and similar census tract measures. RESULTS Of 112 patients screened, 58.9% self-identified as White (n = 66) and 41.1% as Black (n = 46). A total of 50.5% (n = 54) resided in a rural county. The collective median state ADI rank was 7 (IQR, 5-9). The median household income was $38,125 in US dollars (USD) (IQR, $31,436-$48,934 [USD]). Only 12.5% (n = 14) reported a moderate or severe financial need. Among reported needs, financial need moderately correlated with food insecurity (coefficient, 0.46; P < .001) and transportation (coefficient, 0.45; P < .001). Overall, census tract measures and reported needs poorly correlated. Lack of transportation correlated with percentage of households without a vehicle (coefficient, 0.18; P = .03) and limited access to healthy foods (coefficient, 0.18; P = .04). CONCLUSION Given the poor correlation between reported and census needs, population-level measures may not accurately predict patient-reported needs. These findings highlight the importance of SDOH screening in the clinical setting to reduce health disparities and identify opportunities to improve care delivery.
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Affiliation(s)
- Scarlett Hao
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Ashley W Quinn
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - John A Iasiello
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - C Suzanne Lea
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Patrycja Popowicz
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Yuanyuan Fu
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - William Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgical Oncology, University of Texas Health San Antonio, San Antonio, TX
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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Beks H, Walsh SM, Wood S, Clayden S, Alston L, Coffee NT, Versace VL. Application of the Australian Bureau of Statistics Socio-Economic Indexes for Areas in cardiovascular disease research: a scoping review identifying implications for research. AUST HEALTH REV 2024; 48:414-454. [PMID: 38616107 DOI: 10.1071/ah23239] [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: 11/09/2023] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
Objective To scope how the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) has been applied to measure socio-economic status (SES) in peer-reviewed cardiovascular disease (CVD) research. Methods The Joanna Briggs Institute's scoping review methodology was used. Results The search retrieved 2788 unique citations, and 49 studies were included. Studies were heterogeneous in their approach to analysis using SEIFA. Not all studies provided information as to what version was used and how SEIFA was applied in analysis. Spatial unit of analysis varied between studies, with participant postcode most frequently applied. Study quality varied. Conclusions The use of SEIFA in Australian CVD peer-reviewed research is widespread, with variations in the application of SEIFA to measure SES as an exposure. There is a need to improve the reporting of how SEIFA is applied in the methods sections of research papers for greater transparency and to ensure accurate interpretation of CVD research.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Sandra M Walsh
- Department of Rural Health, University of South Australia, Whyalla, SA, Australia
| | - Sarah Wood
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Suzanne Clayden
- Specialist Physicians Clinic, Southwest Healthcare, Warrnambool, Vic., Australia
| | | | - Neil T Coffee
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Vincent L Versace
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
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Singh Ospina N, Diaz-Thomas A, McDonnell ME, Demay MB, Pittas AG, York E, Corrigan MD, Lash RW, Brito JP, Murad MH, McCartney CR. Navigating Complexities: Vitamin D, Skin Pigmentation, and Race. J Clin Endocrinol Metab 2024; 109:1955-1960. [PMID: 38828960 PMCID: PMC11244154 DOI: 10.1210/clinem/dgae314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Indexed: 06/05/2024]
Abstract
Vitamin D plays a critical role in many physiological functions, including calcium metabolism and musculoskeletal health. This commentary aims to explore the intricate relationships among skin complexion, race, and 25-hydroxyvitamin D (25[OH]D) levels, focusing on challenges the Endocrine Society encountered during clinical practice guideline development. Given that increased melanin content reduces 25(OH)D production in the skin in response to UV light, the guideline development panel addressed the potential role for 25(OH)D screening in individuals with dark skin complexion. The panel discovered that no randomized clinical trials have directly assessed vitamin D related patient-important outcomes based on participants' skin pigmentation, although race and ethnicity often served as presumed proxies for skin pigmentation in the literature. In their deliberations, guideline panel members and selected Endocrine Society leaders underscored the critical need to distinguish between skin pigmentation as a biological variable and race and ethnicity as socially determined constructs. This differentiation is vital to maximize scientific rigor and, thus, the validity of resulting recommendations. Lessons learned from the guideline development process emphasize the necessity of clarity when incorporating race and ethnicity into clinical guidelines. Such clarity is an essential step toward improving health outcomes and ensuring equitable healthcare practices.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, University of Florida, Gainesville, FL 32610, USA
