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Radhamony R, Cross WM, Townsin L, Banik B. Culturally and Linguistically Diverse Community Access and Utilisation of the Mental Health Service: An Explanation Using Andersen's Behavioural Model. Issues Ment Health Nurs 2024:1-8. [PMID: 38954511 DOI: 10.1080/01612840.2024.2359602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Andersen's Behavioural Model of Health Service Use (ABMHSU) is a multilevel model that helps understand the factors influencing health service access and utilisation. This framework is a widely used model for health service use in general, as well as in immigrant populations and vulnerable populations. ABMHSU, in this project, provided a framework to explain how the mental health nurses' cultural competence can influence the Victorian CALD community members' mental health care access and utilisation. A unique model of ABMHSU in the current multiple-method project provided a theoretical framework for examining the factors associated with people from the CALD community accessing mental health services in an Australian context to answer the research questions. The key findings of the research were discussed with reference to the extant literature and with triangulation of research results with the ABMHSU in the context of Victoria. The researchers argue that even though predisposing, enabling, and need factors are necessary to determine whether a person is selected for expert care for mental health issues, these factors alone are insufficient. Ongoing research is essential to ascertain the potential of mental health nurses' cultural competence education and cultural responsiveness in addressing the mental health service access and utilisation of the heterogeneous CALD communities. Additional research is advocated to identify the supplementary factors, as there is a dearth of research exploring the potential of ABMHSU worldwide.
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Affiliation(s)
- Reshmy Radhamony
- Institute of Health and Wellbeing, Federation University, Berwick, Victoria, Australia
| | - Wendy M Cross
- School of Health, Federation University, Ballarat, Australia
| | - Louise Townsin
- School of Health, Federation University, Ballarat, Australia
- Research Office, Torrens University, Adelaide, South Australia, Australia
| | - Biswajit Banik
- Institute of Health and Wellbeing, Federation University, Berwick, Victoria, Australia
- Manna Institute, Regional Australia Mental Health Research and Training Institute, University of New England, Armidale, New South Wales, Australia
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Smith SB, Abshire DA, Magwood GS, Herbert LL, Tavakoli AS, Jenerette C. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease: Development of a Situation-Specific Theory for African American Emerging Adults. J Cardiovasc Nurs 2024; 39:E103-E114. [PMID: 37052582 PMCID: PMC10564967 DOI: 10.1097/jcn.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Emerging adulthood (18-25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults. OBJECTIVE This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults. METHODOLOGY Im and Meleis' integrative approach was used to develop the situation-specific theory. RESULTS Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences. DISCUSSION African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required.
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Pereira-Osorio C, Brickell E, Lee B, Arredondo B, Sawyer RJ. Performance of the Modified Caregiver Strain Index in a Sample of Black and White Persons Living With Dementia and Their Caregivers. THE GERONTOLOGIST 2024; 64:gnae052. [PMID: 38769644 PMCID: PMC11181709 DOI: 10.1093/geront/gnae052] [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: 12/18/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia. RESEARCH DESIGN AND METHODS Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and wellbeing. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups. RESULTS Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a 3-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, although personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p = .003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r = 0.67, Black: r = 0.54) and the GAD-2 (White: r = 0.47, Black: r = 0.4), and negatively correlated with self-efficacy ratings (White: r = -0.54, Black: r = -0.55), with a p < .001 for all validity analysis. DISCUSSION AND IMPLICATIONS The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Researchers results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.
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Affiliation(s)
| | - Emily Brickell
- Ochsner Health, Center for Brain Health, New Orleans, Louisiana, USA
| | - Bern Lee
- Ochsner Health, Center for Brain Health, New Orleans, Louisiana, USA
| | - Beth Arredondo
- Ochsner Health, Center for Brain Health, New Orleans, Louisiana, USA
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Khodakarami N, Ukert B. Effects of Affordable Care Act on uninsured hospitalization: Evidence from Texas. Health Serv Res 2024. [PMID: 38830636 DOI: 10.1111/1475-6773.14334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE To examine the impact of the Affordable Care Act (ACA) health insurance exchanges (Marketplace) on the rate of uninsured discharges in Texas. DATA SOURCE AND STUDY SETTING Secondary discharge data from 2011 to 2019 from Texas. STUDY DESIGN We conducted a retrospective study estimating the effects of the ACA Marketplace using difference-in-difference regressions, with the main outcome being the uninsured discharge rate. We stratified our sample by patient's race, age, gender, urbanicity, major diagnostic categories (MDC), and emergent type of admissions. DATA COLLECTION/EXTRACTION METHODS We used Texas hospital discharge records for non-elderly adults collected by the state of Texas and included acute care hospitals who reported data from 2011 to 2019. PRINCIPAL FINDINGS The expansion of insurance through ACA Marketplaces led to reductions in the uninsured discharge rate by 9.9% (95% CI, -17.5%, -2.3%) relative to the baseline mean. The effects of the ACA were felt strongest in counties with any share of Hispanic, in counties with a larger population of Black, and other racial groups, in counties with a significant share of female and older age individuals, in counties considered to be urban, in high-volume diagnoses, and emergent type of admissions. CONCLUSIONS These findings indicate that the ACA facilitated a shift in hospital payor mix from uninsured to insured.
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Affiliation(s)
- Nima Khodakarami
- Department of Health Policy and Administration, Penn State University, Monaca, Pennsylvania, USA
| | - Benjamin Ukert
- Department of Health Policy and Management, Texas A&M University, School of Public Health, College Station, Texas, USA
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Weisz D, Gusmano MK, Amba V, Rodwin VG. Has the Expansion of Health Insurance Coverage via the Implementation of the Affordable Care Act Influenced Inequities in Coronary Revascularization in New York City? J Racial Ethn Health Disparities 2024; 11:1783-1790. [PMID: 37338791 DOI: 10.1007/s40615-023-01650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND/PURPOSE In 2014, New York City implemented the Affordable Care Act (ACA) leading to insurance coverage gains intended to reduce inequities in healthcare services use. The paper documents inequalities in coronary revascularization procedures (percutaneous coronary intervention and coronary artery bypass grafting) usage by race/ethnicity, gender, insurance type, and income before and after the implementation of the ACA. METHODS We used data from the Healthcare Cost and Utilization Project to identify NYC patients hospitalized with the diagnosis of coronary artery disease (CAD) and/or congestive heart failure (CHF) in 2011-2013 (pre-ACA) and 2014-2017 (post-ACA). Next, we calculated age-adjusted rates of CAD and/or CHF hospitalization and coronary revascularization. Logistic regression models were used to identify the variables associated with receiving a coronary revascularization in each period. RESULTS Age-adjusted rates of CAD and/or CHF hospitalization and coronary revascularization in patients 45-64 years of age and 65 years of age and older declined in the post-ACA period. Disparities by gender, race/ethnicity, insurance type, and income in the use of coronary revascularization persist in the post-ACA period. CONCLUSIONS Although this health care reform law led to the narrowing of inequities in the use of coronary revascularization, disparities persist in NYC in the post-ACA period.
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Affiliation(s)
- Daniel Weisz
- Columbia University Robert N. Butler Columbia Aging Center, 722 West 168Th Street, New York, NY, 10032, USA.
| | - Michael K Gusmano
- Lehigh University College of Health, 124 East Morton Street, Bethlehem, PA, 18015, USA
- The Hastings Center, 21 Malcom Gordon Road, Garrison, NY, 10524, USA
| | - Vineeth Amba
- Rutgers University Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Victor G Rodwin
- New York University Robert. F Wagner Graduate School of Public Service, 295 Lafayette St, New York, NY, 10012, USA
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Han CJ, Tounkara F, Kalady MF, Noonan AM, Paskett ED, Von Ah D. Racial/Ethnic Disparities in HRQoL and Associated Risk Factors in Colorectal Cancer Survivors: With a Focus on Social Determinants of Health (SDOH). J Gastrointest Cancer 2024:10.1007/s12029-024-01070-2. [PMID: 38819610 DOI: 10.1007/s12029-024-01070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE This study aimed to understand how health-related quality of life (HRQoL) differs by race/ethnicity in colorectal (CRC) survivors. We aimed to 1) examine racial/ethnic disparities in HRQoL, and 2) explore the roles of social determinants of health (SDOH) risk factors for HRQoL differ by racial/ethnic groups. METHODS In 2,492 adult CRC survivors using Behavioral Risk Factor Surveillance System (BRFSS) survey data (from 2014 to 2021, excluding 2015 due to the absence of CRC data), we used the Centers for Disease Control and Prevention (CDC) HRQoL measure, categorized into "better" and "poor." Multivariate logistic regressions with prevalence risk (PR) were employed for our primary analyses. RESULTS Compared with non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) (PR = 0.61, p = .045) and Hispanics (PR = 0.32, p < .001) reported worse HRQoL in adjusted models. In adjusted models, unemployed/retired and low-income levels were common risk factors for worse HRQoL across all comparison groups (NHW, NHB, non-Hispanic other races, and Hispanics). Other SDOH associated with worse HRQoL include divorced/widowed/never married marital status (non-Hispanic other races and Hispanics), living in rural areas (NHW and NHB), and low education levels (NHB and Hispanics). Marital status, education, and employment status significantly interacted with race/ethnicity, with the strongest interaction between Hispanics and education (PR = 2.45, p = .045) in adjusted models. CONCLUSION These findings highlight the need for culturally tailored interventions targeting modifiable factors (e.g., social and financial supports, health literacy), specifically for socially vulnerable CRC survivors, to address the disparities in HRQoL among different racial/ethnic groups.
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Affiliation(s)
- Claire J Han
- Center for Healthy Aging, Self-Management and Complex Care, Ohio State University College of Nursing, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA.
| | - Fode Tounkara
- Department of Biomedical Informatics, Ohio State University College of Medicine, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
| | - Matthew F Kalady
- Division of Colon and Rectal Surgery, Clinical Cancer Genetics Program, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
| | - Anne M Noonan
- GI Medical Oncology Selection, GI Oncology Disease Specific Research Group Leader, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
| | - Electra D Paskett
- Department of Internal Medicine in the, College of Medicine, Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, 43210, USA
| | - Diane Von Ah
- Center for Healthy Aging, Self-Management, and Complex Care, Ohio State University, College of Nursing, Cancer Survivorship and Control Group, Ohio State University, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA
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Okoli GN, Neilson CJ, Grossman Moon A, Kimmel Supron H, Soos AE, Grewal A, Etsell K, Alessi-Severini S, Richardson C, Harper DM. Exploration of individual socioeconomic and health-related characteristics associated with human papillomavirus vaccination initiation and vaccination series completion among adult females: A comprehensive systematic evidence review with meta-analysis. Vaccine 2024:S0264-410X(24)00601-7. [PMID: 38796328 DOI: 10.1016/j.vaccine.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates among females are lower than the World Health Organization target and vaccination rates specifically among adult females are even much lower. METHODS We systematically evaluated individual socioeconomic and health-related characteristics associated with HPV vaccination initiation and vaccination series completion among adult females (PROSPERO: CRD42023445721). We performed a literature search on December 14, 2022, and supplemented the search on August 1, 2023. We pooled appropriate multivariable-adjusted results using an inverse variance random-effects model and expressed the results as odds ratios with associated 95 % confidence intervals. A point pooled significantly increased/decreased odds of 30-69 % was regarded to be strongly associated, and ≥ 70 % was very strongly associated. RESULTS We included 63 cross-sectional studies. There were strongly increased odds of vaccination initiation among White women compared with Black or Asian women, and those with higher education, health insurance, a history of sexually transmitted infection (STI), receipt of influenza vaccination in the preceding year, not married/cohabiting, not smoking, using contraception, and having visited a healthcare provider in the preceding year. We observed very strongly increased odds of vaccination initiation among those younger and having been born in the country of study. Similarly, there were strongly increased odds of completing the vaccination series for the same variables as initiating vaccination, except for higher education, prior STI, smoking and contraception use. Additional variables associated with strongly increased odds of vaccination series completion not seen in initiation were higher annual household income, being lesbian/bisexual, and having a primary care physician. We observed very strongly increased odds of vaccination series completion similar to vaccination initiation but including for White compared with Black women, higher education, and prior cervical cancer screening. CONCLUSIONS These individual characteristics may be the key to identifying women at increased risk of not being vaccinated against HPV and could inform targeted messaging to drive HPV vaccination.