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marie B Demay
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | | | | | | | - Juan P Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M Hassan Murad
- Mayo Clinic, Evidence-Based Practice Center, Rochester, MN 55905, USA
| | - Christopher R McCartney
- Division of Endocrinology and Metabolism, Department of Medicine, West Virginia University, Morgantown, WV 26506, USA
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Musiwa AS, Sinha V, Hanley J, Ruiz-Casares M. Antenatal care coverage and early childhood mortality in Zimbabwe: new interpretations from nationally representative household surveys. Health Promot Int 2024; 39:daae039. [PMID: 38742894 PMCID: PMC11092268 DOI: 10.1093/heapro/daae039] [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: 05/16/2024] Open
Abstract
Zimbabwe has implemented universal antenatal care (ANC) policies since 1980 that have significantly contributed to improvements in ANC access and early childhood mortality rates. However, Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), two of Zimbabwe's main sources of health data and evidence, often provide seemingly different estimates of ANC coverage and under-five mortality rates. This creates confusion that can result in disparate policies and practices, with potential negative impacts on mother and child health in Zimbabwe. We conducted a comparability analysis of multiple DHS and MICS datasets to enhance the understanding of point estimates, temporal changes, rural-urban differences and reliability of estimates of ANC coverage and neonatal, infant and under-five mortality rates (NMR, IMR and U5MR, separately) from 2009 to 2019 in Zimbabwe. Our two samples z-tests revealed that both DHS and MICS indicated significant increases in ANC coverage and declines in IMR and U5MR but only from 2009 to 2015. NMR neither increased nor declined from 2009 to 2019. Rural-urban differences were significant for ANC coverage (2009-15 only) but not for NMR, IMR and U5MR. We found that there is a need for more precise DHS and MICS estimates of urban ANC coverage and all estimates of NMR, IMR and U5MR, and that shorter recall periods provide more reliable estimates of ANC coverage in Zimbabwe. Our findings represent new interpretations and clearer insights into progress and gaps around ANC coverage and under-five mortality rates that can inform the development, implementation, monitoring and evaluation of policy and practice responses and further research in Zimbabwe.
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Affiliation(s)
- Anthony Shuko Musiwa
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Centre for Research on Children and Families, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
| | - Vandna Sinha
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Centre for Research on Children and Families, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- School of Education, University of Colorado Boulder, Ofelia Miramontes and Leonard Baca Education Building, 249 UCB, Boulder, Colorado 80309-0249, USA
| | - Jill Hanley
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Sherpa University Institute, West-Central Montreal CIUSSS, CLSC de Parc-Extension, 7085 Hutchison Street, Montreal, QC H3N 1Y9, Canada
| | - Mónica Ruiz-Casares
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Centre for Research on Children and Families, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Sherpa University Institute, West-Central Montreal CIUSSS, CLSC de Parc-Extension, 7085 Hutchison Street, Montreal, QC H3N 1Y9, Canada
- School of Child & Youth Care, Toronto Metropolitan University, Sally Horsfall Eaton Centre for Studies in Community Health, 99 Gerrard Street East, Room SHE-641, Toronto, ON M5B 1G7, Canada