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Affiliation(s)
- George N Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | | | | | | | - Alexandra E Soos
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Avneet Grewal
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Katharine Etsell
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Caroline Richardson
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Diane M Harper
- Departments of Family Medicine and Obstetrics & Gynecology, University of Michigan, Michigan, USA
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Nguyen TQ, Kerley CI, Key AP, Maxwell-Horn AC, Wells QS, Neul JL, Cutting LE, Landman BA. Phenotyping Down syndrome: discovery and predictive modelling with electronic medical records. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:491-511. [PMID: 38303157 PMCID: PMC11023778 DOI: 10.1111/jir.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/20/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Individuals with Down syndrome (DS) have a heightened risk for various co-occurring health conditions, including congenital heart disease (CHD). In this two-part study, electronic medical records (EMRs) were leveraged to examine co-occurring health conditions among individuals with DS (Study 1) and to investigate health conditions linked to surgical intervention among DS cases with CHD (Study 2). METHODS De-identified EMRs were acquired from Vanderbilt University Medical Center and facilitated creating a cohort of N = 2282 DS cases (55% females), along with comparison groups for each study. In Study 1, DS cases were one-by-two sex and age matched with samples of case-controls and of individuals with other intellectual and developmental difficulties (IDDs). The phenome-disease association study (PheDAS) strategy was employed to reveal co-occurring health conditions in DS versus comparison groups, which were then ranked for how often they are discussed in relation to DS using the PubMed database and Novelty Finding Index. In Study 2, a subset of DS individuals with CHD [N = 1098 (48%)] were identified to create longitudinal data for N = 204 cases with surgical intervention (19%) versus 204 case-controls. Data were included in predictive models and assessed which model-based health conditions, when more prevalent, would increase the likelihood of surgical intervention. RESULTS In Study 1, relative to case-controls and those with other IDDs, co-occurring health conditions among individuals with DS were confirmed to include heart failure, pulmonary heart disease, atrioventricular block, heart transplant/surgery and primary pulmonary hypertension (circulatory); hypothyroidism (endocrine/metabolic); and speech and language disorder and Alzheimer's disease (neurological/mental). Findings also revealed more versus less prevalent co-occurring health conditions in individuals with DS when comparing with those with other IDDs. Findings with high Novelty Finding Index were abnormal electrocardiogram, non-rheumatic aortic valve disorders and heart failure (circulatory); acid-base balance disorder (endocrine/metabolism); and abnormal blood chemistry (symptoms). In Study 2, the predictive models revealed that among individuals with DS and CHD, presence of health conditions such as congestive heart failure (circulatory), valvular heart disease and cardiac shunt (congenital), and pleural effusion and pulmonary collapse (respiratory) were associated with increased likelihood of surgical intervention. CONCLUSIONS Research efforts using EMRs and rigorous statistical methods could shed light on the complexity in health profile among individuals with DS and other IDDs and motivate precision-care development.
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Affiliation(s)
- T Q Nguyen
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
| | - C I Kerley
- School of Engineering, Vanderbilt University, Nashville, TN, USA
| | - A P Key
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Speech and Hearing Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A C Maxwell-Horn
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Q S Wells
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J L Neul
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L E Cutting
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - B A Landman
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- School of Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Gonzalez T, Nicholas A, Olagbenro M, Feldman SR, Fleischer AB. Race and ethnicity are inadequate predictors of ambulatory visit length and utilization of preventive services. J Natl Med Assoc 2024; 116:131-138. [PMID: 38402107 DOI: 10.1016/j.jnma.2023.12.002] [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: 01/08/2021] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 02/26/2024]
Abstract
Health disparities can be experienced by any disadvantaged group who has limited access to healthcare or decreased quality of care. Quality of care can be measured by physician-patient communication measures such as length of visit, health outcomes, patient satisfaction, or by the services one receives such as screening or health education. This study aims to determine the relationship between length of physician-patient encounter, number of preventive services, ethnicity, and race. This study utilizes data from the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016. Visits with a single diagnosis were selected. Visits with the five most frequent diagnoses were selected by International Classification of Diseases, Ninth or Tenth Revision (ICD-9/ICD-10) classification. The primary outcome is time spent with a physician in minutes and the number of preventive services provided represented by the Preventive Service Index (PSI). Of 255,916 visits, non-white individuals made up 16.2% (95% Confidence Interval 15.9-16.4) while Latinos represented 13.4% (95%CI 13.2-13.6) of individuals. Multivariate analysis revealed minimal differences in visit length in race and ethnic groups regardless of diagnosis. Greater PSI was associated with individuals less than 43 years old (Odds Ratio (OR) 2.0, 95% CI 1.8-2.3, p =< 0.0001), those who reside in metropolitan statistical areas (MSAs) (OR 1.2, 95% CI 1.1-1.4, p = 0.006), non-white individuals (OR 1.2, 95% CI 1.1-1.3, p = 0.004), and those with private insurance (OR 1.3, 95% CI 1.1-1.4, p =< 0.0001). Race and ethnicity do not predict length of time with a physician regardless of diagnosis. Age, race, location within a metropolitan area, and insurance are significant but minimal predictors of receiving preventive services in the rank-order leading five most frequent diagnoses. This large, population-based study highlights improvements in the distribution of healthcare services from previous studies.
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Affiliation(s)
- Tammy Gonzalez
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Andrew Nicholas
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Matthew Olagbenro
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Steven R Feldman
- Wake Forest School of Medicine, 4618 Country Club Road, Winston Salem, NC 27104, USA
| | - Alan B Fleischer
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
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Feuerriegel S, Frauen D, Melnychuk V, Schweisthal J, Hess K, Curth A, Bauer S, Kilbertus N, Kohane IS, van der Schaar M. Causal machine learning for predicting treatment outcomes. Nat Med 2024; 30:958-968. [PMID: 38641741 DOI: 10.1038/s41591-024-02902-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/04/2024] [Indexed: 04/21/2024]
Abstract
Causal machine learning (ML) offers flexible, data-driven methods for predicting treatment outcomes including efficacy and toxicity, thereby supporting the assessment and safety of drugs. A key benefit of causal ML is that it allows for estimating individualized treatment effects, so that clinical decision-making can be personalized to individual patient profiles. Causal ML can be used in combination with both clinical trial data and real-world data, such as clinical registries and electronic health records, but caution is needed to avoid biased or incorrect predictions. In this Perspective, we discuss the benefits of causal ML (relative to traditional statistical or ML approaches) and outline the key components and steps. Finally, we provide recommendations for the reliable use of causal ML and effective translation into the clinic.
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Affiliation(s)
- Stefan Feuerriegel
- LMU Munich, Munich, Germany.
- Munich Center for Machine Learning, Munich, Germany.
| | - Dennis Frauen
- LMU Munich, Munich, Germany
- Munich Center for Machine Learning, Munich, Germany
| | - Valentyn Melnychuk
- LMU Munich, Munich, Germany
- Munich Center for Machine Learning, Munich, Germany
| | - Jonas Schweisthal
- LMU Munich, Munich, Germany
- Munich Center for Machine Learning, Munich, Germany
| | - Konstantin Hess
- LMU Munich, Munich, Germany
- Munich Center for Machine Learning, Munich, Germany
| | - Alicia Curth
- Department of Applied Mathematics & Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Stefan Bauer
- School of Computation, Information and Technology, TU Munich, Munich, Germany
- Helmholtz Munich, Munich, Germany
| | - Niki Kilbertus
- Munich Center for Machine Learning, Munich, Germany
- School of Computation, Information and Technology, TU Munich, Munich, Germany
- Helmholtz Munich, Munich, Germany
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Mihaela van der Schaar
- Cambridge Centre for AI in Medicine, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
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Bauer AG, Shah B, Johnson N, Aduloju-Ajijola N, Bowe-Thompson C, Christensen K, Berkley-Patton JY. Feasibility and Acceptability of the Project Faith Influencing Transformation Intervention in Faith-Based Settings. HEALTH EDUCATION & BEHAVIOR 2024; 51:291-301. [PMID: 37978814 DOI: 10.1177/10901981231211538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
African Americans (AAs) are disproportionately burdened with diabetes and prediabetes. Predominately AA churches may be optimal settings for reaching AAs at greatest diabetes risk, along with related morbidities and mortalities. The current study used the RE-AIM framework to qualitatively examine the feasibility, acceptability, and satisfaction with the Project Faith Influencing Transformation (FIT) intervention, a diabetes risk reduction intervention in AA churches. Participants were (N = 21) church and community members who also participated in the larger Project FIT intervention and were primarily female, with an average age of 60 years (SD = 11.1). Participants completed a brief survey and focus group discussion. Participants discussed intervention effectiveness in changing health behaviors and outcomes, with high rates of adoption, acceptability, and satisfaction across churches that conducted the intervention. Participants also discussed outreach to members of the broader community, the role of the pastor, and challenges to intervention implementation and maintenance-tailored strategies to improve intervention effectiveness are discussed. Given the significant diabetes disparities that exist for AAs, it is imperative to continue to investigate best practices for reaching communities served by churches with sustainable, relevant health programming. This study has the potential to inform more effective, tailored diabetes prevention interventions for high-risk AAs in faith-based settings.
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Affiliation(s)
- Alexandria G Bauer
- Rutgers University-New Brunswick, Piscataway, NJ, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Binoy Shah
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nia Johnson
- Saint Louis University School of Medicine, St. Louis, MO, USA
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Okoro UE, Harland KK, Assimacopoulos E, Findlay S. Trends in Health Care Coverage and Out-Of-Pocket Cost Barriers: A Gender Comparison. J Womens Health (Larchmt) 2024; 33:473-479. [PMID: 38215276 DOI: 10.1089/jwh.2023.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Objective: The presence of disparities in access to health care and insurance coverage can have a tremendous impact on health care outcomes. Programs like the Affordable Care Act were implemented to improve health care access and to address the existing inequities. The objective of this study was to identify any disparities that exist between males and females regarding health care coverage and out-of-pocket cost to health care. Methods: This analysis was a cross-sectional study using the Behavioral Risk Factor Surveillance System survey data collected between 2013 and 2018. The primary predictor was sex assigned at birth (with the binary option of male vs. female). The primary outcome was adequate health coverage. Survey participants who indicated that they had health insurance with no out-of-pocket cost barriers to receiving medical care were considered to have adequate health coverage, while participants who did not meet these criteria were considered to have inadequate health coverage. Covariates measured were age, race/ethnicity, educational level, employment status, and annual household income. SAS survey procedures and weighting methods were used to measure the association between the sex and adequate health coverage, after controlling for covariates. Results: The data spanning 6 years included 2,249,749 adults, of whom 1,898,097 (84.4%) had adequate health coverage. Females made up 55.8% (N = 1,256,243) of the total sample. About 32.6% (N = 733,216) survey participants were aged ≥65 years. Most respondents, 77.6%, were White (Non-Hispanic). Across the 6-year period, females were more likely to have health insurance but with out-of-pocket costs that served as a barrier to their medical care (adjusted odds ratios with 95% CI from 2013 to 2018 were 1.36 [1.29-1.43], 1.38 [1.32-1.46], 1.31 [1.24-1.38], 1.33 [1.26-1.40], and 1.32 [1.25-1.40], respectively). Conclusions: Females were more likely than males to indicate an out-of-pocket cost barrier to medical care despite having health insurance.
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Affiliation(s)
- Uche E Okoro
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Shannon Findlay
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
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13
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Jang S, Chen J. National Estimates of Incremental Work Absenteeism Costs Associated With Adult Children of Parents With Alzheimer's Disease and Related Dementias. Am J Geriatr Psychiatry 2024:S1064-7481(24)00294-X. [PMID: 38604922 DOI: 10.1016/j.jagp.2024.03.011] [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: 01/16/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE More than half of primary caregivers for ADRD patients are adult children, yet there is little empirical evidence on how caring for parents with ADRD affects their employment. Using a nationally representative dataset, this study aimed to estimate incremental work absenteeism costs for adult children of parents with ADRD. DESIGN, SETTING, AND PARTICIPANTS The study used the data from the 2015-2021 Medical Expenditure Panel Survey (MEPS). Multivariate regressions and two-part models were employed to estimate the incremental work absenteeism costs among adult children aged 40 to 64 who had at least one parent diagnosed with ADRD, compared with those who did not have ADRD parents. MEASUREMENTS The incremental work absenteeism costs due to caregiving for adult children with ADRD parents was a cumulated estimation of labor productivity cost at three stages: (1) the likelihood of not working due to unemployment, (2) the likelihood of missing any workdays for caregiving, and (3) the number of workdays missed due to caregiving. RESULTS Adult children with ADRD parents were more likely to be unemployed (OR = 1.80, p = 0.024) and 2.95 times more likely to miss work for caregiving (p = 0.002) than those with non-ADRD parents. The difference in the number of workdays missed for caregiving between children with and without ADRD parents was not significant. The incremental effects of having ADRD parents were estimated to be $4,510.29 ($1,702.09-$6,723.69) per person per year. CONCLUSIONS Having ADRD parents significantly increases the chances of unemployment and missing any workdays for caregiving, leading to higher lost labor productivity costs for adult children with ADRD parents.
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Affiliation(s)
- Seyeon Jang
- Department of Health Policy and Management (SJ, JC), School of Public Health, University of Maryland, College Park, MD; The Hospital and Public Health InterdisciPlinarY Research (HAPPY) Lab (SJ, JC), School of Public Health, University of Maryland, College Park, MD.
| | - Jie Chen
- Department of Health Policy and Management (SJ, JC), School of Public Health, University of Maryland, College Park, MD; The Hospital and Public Health InterdisciPlinarY Research (HAPPY) Lab (SJ, JC), School of Public Health, University of Maryland, College Park, MD
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14
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Nianogo RA, Zhao F, Li S, Nishi A, Basu S. Medicaid Expansion and Racial-Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach. Epidemiology 2024; 35:263-272. [PMID: 38290145 DOI: 10.1097/ede.0000000000001691] [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: 02/01/2024]
Abstract
BACKGROUND Studies have suggested Medicaid expansion enacted in 2014 has resulted in a reduction in overall cardiovascular disease (CVD) mortality in the United States. However, it is unknown whether Medicaid expansion has a similar effect across race-ethnicity and sex. We investigated the effect of Medicaid expansion on CVD mortality across race-ethnicity and sex. METHODS Data come from the behavioral risk factor surveillance system and the US Centers for Disease Control's Wide-ranging Online Data for Epidemiologic Research, spanning the period 2000-2019. We used the generalized synthetic control method, a quasi-experimental approach, to estimate effects. RESULTS Medicaid expansion was associated with -5.36 (mean difference [MD], 95% confidence interval [CI] = -22.63, 11.91) CVD deaths per 100,000 persons per year among Blacks; -4.28 (MD, 95% CI = -30.08, 21.52) among Hispanics; -3.18 (MD, 95% CI = -8.30, 1.94) among Whites; -5.96 (MD, 95% CI = -15.42, 3.50) among men; and -3.34 (MD, 95% CI = -8.05, 1.37) among women. The difference in mean difference (DMD) between the effect of Medicaid expansion in Blacks compared with Whites was -2.18; (DMD, 95% CI = -20.20, 15.83); between that in Hispanics compared with Whites: -1.10; (DMD, 95% CI = -27.40, 25.20) and between that in women compared with men: 2.62; (DMD, 95% CI = -7.95, 13.19). CONCLUSIONS Medicaid expansion was associated with a reduction in CVD mortality overall and in White, Black, Hispanic, male, and female subpopulations. Also, our study did not find any difference or disparity in the effect of Medicaid on CVD across race-ethnicity and sex-gender subpopulations, likely owing to imprecise estimates.
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Affiliation(s)
- Roch A Nianogo
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- California Center for Population Research, UCLA, Los Angeles, CA
| | - Fan Zhao
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- California Center for Population Research, UCLA, Los Angeles, CA
| | - Stephen Li
- Los Angeles County Department of Public Health (LACDPH), Los Angeles, CA
| | - Akihiro Nishi
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- California Center for Population Research, UCLA, Los Angeles, CA
- Bedari Kindness Institute, University of California, Los Angeles, Los Angeles, CA
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, MA
- Research and Development, Waymark, San Francisco, CA
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15
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Xu J, Luo L, Gamaldo A, Verdery A, Hardy M, Buxton OM, Xiao Q. Trends in sleep duration in the U.S. from 2004 to 2018: A decomposition analysis. SSM Popul Health 2024; 25:101562. [PMID: 38077245 PMCID: PMC10698270 DOI: 10.1016/j.ssmph.2023.101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 03/02/2024] Open
Abstract
Average sleep duration in the United States declined in recent years, and the decline may be linked with many biopsychosocial factors. We examine how a set of biopsychosocial factors have differentially contributed to the temporal trends in self-reported sleep duration across racial groups between 2004-2005 and 2017-2018. Using repeated nationally representative cross-sections from the National Health Interview Survey, we decompose the influence of biopsychosocial factors on sleep duration trends into two components. One component corresponds to coefficient changes (i.e., changes in the associations between behaviors or exposures and sleep duration) of key biopsychosocial factors, and the other part accounts for the compositional changes (i.e., changes in the distributions of exposures) in these biopsychosocial factors during the study period. We reveal that changes in the coefficients of some biopsychosocial factors are more important than compositional changes in explaining the decline in sleep duration within each racial/ethnic group. Our findings highlight racial differences manifest across multiple biopsychosocial domains that are shifting in terms of association and composition. Methodologically, we note that the standard regression approach for analyzing temporal trends neglects the role of coefficient changes over time and is thus insufficient for fully capturing how biopsychosocial factors may have influenced the temporal patterns in sleep duration and related health outcomes.
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Affiliation(s)
- Jiahui Xu
- The Pennsylvania State University, University Park, PA, USA
| | - Liying Luo
- The Pennsylvania State University, University Park, PA, USA
| | | | - Ashton Verdery
- The Pennsylvania State University, University Park, PA, USA
| | - Melissa Hardy
- The Pennsylvania State University, University Park, PA, USA
| | | | - Qian Xiao
- The University of Texas Health Science Center at Houston, Houston, TX, USA
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16
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Herrera MM, Tiao J, Rosenberg A, Zubizarreta N, Poeran J, Chaudhary SB. Does Medicare Insurance Mitigate Racial/Ethnic Disparities in Access to Lumbar Spinal Surgery When Compared to Commercial Insurance? Clin Spine Surg 2024:01933606-990000000-00263. [PMID: 38366343 DOI: 10.1097/bsd.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/29/2023] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Compare disparities in lumbar surgical care utilization in Commercially insured versus Medicare patients. SUMMARY OF BACKGROUND DATA While disparities in spinal surgery have been previously described, less evidence exists on effective strategies to mitigate them. Theoretically, universal health care coverage under Medicare should improve health care access. MATERIALS AND METHODS Utilizing National Inpatient Sample data (2003-2018), we included inpatient lumbar discectomy or laminectomy/fusion cases in black, white, or Hispanic patients aged 18-74 years, with Commercial or Medicare insurance. A multivariable Poisson distribution model determined race/ethnicity subgroup-specific rate ratios (RRs) of patients undergoing lumbar surgery compared to their respective population distribution (using US Census data) based on race/ethnicity, region, gender, primary payor, and age (Commercially insured age subgroups: 18-39, 40-54, and 55-64 y; Medicare age subgroup: 65-74 y). RESULTS Of the 2,310,956 lumbar spine procedures included, 88.9%, 6.1%, and 5.0% represented white, black, and Hispanic patients, respectively. Among Commercially insured patients, black and Hispanic (compared to white) patients had lower rates of surgical care utilization; however, these disparities decreased with increasing age: black (RR=0.37, 95% CI: 0.37-0.38) and Hispanic patients (RR=0.53, 95% CI: 0.52-0.54) aged 18-39 years versus black (RR=0.72, 95% CI: 0.71-0.73) and Hispanic patients (RR=0.64, 95% CI: 0.63-0.65) aged 55-64 years. Racial/ethnic disparities persisted in Medicare patients, especially when compared to the neighboring age subgroup that was Commercially insured: black (RR=0.61, 95% CI: 0.60-0.62) and Hispanic patients (RR=0.61, 95% CI: 0.60-0.61) under Medicare. CONCLUSIONS Disparities in surgical care utilization among black and Hispanic patients persist regardless of health care coverage, and an expansion of Medicare eligibility alone may not comprehensively address health care disparities. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Justin Tiao
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Departments of Population Health Science and Policy/Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Saad B Chaudhary
- Institute for Healthcare Delivery Science, Departments of Population Health Science and Policy/Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York
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17
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Elsafoury S, Jones HE, Kelvin EA. Impact of the Affordable Health Care Act (ACA) on Racial/Ethnic Inequities in Access to and Utilization of Healthcare in New York City. J Racial Ethn Health Disparities 2024; 11:406-415. [PMID: 36781587 DOI: 10.1007/s40615-023-01528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
The Affordable Care Act (ACA) expanded health insurance coverage in the USA, but whether it increased healthcare utilization or reduced racial/ethnic inequities in access to and utilization of care is unclear. We evaluated the ACA impact on health insurance coverage, unmet medical need, and having a personal doctor and whether this impact was modified by racial/ethnic identity among New York City (NYC) residents. We used data from multiple years of the Community Health Survey (2009-2017) and used logistic regression to assess whether having health insurance, unmet medical need, or a personal doctor varied pre- (2009-2012) versus post-ACA (2013-2017), adjusting for age, sex, nativity status, and general health. We assessed effect measure modification by race/ethnicity and stratified if we found significant interaction. We found that health insurance coverage and having a personal doctor increased post-ACA (aOR = 1.44, p < 0.001 and aOR = 1.09, p = 0.024, respectively) while having unmet medical need decreased (aOR = 0.90, p = 0.004). There was little indication of interaction between ACA and race/ethnicity; in stratified models, the ACA had a stronger impact on health insurance coverage for those of other race than all other groups (aOR = 2.16, p = 0.002 versus aOR 1.22-1.54 for white, Black, and Hispanic adults) and a stronger impact on having a personal doctor for Hispanic adults (aOR 1.27, p < 0.001 versus weaker non-significant associations for other groups), with no effect modification for unmet medical need. Thus, it appears that ACA improved healthcare access and utilization but did not have a major impact on reducing racial/ethnic inequities in these outcomes in NYC.
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Affiliation(s)
- Shaimaa Elsafoury
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125Th Street, New York, NY, 10027, USA
| | - Heidi E Jones
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125Th Street, New York, NY, 10027, USA
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
- CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125Th Street, New York, NY, 10027, USA.
- Department of Occupational Health, Epidemiology & Prevention, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, NY, USA.