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Khadke S, Kumar A, Al‐Kindi S, Rajagopalan S, Kong Y, Nasir K, Ahmad J, Adamkiewicz G, Delaney S, Nohria A, Dani SS, Ganatra S. Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States. J Am Heart Assoc 2024; 13:e033428. [PMID: 38533798 PMCID: PMC11179791 DOI: 10.1161/jaha.123.033428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/30/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND While the impacts of social and environmental exposure on cardiovascular risks are often reported individually, the combined effect is poorly understood. METHODS AND RESULTS Using the 2022 Environmental Justice Index, socio-environmental justice index and environmental burden module ranks of census tracts were divided into quartiles (quartile 1, the least vulnerable census tracts; quartile 4, the most vulnerable census tracts). Age-adjusted rate ratios (RRs) of coronary artery disease, strokes, and various health measures reported in the Prevention Population-Level Analysis and Community Estimates data were compared between quartiles using multivariable Poisson regression. The quartile 4 Environmental Justice Index was associated with a higher rate of coronary artery disease (RR, 1.684 [95% CI, 1.660-1.708]) and stroke (RR, 2.112 [95% CI, 2.078-2.147]) compared with the quartile 1 Environmental Justice Index. Similarly, coronary artery disease 1.057 [95% CI,1.043-1.0716] and stroke (RR, 1.118 [95% CI, 1.102-1.135]) were significantly higher in the quartile 4 than in the quartile 1 environmental burden module. Similar results were observed for chronic kidney disease, hypertension, diabetes, obesity, high cholesterol, lack of health insurance, sleep <7 hours per night, no leisure time physical activity, and impaired mental and physical health >14 days. CONCLUSIONS The prevalence of CVD and its risk factors is highly associated with increased social and environmental adversities, and environmental exposure plays an important role independent of social factors.
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Affiliation(s)
- Sumanth Khadke
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Ashish Kumar
- Department of Medicine, Cleveland ClinicAkron GeneralAkronOHUSA
| | - Sadeer Al‐Kindi
- Division of Cardiovascular Prevention and Wellness, Houston MethodistDeBakey Heart and Vascular CenterHoustonTXUSA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of MedicineClevelandOHUSA
| | - Yixin Kong
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston MethodistDeBakey Heart and Vascular CenterHoustonTXUSA
| | - Javaria Ahmad
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Gary Adamkiewicz
- Department of Environmental HealthHarvard T.H. Chan, School of Public HealthBostonMAUSA
| | - Scott Delaney
- Department of Environmental HealthHarvard T.H. Chan, School of Public HealthBostonMAUSA
| | - Anju Nohria
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMAUSA
| | - Sourbha S. Dani
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
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Ly KN, Yin S, Spradling PR. Disparities in Social Vulnerability and Premature Mortality among Decedents with Hepatitis B, United States, 2010-2019. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01968-4. [PMID: 38472630 PMCID: PMC11390983 DOI: 10.1007/s40615-024-01968-4] [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: 11/06/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Current US hepatitis B mortality rates remain three times higher than the national target. Mortality reduction will depend on addressing hepatitis B disparities influenced by social determinants of health. OBJECTIVES This study aims to describe characteristics of hepatitis B-listed decedents, which included US birthplace status and county social vulnerability attributes and quantify premature mortality. METHODS We conducted a cross-sectional analysis of 17,483 hepatitis B-listed decedents using the 2010-2019 US Multiple-Cause-of-Death data merged with the county-level Social Vulnerability Index (SVI). Outcomes included the distribution of decedents according to US birthplace status and residence in higher versus lower death burden counties by sociodemographic characteristics, years of potential life lost (YPLL), and SVI quartiles. RESULTS Most hepatitis B-listed decedents were US-born, male, and born during 1945-1965. Median YPLL was 17.2; 90.0% died prematurely. US-born decedents were more frequently White, non-college graduates, unmarried, and had resided in a county with < 500,000 people; non-US-born decedents were more frequently Asian/Pacific Islander, college graduates, married, and had resided in a county with ≥ 1 million people. Higher death burden (≥ 20) counties were principally located in coastal states. US-born decedents more frequently resided in counties in the highest SVI quartile for "Household Characteristics" and "Uninsured," whereas non-US-born decedents more frequently resided in counties in the highest SVI quartile for "Racial/Ethnic Minority Status" and "Housing Type/Transportation." CONCLUSION This analysis found substantial premature hepatitis B mortality and residence in counties ranked high in social vulnerability. Successful interventions should be tailored to disproportionately affected populations and the social vulnerability features of their geographic areas.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA.
| | - Shaoman Yin
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA.