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18
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Borja S, Valdovinos MG, Rivera KM, Giraldo-Santiago N, Gearing RE, Torres LR. "It's Not That We Care Less": Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:148. [PMID: 38397639 PMCID: PMC10887805 DOI: 10.3390/ijerph21020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a diagnosis of diabetes and depression or were closely associated with someone who did. This study identified key individual and structural barriers and facilitators affecting healthcare access and treatment for Latinos living with comorbid diagnoses. A thematic analysis revealed structural barriers to healthcare access, including financial burdens and navigating healthcare institutions. Personal barriers included fears, personal responsibility, and negative family dynamics. Facilitators included accessible information, family support, and spirituality. These findings underscore the need to address these multi-level factors and for healthcare institutions and providers to actively involve Hispanic community members in developing services and interventions.
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Affiliation(s)
- Sharon Borja
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA;
| | | | - Kenia M. Rivera
- Department of Psychology, University of Denver, Denver, CO 80208, USA;
| | | | - Robin E. Gearing
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA;
| | - Luis R. Torres
- School of Social Work, University of Texas, Rio Grande Valley, Edinburg, TX 78539, USA;
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19
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Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res 2023; 58 Suppl 3:300-310. [PMID: 38015865 PMCID: PMC10684044 DOI: 10.1111/1475-6773.14202] [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: 11/30/2023] Open
Abstract
OBJECTIVE To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.
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Affiliation(s)
- Monique Jindal
- Department of Academic Internal MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Krisda H. Chaiyachati
- Verily, Inc.South San FranciscoCaliforniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Mongan InstituteMassachusetts General HospitalBostonMassachusettsUSA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Karoline Mortensen
- Department of Health Management and PolicyMiami Herbert Business SchoolCoral GablesFloridaUSA
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20
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Samalik JM, Goldberg CS, Modi ZJ, Fredericks EM, Gadepalli SK, Eder SJ, Adler J. Discrepancies in Race and Ethnicity in the Electronic Health Record Compared to Self-report. J Racial Ethn Health Disparities 2023; 10:2670-2675. [PMID: 36418736 DOI: 10.1007/s40615-022-01445-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/19/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Racial and ethnic disparities are commonplace in health care. Research often relies on sociodemographic information recorded in the electronic health record (EHR). Little evidence is available about the accuracy of EHR-recorded sociodemographic information, and none in pediatrics. Our objective was to determine the accuracy of EHR-recorded race and ethnicity compared to self-report. METHODS Patients/guardians enrolled in two prospective observational studies (10/2014-1/2019) provided self-reported sociodemographic information. Corresponding EHR information was abstracted. EHR information was compared to self-report, considered "gold standard." Agreement was evaluated with Cohen's kappa. RESULTS A total of 503 patients (42% female, median age 12.8 years) were identified. Self-reported race (N = 484) was 73% White, 16% Black or African American (AA), 4% Asian, 5% multiracial, and 2% other. Self-reported ethnicity (N = 410) was 9% Hispanic/Latino, and 88% non-Hispanic/Latino. Agreement between self-reported and EHR-recorded race was substantial (kappa = 0.77, 95% CI 0.72-0.83). Race was discordant among 10% (47/476). Hispanic/Latino ethnicity also had strong agreement (kappa = 0.77, 95% CI 0.65-0.89). Among those who self-reported Hispanic/Latino and reported race (N = 21), race was less accurately recorded in the EHR (kappa = 0.26, 95% CI 0-0.54). Race did not match among 43% with recorded race (9/21). Among self-reported racial and/or ethnic minorities, 13% (12/164) were misclassified in the EHR as non-Hispanic White. CONCLUSIONS We found race and ethnicity are often inaccurately recorded in the EHR for patients who self-identify as minorities, leading to under-representation of minorities in the EHR. Inaccurately recorded race and ethnicity has important implications for disparity research, and for informing health policy. Reliable processes are needed to incorporate self-reported race and ethnicity in the EHR at institutional and national levels.
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Affiliation(s)
- Joann M Samalik
- Division of Pediatric Gastroenterology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Caren S Goldberg
- Division of Pediatric Cardiology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Zubin J Modi
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Nephrology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Psychology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Samir K Gadepalli
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Surgery, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sally J Eder
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy Adler
- Division of Pediatric Gastroenterology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
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21
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Kwok JH, Léger PT. Elevating research on how healthcare payment and financing can improve health equity. Health Serv Res 2023; 58 Suppl 3:284-288. [PMID: 38015862 PMCID: PMC10684036 DOI: 10.1111/1475-6773.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Affiliation(s)
- Jennifer H. Kwok
- Division of Health Policy and AdministrationUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Pierre Thomas Léger
- Division of Health Policy and AdministrationUniversity of Illinois ChicagoChicagoIllinoisUSA
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22
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Ukert B, Giannouchos TV. Association of the affordable care act with racial and ethnic disparities in uninsured emergency department utilization. BMC Health Serv Res 2023; 23:1302. [PMID: 38007468 PMCID: PMC10676572 DOI: 10.1186/s12913-023-10168-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 10/17/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Disparities in uninsured emergency department (ED) use are well documented. However, a comprehensive analysis evaluating how the Affordable Care Act (ACA) may have reduced racial and ethnic disparities is lacking. The goal was to assess the association of the ACA with racial and ethnic disparities in uninsured ED use. METHODS This study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) for Georgia, Florida, Massachusetts, and New York from 2011 to 2017. Participants include non-elderly adults between 18 and 64 years old. Outcomes include uninsured rates of ED visits by racial and ethnic groups and stratified by medical urgency using the New York University ED algorithm. Visits were aggregated to year-quarter ED visits per 100,000 population and stratified for non-Hispanic White, non-Hispanic Black, and Hispanic non-elderly adults. Quasi-experimental difference-in-differences and triple differences regression analyses to identify the effect of the ACA and the separate effect of the Medicaid expansion were used comparing uninsured ED visits by race and ethnicity groups pre-post ACA. RESULTS The ACA was associated with a 14% reduction in the rate of uninsured ED visits per 100,000 population (from 10,258 pre-ACA to 8,877 ED visits per 100,000 population post-ACA) overall. The non-Hispanic Black compared to non-Hispanic White disparity decreased by 12.4% (-275.1 ED visits per 100,000) post-ACA. About 60% of the decline in the Black-White disparity was attributed to disproportionate declines in ED visit rates for conditions classified as not-emergent (-93.2 ED visits per 100,000), and primary care treatable/preventable (-64.1 ED visits per 100,000), while the disparity in ED visit rates for injuries and not preventable conditions also declined (-106.57 ED visits per 100,000). All reductions in disparities were driven by the Medicaid expansion. No significant decrease in Hispanic-White disparity was observed. CONCLUSIONS The ACA was associated with fewer uninsured ED visits and reduced the Black-White ED disparity, driven mostly by a reduction in less emergent ED visits after the ACA in Medicaid expansion states. Disparities between Hispanic and non-Hispanic White adults did not decline after the ACA. Despite the positive momentum of declining disparities in uninsured ED visits, disparities, especially among Black people, remain.
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Affiliation(s)
- Benjamin Ukert
- Department of Health Policy and Management, Texas A&M University, 212 Adriance Lab Road, 1266 TAMU, College Station, 77843-1266, USA.
| | - Theodoros V Giannouchos
- Department of Health Policy and Organization, The University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35233, USA.
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Islam S, Zhang D, Ho K, Divers J. Racial Disparities in Hospitalization Rates During Long-Term Follow-Up After Deceased-Donor Kidney Transplantation. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01847-4. [PMID: 37930581 DOI: 10.1007/s40615-023-01847-4] [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: 05/17/2023] [Revised: 08/23/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To compare hospitalization rates between African American (AA) and European American (EA) deceased-donor (DD) kidney transplant (KT) recipients during over a10-year period. METHOD Data from the Scientific Registry of Transplant Recipients and social determinants of health (SDoH), measured by the Social Deprivation Index, were used. Hospitalization rates were estimated for kidney recipients from AA and EA DDs who had one kidney transplanted into an AA and one into an EA, leading to four donor/recipient pairs (DRPs): AA/AA, AA/EA, EA/AA, and EA/EA. Poisson-Gamma models were fitted to assess post-transplant hospitalizations. RESULT Unadjusted hospitalization rates (95% confidence interval) were higher among all DRP involving AA, 131.1 (122.5, 140.3), 134.8 (126.3, 143.8), and 102.4 (98.9, 106.0) for AA/AA, AA/EA, and EA/AA, respectively, compared to 97.1 (93.7, 100.6) per 1000 post-transplant person-years for EA/EA pairs. Multivariable analysis showed u-shaped relationships across SDoH levels within each DRP, but findings varied depending on recipients' race, i.e., AA recipients in areas with the worst SDoH had higher hospitalization rates. However, EA recipients in areas with the best SDoH had higher hospitalization rates than their counterparts. CONCLUSIONS Relationship between healthcare utilization and SDoH depends on DRP, with higher hospitalization rates among AA recipients living in areas with the worst SDoH and among EA recipients in areas with the best SDoH profiles. SDoH plays an important role in driving disparities in hospitalizations after kidney transplantation.
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Affiliation(s)
- Shahidul Islam
- Department of Foundations of Medicine, Division of Health Services Research, NYU Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY, 11501, USA.
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA.
| | - Donglan Zhang
- Department of Foundations of Medicine, Division of Health Services Research, NYU Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY, 11501, USA
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Kimberly Ho
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Jasmin Divers
- Department of Foundations of Medicine, Division of Health Services Research, NYU Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY, 11501, USA
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA
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24
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Metzger IW, Moreland A, Garrett RJ, Reid-Quiñones K, Spivey BN, Hamilton J, López C. Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse. CHILD MALTREATMENT 2023; 28:648-660. [PMID: 37042334 DOI: 10.1177/10775595231169782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Black families are significantly less likely to receive evidence-based trauma treatment services; however, little is known about factors impacting engagement, particularly at Children's Advocacy Centers (CACs). The goal of this study is to better understand barriers and facilitators of service utilization for Black caregivers of CAC referred youth. Participants (n = 15) were randomly selected Black maternal caregivers (ages 26-42) recruited from a pool of individuals who were referred to receive CAC services. Black maternal caregivers reported barriers to accessing services at CACs including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors. We conclude by identifying specific barriers to the initiation and engagement in services for Black families, and we provide suggestions for CACs seeking to improve engagement of Black families referred for trauma-related mental health services.
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Affiliation(s)
| | - Angela Moreland
- National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | - Cristina López
- National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston, SC, USA
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25
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Kangmennaang J, Siiba A, Bisung E. Does Trust Mediate the Relationship Between Experiences of Discrimination and Health Care Access and Utilization Among Minoritized Canadians During COVID-19 Pandemic? J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01809-w. [PMID: 37787945 DOI: 10.1007/s40615-023-01809-w] [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: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES We sought to determine if trust in government institutions mediate the relationship between experiences of discrimination and health care utilization during the COVID-19 pandemic. METHODS We used data from Statistics Canada's Crowdsourcing Data: Impacts of COVID-19 on Canadians-Experiences of Discrimination. We used generalized linear latent and mixed models (Gllamm) with a binomial and logit link function as well as generalized structural equation modeling (GSEM) to determine if reported discrimination and trust were associated with difficulties in accessing health services, health care, and the likelihood of experiencing negative health impacts. We also examined if trust mediated the relationship between experiences of discrimination and these health outcomes. Our analytical sample consisted of 2568 individuals who self-identified as belonging to a visible minority group. RESULTS The multivariate results indicate that experiences of discrimination during COVID-19 were associated with higher odds of reporting difficulties in accessing general health services (OR = 1.99, p ≤ 0.01), receiving care (OR = 1.65, p ≤ 0.01), and higher likelihood of reporting negative health impacts (OR = 1.68, p ≤ 0.01). Our mediation analysis indicated that trust in public institutions explained a substantial portion of the association between reported discrimination and all the health outcomes, although the effects of experiencing discrimination remain significant and robust. CONCLUSION The findings show that building and maintaining trust is important and critical in a pandemic recovery world to build back better.
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26
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Altman CE, Hamilton C, Dondero M. The Intersection of State-Level Immigrant Policy Climates and Medicaid Expansion: an Examination Among Immigrants. J Racial Ethn Health Disparities 2023; 10:2195-2206. [PMID: 36036841 DOI: 10.1007/s40615-022-01399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
States have broad discretion over the implementation of policies like Medicaid expansion and other policies that impact the well-being and integration of immigrants. While numerous studies document Medicaid expansion on immigrants' health insurance coverage and the role of state immigrant policy climates on immigrants' well-being, no research to date has studied whether the association between a state's Medicaid expansion on immigrants' health insurance coverage varies based on the inclusiveness or exclusiveness of a state's immigrant policy climate. We combine nationally representative data from the 2014-2018 American Community Survey (ACS) with state policy data and estimate multivariate regression models. The results reveal a state immigrant policy climate gradient whereby ACA Medicaid expansion on noncitizens is negative and most severe in exclusionary climates. This study highlights how state policies intersect as important structural forces that influence immigrant health and well-being.
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Affiliation(s)
- Claire E Altman
- Department of Health Sciences and Truman School of Government and Public Affairs, University of Missouri, 304 Clark Hall, Columbia, MO, 65211, USA.
| | - Christal Hamilton
- Center on Poverty and Social Policy, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Molly Dondero
- Department of Sociology, American University, 4400 Massachusetts Avenue NW, Washington D.C., 20016, USA
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Carlson MS, Romo ML, Kelvin EA. Impact of the First Year of the COVID-19 on Unmet Healthcare Need among New York City Adults: a Universal Healthcare Experiment. J Urban Health 2023; 100:962-971. [PMID: 37583004 PMCID: PMC10618138 DOI: 10.1007/s11524-023-00752-9] [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] [Accepted: 06/12/2023] [Indexed: 08/17/2023]
Abstract
We examined the impact of the first year of the COVID-19 pandemic on unmet healthcare need among New Yorkers and potential differences by race/ethnicity and health insurance. Data from the Community Health Survey, collected in 2018, 2019, and 2020, were merged to compare unmet healthcare need within the past 12 months during the pandemic versus the 2 years prior to 2020. Univariate and multivariable logistic regression models evaluated change in unmet healthcare need overall, and we assessed whether race/ethnicity or health insurance status modified the association. Overall, 12% of New Yorkers (N = 27,660) experienced unmet healthcare during the 3-year period. In univariate and multivariable models, the first year of the pandemic (2020) was not associated with change in unmet healthcare need compared with 2018-2019 (OR = 1.04, p = 0.548; OR = 1.03, p = 0.699, respectively). There was no statistically significant interaction between calendar year and race/ethnicity, but there was significant interaction with health insurance status (interaction p = 0.009). Stratifying on health insurance status, those uninsured had borderline significant lower odds of experiencing unmet healthcare need during 2020 compared to the 2 years prior (OR = 0.72, p = 0.051) while those with insurance had a slight increase that was not significant (OR = 1.12, p = 0.143). Unmet healthcare need among New Yorkers during the first year of the pandemic did not differ significantly from 2018-2019. Federal pandemic relief funding, which offered no-cost COVID-19 testing and care to all, irrespective of health insurance or legal status, may have helped equalized access to healthcare.
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Affiliation(s)
- Madelyn S Carlson
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
| | - Matthew L Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Occupational Health, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, NY, USA
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Ramon AE, Possemato K, Beehler GP. Headache Disorders in VHA Primary Care: Prevalence, Psychiatric Comorbidity, and Health Care Utilization. Behav Med 2023:1-10. [PMID: 37712622 DOI: 10.1080/08964289.2023.2249169] [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: 04/22/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Military veterans are at increased risk for headache disorders compared to the general population, yet the prevalence and burden associated with headache disorders among veterans is not yet well understood. In this electronic medical record study, we examined the prevalence of headache disorders among veterans seen in a northeastern network of Veterans Health Administration (VHA) primary care during 2017-2018. We also examined rates of psychiatric comorbidity and health care utilization of veterans with headache disorders for the year following the date of the first headache code in the medical record. Of the total population of veterans in the network, 1.3% had a headache disorder and another 3.5% had a possible headache disorder. Migraine and chronic migraine represented the majority of cases. Posttraumatic stress disorder was the most frequent psychiatric comorbidity. Having a headache disorder was associated with higher rates of primary care, neurology, pain clinic, and mental health service use but not higher rates of emergency department or Whole Health (e.g., patient-centered, holistic health services) use. Prevalence findings are comparable to those previously found among veterans, but a substantial proportion of veterans may have been misdiagnosed. Veterans with headache disorders have high rates of psychiatric comorbidity and use several types of health services at higher rates. Findings highlight the need for interdisciplinary care and further education and support for primary care providers. Primary care settings that integrate evidence-based behavioral and Whole Health services may be an optimal way of providing more holistic care for headache disorders.
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29
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Ayyala-Somayajula D, Dodge JL, Farias A, Terrault N, Lee BP. Healthcare affordability and effects on mortality among adults with liver disease from 2004 to 2018 in the United States. J Hepatol 2023; 79:329-339. [PMID: 36996942 PMCID: PMC10524480 DOI: 10.1016/j.jhep.2023.03.020] [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: 01/21/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND & AIMS Liver disease is associated with substantial morbidity and mortality, likely incurring financial distress (i.e. healthcare affordability and accessibility issues), although long-term national-level data are limited. METHODS Using the National Health Interview Survey from 2004 to 2018, we categorised adults based on report of liver disease and other chronic conditions linked to mortality data from the National Death Index. We estimated age-adjusted proportions of adults reporting healthcare affordability and accessibility issues. Multivariable logistic regression and Cox regression were used to assess the association of liver disease with financial distress and financial distress with all-cause mortality, respectively. RESULTS Among adults with liver disease (n = 19,407) vs. those without liver disease (n = 996,352), those with cancer history (n = 37,225), those with emphysema (n = 7,937), and those with coronary artery disease (n = 21,510), the age-adjusted proportion reporting healthcare affordability issues for medical services was 29.9% (95% CI 29.7-30.1%) vs. 18.1% (95% CI 18.0-18.3%), 26.5% (95% CI 26.3-26.7%), 42.2% (95% CI 42.1-42.4%), and 31.6% (31.5-31.8%), respectively, and for medications: 15.5% (95% CI 15.4-15.6%) vs. 8.2% (95% CI 8.1-8.3%), 14.8% (95% CI 14.7-14.9%), 26.1% (95% CI 26.0-26.2%), and 20.6% (95% CI 20.5-20.7%), respectively. In multivariable analysis, liver disease (vs. without liver disease, vs. cancer history, vs. emphysema, and vs. coronary artery disease) was associated with inability to afford medical services (adjusted odds ratio [aOR] 1.84, 95% CI 1.77-1.92; aOR 1.32, 95% CI 1.25-1.40; aOR 0.91, 95% CI 0.84-0.98; and aOR 1.11, 95% CI 1.04-1.19, respectively) and medications (aOR 1.92, 95% CI 1.82-2.03; aOR 1.24, 95% CI 1.14-1.33; aOR 0.81, 95% CI 0.74-0.90; and aOR 0.94, 95% CI 0.86-1.02, respectively), delays in medical care (aOR 1.77, 95% CI 1.69-1.87; aOR 1.14, 95% CI 1.06-1.22; aOR 0.88, 95% CI 0.79-0.97; and aOR 1.05, 95% CI 0.97-1.14, respectively), and not receiving the needed medical care (aOR 1.86, 95% CI 1.76-1.96; aOR 1.16, 95% CI 1.07-1.26; aOR 0.89, 95% CI 0.80-0.99; aOR 1.06, 95% CI 0.96-1.16, respectively). In multivariable analysis, among adults with liver disease, financial distress (vs. without financial distress) was associated with increased all-cause mortality (aHR 1.24, 95% CI 1.01-1.53). CONCLUSIONS Adults with liver disease face greater financial distress than adults without liver disease and adults with cancer history. Financial distress is associated with increased risk of all-cause mortality among adults with liver disease. Interventions to improve healthcare affordability should be prioritised in this population. IMPACT AND IMPLICATIONS Adults with liver disease use many medical services, but long-term national studies regarding the financial repercussions and the effects on mortality for such patients are lacking. This study shows that adults with liver disease are more likely to face issues affording medical services and prescription medication, experience delays in medical care, and needing but not obtaining medical care owing to cost, compared with adults without liver disease, adults with cancer history, are equally likely as adults with coronary artery disease, and less likely than adults with emphysema-patients with liver disease who face these issues are at increased risk of death. This study provides the impetus for medical providers and policymakers to prioritise interventions to improve healthcare affordability for adults with liver disease.
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Affiliation(s)
- Divya Ayyala-Somayajula
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer L Dodge
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Albert Farias
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Norah Terrault
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian P Lee
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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30
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Ma A, Campbell J, Sanchez A, Sumner S, Ma M. Racial Concordance on Healthcare Use within Hispanic Population Subgroups. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01700-8. [PMID: 37479955 DOI: 10.1007/s40615-023-01700-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To examine the association of patient-provider racial and ethnic concordance on healthcare use within Hispanic ethnic subgroups. METHODS We estimate multivariate probit models using data from the Medical Expenditure Panel Survey, the only national data source measuring how patients use and pay for medical care, health insurance, and out-of-pocket spending. We collect and utilize data on preventive care visits, visits for new health problems, and visits for ongoing health problems from survey years 2007-2017 to measure health outcomes. Additionally, we include data on race and ethnicity concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis. The sample includes 59,158 observations: 74.3% identified as Mexican, 10.6% identified as Puerto Rican, 5.1% identified as Cuban, 4.8% identified as Dominican, and 5.2% classified in the survey as Other Hispanics. Foreign-born respondents comprised 56% of the sample. A total of 8% (4678) of cases in the sample involved Hispanic provider-patient concordance. RESULTS Hispanic patient-provider concordance is statistically significant and positively associated with higher probabilities of seeking preventive care (coef=.211, P<.001), seeking care for a new problem (coef=.208, P<.001), and seeking care for an ongoing problem (coef=.208, P<.001). We also find that the association is not equal across the Hispanic subgroups. The association is lowest for Mexicans in preventive care (coef=.165, P<.001) and new problems (coef=.165, P<.001) and highest for Cubans in preventive care (coef=.256, P<.001) and ongoing problems (coef=.284, P<.001). Results are robust to the interaction of the Hispanic patient-provider concordance for the Hispanic patient categories and being foreign-born. CONCLUSIONS In summary, racial disparities were observed in health utilization within Hispanic subgroups. While Hispanic patient-provider concordance is statistically significant in associating with healthcare utilization, the findings indicate that this association varies across Hispanic subpopulations. The observations suggest the importance of disaggregating Hispanic racial and ethnic categories into more similar cultural or origin groups. Linked with the existence of significant differences in mortality and other health outcomes across Hispanic subgroups, our results have implications for the design of community health promotion activities which should take these differences into account. Studies or community health programs which utilize generalized findings about Hispanic populations overlook differences across subgroups which may be crucial in promoting healthcare utilization.