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Mattingly TJ. A Research Framework to Improve Health Disparity Evidence Gaps in Value Assessments. PHARMACOECONOMICS 2024; 42:253-259. [PMID: 38085442 DOI: 10.1007/s40273-023-01340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 02/13/2024]
Abstract
A value assessment is intended as a tool for evaluating healthcare treatments to gauge value and inform decisions. Economic value assessments typically incorporate a cost-effectiveness analysis, focusing on costs and health outcomes important to payers, missing important information to ensure existing markets optimize resource allocation. Despite frequent calls for more explicit consideration of health equity impacts in value assessments, health economists continue to develop models informed by traditional cost and quality-of-life data that do not capture differences experienced by health disparity populations. This conceptual paper proposes a research framework to enhance data collection and analysis to address these gaps and better quantify the value of a health innovation, and better assess how a new intervention impacts health disparities. The framework comprises three distinct phases that build on one another: (1) contextualization of lived experiences for disadvantaged communities; (2) individual-level quantification of health disparities for cost and quality-of-life measures; and (3) quantifying community-level impacts.
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Affiliation(s)
- T Joseph Mattingly
- Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT, 84112, USA.
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Johnston A, Smith GN, Tanuseputro P, Coutinho T, Edwards JD. Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data. Paediatr Perinat Epidemiol 2024; 38:254-267. [PMID: 38220144 DOI: 10.1111/ppe.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data. OBJECTIVES To summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research. METHODS This is a methodological guidance paper. RESULTS Several conceptual and methodological factors related to the data-generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered. CONCLUSIONS To advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
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Jayasekera J, El Kefi S, Fernandez JR, Wojcik KM, Woo JMP, Ezeani A, Ish JL, Bhattacharya M, Ogunsina K, Chang CJ, Cohen CM, Ponce S, Kamil D, Zhang J, Le R, Ramanathan AL, Butera G, Chapman C, Grant SJ, Lewis-Thames MW, Dash C, Bethea TN, Forde AT. Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review. J Natl Cancer Inst Monogr 2023; 2023:231-245. [PMID: 37947336 PMCID: PMC10637025 DOI: 10.1093/jncimonographs/lgad020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. RESULTS A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. CONCLUSIONS A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.
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Affiliation(s)
- Jinani Jayasekera
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Safa El Kefi
- NYU Langone Health, New York University, New York, NY, USA
| | - Jessica R Fernandez
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M Wojcik
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer M P Woo
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Adaora Ezeani
- Health Behaviors Research Branch of the Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer L Ish
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Manami Bhattacharya
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, and the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kemi Ogunsina
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Che-Jung Chang
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Camryn M Cohen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dalya Kamil
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Julia Zhang
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Sophomore at Williams College, Williamstown, MA, USA
| | - Randy Le
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Amrita L Ramanathan
- Diabetes, Endocrinology, & Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston Veterans Affairs, Houston, TX, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allana T Forde
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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11
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Yabroff KR, Boehm AL, Nogueira LM, Sherman M, Bradley CJ, Shih YCT, Keating NL, Gomez SL, Banegas MP, Ambs S, Hershman DL, Yu JB, Riaz N, Stockler MR, Chen RC, Franco EL. An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals. J Natl Cancer Inst 2023; 115:1115-1120. [PMID: 37806780 DOI: 10.1093/jnci/djad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | | | - Leticia M Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Mark Sherman
- Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scarlett L Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, CA, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | - James B Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wells, Australia
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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12
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Yabroff KR, Boehm AL, Nogueira LM, Sherman M, Bradley CJ, Shih YCT, Keating NL, Gomez SL, Banegas MP, Ambs S, Hershman DL, Yu JB, Riaz N, Stockler MR, Chen RC, Franco EL. An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals. JNCI Cancer Spectr 2023; 7:pkad063. [PMID: 37806772 PMCID: PMC10560610 DOI: 10.1093/jncics/pkad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | | | - Leticia M Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Mark Sherman
- Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Scarlett L Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, CA, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | - James B Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wells, Australia
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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