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Affiliation(s)
- Alyson Ma
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA
| | - Jason Campbell
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA
| | - Alison Sanchez
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA.
| | - Steven Sumner
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA
| | - Mindy Ma
- Department of Psychology & Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA
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Pradhan S, Harvey SM, Bui LN, Yoon J. Postpartum Medicaid coverage and outpatient care utilization among low-income birthing individuals in Oregon: impact of Medicaid expansion. Front Public Health 2023; 11:1025399. [PMID: 37469686 PMCID: PMC10352675 DOI: 10.3389/fpubh.2023.1025399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/26/2023] [Indexed: 07/21/2023] Open
Abstract
Objective This study examined the effect of Medicaid expansion in Oregon on duration of Medicaid enrollment and outpatient care utilization for low-income individuals during the postpartum period. Methods We linked Oregon birth certificates, Medicaid enrollment files, and claims to identify postpartum individuals (N = 73,669) who gave birth between 2011 and 2015. We created one pre-Medicaid expansion (2011-2012) and two post-expansion (2014-2015) cohorts (i.e., previously covered and newly covered by Medicaid). We used ordinary least squares and negative binomial regression models to examine changes in postpartum coverage duration and number of outpatient visits within a year of delivery for the post-expansion cohorts compared to the pre-expansion cohort. We examined monthly and overall changes in outpatient utilization during 0-2 months, 3-6 months, and 7-12 months after delivery. Results Postpartum coverage duration increased by 3.14 months and 2.78 months for the post-Medicaid expansion previously enrolled and newly enrolled cohorts (p < 0.001), respectively. Overall outpatient care utilization increased by 0.06, 0.19, and 0.34 visits per person for the previously covered cohort and 0.12, 0.13, and 0.26 visits per person for newly covered cohort during 0-2 months, 3-6 months, and 7-12 months, respectively. Monthly change in utilization increased by 0.006 (0-2 months) and 0.004 (3-6 months) visits per person for post-Medicaid previously enrolled cohort and decreased by 0.003 (0-2 months) and 0.02 (7-12 months) visits per person among newly enrolled cohort. Conclusion Medicaid expansion increased insurance coverage duration and outpatient care utilization during postpartum period in Oregon, potentially contributing to reductions in pregnancy-related mortality and morbidities among birthing individuals.
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Affiliation(s)
- Satyasandipani Pradhan
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - S. Marie Harvey
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Linh N. Bui
- Public Health Program, School of Natural Sciences, Mathematics, and Engineering, California State University, Bakersfield, CA, United States
| | - Jangho Yoon
- Department of Preventive Medicine and Biostatistics, F. Edward Hebert School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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32
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Hotca A, Bloom JR, Runnels J, Salgado LR, Cherry DR, Hsieh K, Sindhu KK. The Impact of Medicaid Expansion on Patients with Cancer in the United States: A Review. Curr Oncol 2023; 30:6362-6373. [PMID: 37504329 PMCID: PMC10378187 DOI: 10.3390/curroncol30070469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Since 2014, American states have had the option to expand their Medicaid programs as part of the Affordable Care Act (ACA), which was signed into law by former President Barack H. Obama in 2010. Emerging research has found that Medicaid expansion has had a significant impact on patients with cancer, who often face significant financial barriers to receiving the care they need. In this review, we aim to provide a comprehensive examination of the research conducted thus far on the impact of Medicaid expansion on patients with cancer. We begin with a discussion of the history of Medicaid expansion and the key features of the ACA that facilitated it. We then review the literature, analyzing studies that have investigated the impact of Medicaid expansion on cancer patients in terms of access to care, quality of care, and health outcomes. Our findings suggest that Medicaid expansion has had a positive impact on patients with cancer in a number of ways. Patients in expansion states are more likely to receive timely cancer screening and diagnoses, and are more likely to receive appropriate cancer-directed treatment. Additionally, Medicaid expansion has been associated with improvements in cancer-related health outcomes, including improved survival rates. However, limitations and gaps in the current research on the impact of Medicaid expansion on patients with cancer exist, including a lack of long-term data on health outcomes. Additionally, further research is needed to better understand the mechanisms through which Medicaid expansion impacts cancer care.
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Affiliation(s)
- Alexandra Hotca
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Julie R Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Juliana Runnels
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lucas Resende Salgado
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daniel R Cherry
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kunal K Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Jester DJ, Kohn JN, Tibiriçá L, Thomas ML, Brown LL, Murphy JD, Jeste DV. Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults. Am J Psychiatry 2023; 180:483-494. [PMID: 37038741 PMCID: PMC10329971 DOI: 10.1176/appi.ajp.20220158] [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] [Indexed: 04/12/2023]
Abstract
OBJECTIVE The authors sought to determine the impact of selected social determinants of health (SDoH) on psychological health and well-being (defined as depression, cognition, and self-rated health) among Black and Hispanic/Latinx adults relative to White adults 51-89 years of age. METHODS Disparities in depressive symptomatology, cognition, and self-rated health were measured among 2,306 non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 non-Hispanic/Latinx White adults who participated in the Health and Retirement Study (N=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected SDoH explained a larger share of the disparities than age, sex, measures of health, health behaviors, and health care utilization. Selected SDoH included education, parental education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage. RESULTS Black and Hispanic/Latinx adults reported worse depressive symptomatology, cognition, and self-rated health than White adults. Selected SDoH were associated with a larger proportion of the Black-White disparities in depressive symptomatology (51%), cognition (39%), and self-rated health (37%) than were age, sex, measures of health, health behaviors, and health care utilization. SDoH were associated with a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and physical health correlated with the disparity in depressive symptomatology (28%). Education, parental education, years worked, income, and insurance parity were SDoH associated with these disparities. CONCLUSIONS Differences in SDoH underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key SDoH.
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Affiliation(s)
- Dylan J. Jester
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Jordan N. Kohn
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Lize Tibiriçá
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Michael L. Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO
| | - Lauren L. Brown
- Divison of Health Management and Policy, School of Public Health, San Diego State University, San Diego, CA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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Lee WC, Lin S, Yang TC, Serag H. Cross-sectional study of food insecurity and medical expenditures by race and ethnicity. ETHNICITY & HEALTH 2023; 28:794-808. [PMID: 36576145 DOI: 10.1080/13557858.2022.2161090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/14/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Food insecurity is a risk factor for morbidity and mortality leading to high medical expenditures, but race/ethnicity was used as adjustments in the literature. The study sought to use race/ethnicity as a key predictor to compare racial differences in associations between food insecurity and expenditures of seven health services among non-institutionalized adults. DESIGN This cross-sectional study used Medical Expenditure Panel Survey that collects information on food insecurity in 2016 (n=24,179) and 2017 (n=22,539). We examined the association between race/ethnicity and food insecurity status and documented the extent to which impacts of food insecurity on medical expenditures varied by race/ethnicity. We fit multivariable models for each racial group, adjusting for states, age, gender, insurance, and education. Adults older than 18 years were included. RESULTS The results show that blacks experienced an inter-racial disparity in food insecurity whereas Hispanics experienced intra-racial disparity. A higher percentage of blacks (28.7%) reported at least one type of food insecurity (11.2% of whites). Around 20% of blacks reported being worried about running out of food and the corresponding number is 8.4% among whites. Hispanics reported more food insecurity issues than whites. Moreover, food insecurity is positively associated with expenditures on emergency room utilization (99% increase for other races vs. 51% increase for whites) but is negatively associated with dental care utilization (43% decrease for blacks and 44% for whites). Except for Hispanics, prescription expenditure has the most positive association with food insecurity, and food insecure blacks are the only group that did not significantly use home health. CONCLUSION The study expanded our understanding of food insecurity by investigating how it affected seven types of medical expenditures for each of four racial populations. An interdisciplinary effort is needed to enhance the food supply for minorities. Policy interventions to address intra-racial disparities among Hispanics and inter-racial disparities among African Americans are imperative to close the gap.
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Affiliation(s)
- Wei-Chen Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sherry Lin
- Department of Health Policy and Management, Texas A&M University, College Station, TX, USA
| | - Tse-Chuan Yang
- Department of Sociology, State University of New York at Albany, Albany, NY, USA
| | - Hani Serag
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Solarczyk JK, Roberts HJ, Wong SE, Ward DT. Healthcare Disparities in Orthopaedic Surgery: A Comparison of Anterior Cruciate Ligament Reconstruction Incidence Proportions With US Census-Derived Demographics. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202307000-00002. [PMID: 37410658 PMCID: PMC10328594 DOI: 10.5435/jaaosglobal-d-22-00271] [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: 11/14/2022] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Disparities exist and affect outcomes after anterior cruciate ligament (ACL) injury. The purpose of this study was to investigate the association between race, ethnicity, and insurance type on the incidence of ACL reconstruction in the United States. METHODS The Healthcare Cost and Utilization Project database was used to determine demographics and insurance types for those undergoing elective ACL reconstruction from 2016 to 2017. The US Census Bureau was used to obtain demographic and insurance data for the general population. RESULTS Non-White patients undergoing ACL reconstruction with commercial insurance were more likely to be younger, male, less burdened with comorbidities including diabetes, and less likely to smoke. When we compared Medicaid patients who had undergone ACL reconstruction with all Medicaid recipients, there was an under-representation of Black patients and a similar percentage of White patients undergoing ACL reconstruction (P < 0.001). DISCUSSION This study suggests ongoing healthcare disparities with lower rates of ACL reconstruction for non-White patients and those with public insurance. Equal proportions of patients identifying as Black undergoing ACL reconstruction as compared with the underlying general population suggests a possible narrowing in disparities. More data are needed at numerous points of care between injury, surgery, and recovery to identify and address disparities.
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Affiliation(s)
- Justin K. Solarczyk
- From the University of California San Francisco School of Medicine, San Francisco, CA (Mr. Solarczyk); the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN (Dr. Roberts); and the Department of Orthopaedic Surgery, University of California at San Francisco, Francisco, CA (Dr. Wong and Dr. Ward)
| | - Heather J. Roberts
- From the University of California San Francisco School of Medicine, San Francisco, CA (Mr. Solarczyk); the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN (Dr. Roberts); and the Department of Orthopaedic Surgery, University of California at San Francisco, Francisco, CA (Dr. Wong and Dr. Ward)
| | - Stephanie E. Wong
- From the University of California San Francisco School of Medicine, San Francisco, CA (Mr. Solarczyk); the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN (Dr. Roberts); and the Department of Orthopaedic Surgery, University of California at San Francisco, Francisco, CA (Dr. Wong and Dr. Ward)
| | - Derek T. Ward
- From the University of California San Francisco School of Medicine, San Francisco, CA (Mr. Solarczyk); the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN (Dr. Roberts); and the Department of Orthopaedic Surgery, University of California at San Francisco, Francisco, CA (Dr. Wong and Dr. Ward)
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Zhou J, Chen C, Wang J, Liu S, Li X, Wei Y, Ye L, Ye J, Kraus VB, Lv Y, Shi X. Development and Validation of a Lifespan Prediction Model in Chinese Adults Aged 65 Years or Older. J Am Med Dir Assoc 2023; 24:1068-1073.e6. [PMID: 36965505 PMCID: PMC10335838 DOI: 10.1016/j.jamda.2023.02.016] [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: 11/29/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES Previous studies investigated factors associated with mortality. Nevertheless, evidence is limited regarding the determinants of lifespan. We aimed to develop and validate a lifespan prediction model based on the most important predictors. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS A total of 23,892 community-living adults aged 65 years or older with confirmed death records between 1998 and 2018 from 23 provinces in China. METHODS Information including demographic characteristics, lifestyle, functional health, and prevalence of diseases was collected. The risk prediction model was generated using multivariate linear regression, incorporating the most important predictors identified by the Lasso selection method. We used 1000 bootstrap resampling for the internal validation. The model performance was assessed by adjusted R2, root mean square error (RMSE), mean absolute error (MAE), and intraclass correlation coefficient (ICC). RESULTS Twenty-one predictors were included in the final lifespan prediction model. Older adults with longer lifespans were characterized by older age at baseline, female, minority race, living in rural areas, married, with healthier lifestyles and more leisure engagement, better functional status, and absence of diseases. The predicted lifespans were highly consistent with observed lifespans, with an adjusted R2 of 0.893. RMSE was 2.86 (95% CI 2.84-2.88) and MAE was 2.18 (95% CI 2.16-2.20) years. The ICC between observed and predicted lifespans was 0.971 (95% CI 0.971-0.971). CONCLUSIONS AND IMPLICATIONS The lifespan prediction model was validated with good performance, the web-based prediction tool can be easily applied in practical use as it relies on all easily accessible variables.
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Affiliation(s)
- Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sixin Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xinwei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yuan Wei
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Lihong Ye
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaming Ye
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Virginia Byers Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
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Fazal M, Oles N, Beckham SW, Wang J, Noyes M, Twose C, Coon D. Sociodemographics of Patient Populations Undergoing Gender-Affirming Surgery: A Systematic Review of All Cohort Studies. Transgend Health 2023; 8:213-219. [PMID: 37342473 PMCID: PMC10278024 DOI: 10.1089/trgh.2021.0111] [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] [Indexed: 11/12/2022] Open
Abstract
Importance Sociodemographic and health characteristics of patients undergoing gender-affirming surgery (GAS) are currently unknown. Understanding these patient characteristics is vital to optimizing patient-centered care for transgender patients. Objective To determine sociodemographic characteristics for the transgender population undergoing GAS. Collected sociodemographic information included the following: age, race/ethnicity, body metrics, hormone replacement therapy administration and duration, substance use, psychiatric comorbidities, and medical comorbidities. Evidence Review A search of seven electronic databases (PubMed, PsycINFO, Embase, CINAHL, Web of Science, Cochrane, and Gender Studies) was used to find all articles on GAS from inception through May 2019. The 15,190 articles were then subjected to two levels of screening, and articles unrelated to gender-affirming care, unavailable in English, n<5, and with no outcomes reporting were excluded. Textbook chapters and letters were also excluded. Findings A total of 406 studies were fully extracted, with 307 studies reporting age (n=22,727 patients), 19 reporting race/ethnicity (n=1184), 74 reporting body metrics (body mass index [BMI] n=6852, height n=416, and weight n=475), 58 reporting hormone therapies (n=5104), 56 reporting substance use (n=1146), 44 reporting psychiatric comorbidities (n=574), and 47 reporting medical comorbidities (n=573). From the 406 studies, 80 were done in the United States. Regarding U.S. studies, 59 studies reported age (n=5365), 10 reported race/ethnicity (n=709), 22 reported body metrics (BMI n=2519), 18 reported hormone therapies (n=3285), 15 reported substance use (n=478), 44 reported psychiatric comorbidities (n=394), and 47 reported medical comorbidities (n=293). Age was the most reported characteristic, reported in 75.62% of studies (73.75% of U.S. studies). Race/ethnicity was the least commonly reported data, reported in 4.68% of studies (12.50% of U.S. studies). Conclusions and Relevance The type of sociodemographic information reported by GAS studies is inconsistently reported. To improve patient-centered care for transgender patients, further work is needed to create a standardization of collected sociodemographic information.
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Affiliation(s)
- Maria Fazal
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Norah Oles
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Plastic Surgery, Center for Transgender Health, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Sam Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - June Wang
- Department of Plastic Surgery, Center for Transgender Health, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Melissa Noyes
- Department of Plastic Surgery, Center for Transgender Health, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
| | - Devin Coon
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Plastic Surgery, Center for Transgender Health, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Cote DJ, Wang R, Morimoto LM, Metayer C, Zada G, Wiemels JL, Ma X. Association between birth characteristics and incidence of pituitary adenoma and craniopharyngioma: a registry-based study in California, 2001-2015. Cancer Causes Control 2023:10.1007/s10552-023-01718-7. [PMID: 37225897 PMCID: PMC10363066 DOI: 10.1007/s10552-023-01718-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE To evaluate the association between birth characteristics, including parental sociodemographic characteristics, and early-onset pituitary adenoma (PA) and craniopharyngioma. METHODS Leveraging the population-based California Linkage Study of Early-onset Cancers, we identified the birth characteristics of incident cases with PA (n = 1,749) or craniopharyngioma (n = 227) who were born from 1978 to 2015 and diagnosed 1988-2015, as well as controls in a 50:1 ratio matched on birth year. Adjusted odds ratios (OR) and 95% confidence interval (CI) estimates were computed using unconditional multivariable logistic regression. RESULTS Males had a lower risk of PA than females (OR = 0.37, 95%CI: 0.34-0.41), and Black (OR = 1.55, 95%CI: 1.30-1.84) or Hispanic (OR = 1.53, 95%CI: 1.34-1.74) individuals had a higher risk compared to non-Hispanic Whites. Older maternal age was positively associated with PA (OR = 1.09, 95%CI: 1.04-1.15 per 5 years, p < 0.01), as was higher maternal education (OR = 1.12, 95%CI: 1.04-1.20 per year, p < 0.01). There were no statistically significant associations between birthweight (OR = 1.04, 95%CI: 0.99-1.09 per 500 g, p = 0.12), birth plurality, or birth order and PA. When stratified by race and ethnicity, the significant association with maternal education was identified only for non-Hispanic White individuals. On multivariable logistic regression, no statistically significant associations were identified between birth characteristics and incidence of craniopharyngioma, except that risk was higher among Hispanic (OR = 1.45, 95%CI: 1.01-2.08) compared to non-Hispanic White individuals. CONCLUSION In this large, population-based study, female sex, older maternal age, higher maternal education, and Hispanic ethnicity and Black race compared to non-Hispanic White race, were associated with an increased risk of PA in children and young adults.
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Affiliation(s)
- David J Cote
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, 1200 N. State Street, Suite 3300, Los Angeles, CA, 90033, USA.
- Center for Genetic Epidemiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Libby M Morimoto
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Catherine Metayer
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, 1200 N. State Street, Suite 3300, Los Angeles, CA, 90033, USA
| | - Joseph L Wiemels
- Center for Genetic Epidemiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Lee YH, Woods C, Shelley M, Arndt S, Liu CT, Chang YC. Racial and Ethnic Disparities and Prevalence in Prescription Drug Misuse, Illicit Drug Use, and Combination of Both Behaviors in the United States. Int J Ment Health Addict 2023:1-17. [PMID: 37363760 PMCID: PMC10198020 DOI: 10.1007/s11469-023-01084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
This study examines racial and ethnic disparities and prevalence in prescription drug misuse, illicit drug use, and the combination of both behaviors in the United States. Using five waves of the National Survey on Drug Use and Health (NSDUH, 2015-2019; n = 276,884), a multinomial logistic regression model estimated the outcomes of prescription drug misuse, illicit drug use, and the combination of both behaviors. Participants' age was considered as an interaction effect. Approximately 5.4%, 2.9%, and 2.5% misused prescription drug, used illicit drug, or had both behaviors, respectively. Compared with White participants, Black (AOR = 0.69, 99.9 CI: 0.61, 0.79) and Asian (AOR = 0.60, 99.9% CI: 0.42, 0.87) participants had significantly lower odds of reporting prescription drug misuse. Individuals who were classified as others had higher odds of reporting illicit drug use (AOR = 1.31; 99.9% CI: 1.05, 1.64), compared with White participants. Black (AOR = 0.40, 99.9% CI: 0.29, 0.56) and Hispanic (AOR = 0.71, 99.9% CI: 0.55, 0.91) participants were significantly less likely to have both prescription drug misuse and illicit drug use behaviors. Interaction analysis showed that Black participants between 18 and 49 years old were less likely to participate in prescription drug misuse. However, Black participants who were 50 years of age or above were more likely to engage in illicit drug use and the combination of both prescription drug misuse and illicit drug use (all p < 0.001). Hispanic adult participants between 18 and 49 years old were more likely to engage in illicit drug use. Successful intervention and cessation programs may consider the cultural and age disparities among different racial and ethnic groups.
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Affiliation(s)
- Yen-Han Lee
- University of Central Florida, Orlando, FL 32816 USA
| | - Chase Woods
- Missouri State University, Springfield, MO 65804 USA
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Mulia N, Ye Y, Greenfield TK, Martinez P, Patterson D, Kerr WC, Karriker-Jaffe KJ. Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth? Prev Med 2023; 169:107426. [PMID: 36709864 PMCID: PMC9877144 DOI: 10.1016/j.ypmed.2023.107426] [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: 09/17/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
Wide-ranging effects of the COVID-19 pandemic have led to increased psychological distress and alcohol consumption, and disproportionate hardship for disadvantaged groups. Early in the pandemic, telehealth services were expanded to maintain healthcare access amidst lockdowns, medical office closures, and fear of infection. This study examines general and behavioral healthcare access and disparities during the first year of the pandemic. Data are from the 2019-2020 US National Alcohol Survey (collected February 2019 to April 2020) and its COVID follow-up survey conducted January 30 to March 28, 2021 (N = 1819). General and behavioral healthcare-related outcomes were assessed at follow-up, and included perceived need for and receipt of care, delayed care, and use of telehealth since April 1, 2020. Results indicate that the majority of respondents with perceived need for healthcare received some behavioral healthcare (reported by 63%) and particularly general healthcare (88%), but nearly half (48%) delayed needed care. Delays were mostly due to COVID-related reasons, but cost barriers also were common and significantly impeded care-seeking by uninsured persons, young adults, rural residents, and persons whose employment was reduced by the pandemic. Disparities in the receipt of healthcare were pronounced for Hispanic/Latinx (vs. White) and lower-income (vs. higher-income) groups (AORs <0.37, p's < 0.05). Notably, telehealth was commonly used by Hispanic/Latinx and lower-income groups for general and particularly behavioral healthcare. Results suggest that telehealth has provided an important bridge to healthcare for certain medically underserved groups during the pandemic, and may be vital to future efforts to increase equity in healthcare access.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Yu Ye
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Priscilla Martinez
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Deidre Patterson
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - William C Kerr
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
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Gong F. Racial and Ethnic Disparities in Health Insurance Coverage in the USA: Findings from the 2018 National Health Interview Survey. J Racial Ethn Health Disparities 2023; 10:651-659. [PMID: 35235187 DOI: 10.1007/s40615-022-01253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/09/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
Under the broad context of health care reforms, I explored racial and ethnic disparities in health insurance coverage as well as potential mechanisms that might contribute to these disparities for an extensive list of groups. The study used the 2018 National Health Interview Survey to analyze the effects of race/ethnicity on uninsurance, with adjustment for other predisposing characteristics (age, gender, marital status, and immigration status), enabling resources (education, income, language proficiency, and region), and need (self-reported health status). Results from the study documented an average uninsured rate of 13%, with substantial variations across different racial and ethnic groups, ranging from over 30% among Native Americans and Mexicans to less than 10% among whites and Asian subgroups. Enabling resources significantly reduced uninsurance among African Americans, Puerto Ricans, and Cubans compared to whites. On the other hand, these confounding factors only partially contributed to uninsurance among Native Americans, Mexicans, Mexican Americans, Dominicans, and other Central and South Americans. This study revealed substantial racial/ethnic disparities in uninsured rates, with Native Americans and a few Hispanic subgroups (Mexicans, Mexican Americans, and Dominicans) having higher and Asian Indians having lower rates than whites in uninsurance. Pathways leading to coverage varied by race/ethnicity. The main findings yielded empirical, theoretical, and policy implications that contributed to health care disparity research.
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Affiliation(s)
- Fang Gong
- Department of Sociology, Ball State University, Muncie, IN, 47306, USA.
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Yang SA, Ciociola EC, Mitchell W, Hall N, Lorch AC, Miller JW, Friedman DS, Boland MV, Elze T, Zebardast N. Effectiveness of Microinvasive Glaucoma Surgery in the United States: Intelligent Research in Sight Registry Analysis 2013-2019. Ophthalmology 2023; 130:242-255. [PMID: 36522820 DOI: 10.1016/j.ophtha.2022.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of microinvasive glaucoma surgery (MIGS) with and without concurrent phacoemulsification. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS Patients in the Intelligent Research in Sight (IRIS®) Registry who underwent Xen gel stent (ab interno) implantation, endoscopic cyclophotocoagulation (ECP), or goniotomy or canaloplasty from 2013 through 2019. METHODS Kaplan-Meier survival analysis was used to assess reoperation rates. We defined reoperation as any subsequent glaucoma surgery occurring 1 month to 3 years after the initial procedure. Multivariable Cox proportional hazard models were used to determine factors predictive of reoperation. MAIN OUTCOME MEASURES Reoperation rate, mean intraocular pressure (IOP) and visual acuity (VA), postoperative complications, predictors of reoperation, and reoperation procedure type. RESULTS A total of 79 363 eyes from 57 561 patients were included, with 15 118 eyes (19%) receiving stand-alone MIGS and 64 245 eyes (81%) receiving MIGS concurrent with phacoemulsification. Overall, patients who underwent MIGS concurrently with phacoemulsification showed lower reoperation rates compared with stand-alone MIGS, most pronounced in ECP and goniotomy or canaloplasty. At postoperative year 2, the cumulative reoperation rate for stand-alone procedures was 15% for ECP, 24% for Xen implantation, and 24% for goniotomy or canaloplasty compared with 3% for ECP, 19% for Xen implantation, and 6% for goniotomy or canaloplasty concurrent with phacoemulsification (P < 0.001 for each stand-alone MIGS vs. MIGS with phacoemulsification). Black race, older age, moderate and severe glaucoma, higher baseline IOP, and glaucoma subtype were associated with higher reoperation risk. Although IOP decreased in all groups, stand-alone MIGS showed a more substantial decrease in mean IOP. Complication rates from MIGS were low overall: 1% for ECP, 1% for Xen implantation, and 2% for goniotomy or canaloplasty. CONCLUSIONS In current United States clinical practice, MIGS has substantially lower reoperation rates when performed with phacoemulsification, especially for ECP and goniotomy or canaloplasty. Approximately one-sixth of patients undergoing stand-alone ECP and one-quarter of patients undergoing stand-alone Xen implantation or goniotomy or canaloplasty require reoperation by 2 years. Black race, diagnosis coding of moderate to severe glaucoma, and higher baseline IOP were associated with higher risk of reoperation after MIGS procedures. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Shuang-An Yang
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - William Mitchell
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Michael V Boland
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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- Stanford University, Palo Alto, California; Wills Eye Hospital, Philadelphia, Pennsylvania; American Academy of Ophthalmology, San Francisco, California; eScience Institute, University of Washington, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle, Washington
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O'Brien DT, Ristea A, Dass S. Exposure to infection when accessing groceries reveals racial and socioeconomic inequities in navigating the pandemic. Sci Rep 2023; 13:2484. [PMID: 36774420 PMCID: PMC9922100 DOI: 10.1038/s41598-023-28194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/13/2023] [Indexed: 02/13/2023] Open
Abstract
Disasters often create inequitable consequences along racial and socioeconomic lines, but a pandemic is distinctive in that communities must navigate the ongoing hazards of infection exposure. We examine this for accessing essential needs, specifically groceries. We propose three strategies for mitigating risk when accessing groceries: visit grocery stores less often; prioritize generalist grocery stores; seek out stores whose clientele have lower infection rates. The study uses a unique combination of data to examine racial and socioeconomic inequities in the ability to employ these strategies in the census block groups of greater Boston, MA in April 2020, including cellphone-generated GPS records to observe store visits, a resident survey, localized infection rates, and demographic and infrastructural characteristics. We also present an original quantification of the amount of infection risk exposure when visiting grocery stores using visits, volume of visitors at each store, and infection rates of those visitors' communities. Each of the three strategies for mitigating exposure were employed in Boston, though differentially by community. Communities with more Black and Latinx residents and lower income made relatively more grocery store visits. This was best explained by differential use of grocery delivery services. Exposure and exposure per visit were higher in communities with more Black and Latinx residents and higher infection rates even when accounting for strategies that diminish exposure. The findings highlight two forms of inequities: using wealth to transfer risk to others through grocery deliveries; and behavioral segregation by race that makes it difficult for marginalized communities to avoid hazards.
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Affiliation(s)
- Daniel T O'Brien
- School of Public Policy and Urban Affairs, Northeastern University, 1135 Tremont St., Boston, MA, 02120, USA.
- Boston Area Research Initiative, Northeastern & Harvard Universities, Boston, MA, USA.
| | - Alina Ristea
- School of Public Policy and Urban Affairs, Northeastern University, 1135 Tremont St., Boston, MA, 02120, USA
- Boston Area Research Initiative, Northeastern & Harvard Universities, Boston, MA, USA
- University College London, London, England
| | - Sarina Dass
- School of Public Policy and Urban Affairs, Northeastern University, 1135 Tremont St., Boston, MA, 02120, USA
- Boston Area Research Initiative, Northeastern & Harvard Universities, Boston, MA, USA
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Le TK, Cha L, Gee G, Dean LT, Juon HS, Tseng W. Asian American Self-Reported Discrimination in Healthcare and Having a Usual Source of Care. J Racial Ethn Health Disparities 2023; 10:259-270. [PMID: 35018579 DOI: 10.1007/s40615-021-01216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Self-reported racial or ethnic discrimination in a healthcare setting has been linked to worse health outcomes and not having a usual source of care, but has been rarely examined among Asian ethnic subgroups. OBJECTIVE We examined the association between Asian ethnic subgroup and self-reported discrimination in a healthcare setting, and whether both factors were associated with not having a usual source of care. DESIGN Using the California Health Interview Survey (CHIS) 2015-2017, we used logistic regression models to assess associations among Asian ethnic subgroup, self-reported discrimination, and not having a usual source of care. Interactions between race and self-reported discrimination, foreign-born status, poverty level, and limited English proficiency were also analyzed. PARTICIPANTS Respondents represented adults age 18 + residing in California who identified as White, Black, Hispanic, American Indian/Alaska Native, Asian (including Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian), and Other. MAIN MEASURES We examined two main outcomes: self-reported discrimination in a healthcare setting and having a usual source of care. KEY RESULTS There were 62,965 respondents. After survey weighting, Asians (OR 1.78, 95% CI 1.19-2.66) as an aggregate group were more likely to report discrimination than non-Hispanic Whites. When Asians were disaggregated, Japanese (3.12, 1.36-7.13) and Koreans (2.42, 1.11-5.29) were more likely to report discrimination than non-Hispanic Whites. Self-reported discrimination was marginally associated with not having a usual source of care (1.25, 0.99-1.57). Koreans were the only group associated with not having a usual source of care (2.10, 1.23-3.60). Foreign-born Chinese (ROR 7.42, 95% CI 1.7-32.32) and foreign-born Japanese (ROR 4.15, 95% CI 0.82-20.95) were more associated with self-reported discrimination than being independently foreign-born and Chinese or Japanese. CONCLUSIONS Differences in self-reported discrimination in a healthcare setting and not having a usual source of care were observed among Asian ethnic subgroups. Better understanding of these differences in their sociocultural contexts will guide interventions to ensure equitable access to healthcare.
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Affiliation(s)
- Thomas K Le
- School of Medicine, Johns Hopkins University, 733 N. Broadway, Suite 137 Miller Research Building, Baltimore, MD, 21205, USA.
| | - Leah Cha
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gilbert Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Lorraine T Dean
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Winston Tseng
- Health Research for Action, Berkeley Public Health, University of California at Berkeley, Berkeley, CA, USA
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Access to primary care physicians, race/ethnicity, and premature mortality: Analysis of 154,516 deaths in Washington State, United States. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01823-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Snowden LR, Wallace N, Graaf G. Subsidized Marketplace Purchases Reduced Racial Disparities in Private Coverage Under the Affordable Care Act. J Racial Ethn Health Disparities 2023; 10:141-148. [PMID: 35032008 PMCID: PMC8760123 DOI: 10.1007/s40615-021-01204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/11/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
The Affordable Care Act's Marketplaces, by allowing subsidized purchase of insurance coverage by persons with incomes from the poverty line to middle income, and through active outreach and enrollment assistance efforts, are well situated to reduce large African American-white private coverage disparities. Using data from the National Health Interview Survey for multiyear periods before and after Affordable Care Act implementation, from 2011-2013 to 2015-2018, this study assessed how much disparity reduction occurred when Marketplaces were implemented. Analysis compared private coverage take-up by African Americans and whites for persons with incomes between 100 and 400% of the Federal Poverty Line (FPL), controlling for African American-white income differences and other covariates. African Americans' gains were significantly greater than whites' and disparities did close. However, both groups gained considerably less coverage than they might have, and some disparity remained. To make ongoing operations more effective and to guide future subsidy extensions and increases as enacted in the American Rescue Plan, more research is needed into the incentive value of subsidies and to discover which Marketplace outreach and enrollment assistance efforts were most effective. In advancing these aims, high priority should be given to identifying strategies that were particularly successful in reaching and engaging uninsured African Americans.
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Affiliation(s)
- Lonnie R Snowden
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, Berkeley, CA, 94720-7360, USA
| | - Neal Wallace
- OHSU-PSU School of Public Health, Portland State University, 1805 SW 4th Ave 523E, Portland, OR, 97201, USA
| | - Genevieve Graaf
- School of Social Work, University of Texas, Arlington, 211 S. Cooper St., Arlington, TX, 76017, USA.
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Access to Reproductive Healthcare Services Among African Women Living in Beijing: Understanding the Challenges. J Racial Ethn Health Disparities 2023; 10:343-349. [PMID: 34984655 PMCID: PMC8725958 DOI: 10.1007/s40615-021-01225-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 02/03/2023]
Abstract
A growing body of research has explored the healthcare experiences of African migrants in China. However, within this extant literature, there is a lacuna on the reproductive healthcare experiences of African women within this population. This study adopts semi-structured in-depth interviews in exploring the challenges to reproductive healthcare access among African women in Beijing. Results indicate that African women face multiple barriers to accessing reproductive healthcare. In particular, the absence of reproductive health awareness, discriminatory immigration policy, discontentment with healthcare services, and language barrier were the key challenges identified. The study highlights the challenges of reproductive healthcare experiences among African migrant women in Beijing, China, and recommends the implementation of secure and equitable policies that cater for the needs of African women and minorities in the healthcare setting.
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Villavicencio A, Kelsey G, Nogueira NF, Zukerberg J, Salazar AS, Hernandez L, Raccamarich P, Alcaide ML. Knowledge, attitudes, and practices towards HPV vaccination among reproductive age women in a HIV hotspot in the US. PLoS One 2023; 18:e0275141. [PMID: 36656804 PMCID: PMC9851547 DOI: 10.1371/journal.pone.0275141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, responsible for cervical cancer and increased risk of Human Immunodeficiency Virus (HIV) acquisition. Despite an effective HPV vaccine, women's HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, attitudes, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage. METHODS From April to June 2022, 100 HIV-negative, cisgender, sexually active women aged 18-45 years were recruited from the Miami community. Participants completed validated questionnaires using REDCap© electronic surveys, assessing socio-demographics and sexual behaviors; HPV knowledge, screening, vaccination practices; barriers and motivators to HPV vaccination. A cumulative HPV knowledge score (HPV score) was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher's exact test, studentized t-test, and multivariate logistic regression (MLR). RESULTS A total of 100 participants were enrolled, and 84 who knew their vaccination status were included in the analysis. Of these, 43 reported receiving at least 1 HPV vaccine dose (vaccinated group) and 41 reported never being vaccinated (unvaccinated group). Mean age was 24.7 (SD 4.03) years for the vaccinated group and 31.4 (SD 8.33) for the unvaccinated group. Mean HPV score was 18.9/29 (SD 6.05) for the vaccinated group and 9.1/29 (SD 8.82) for the unvaccinated group. Amongst vaccinated participants, 76.74% reported a history of HPV/Pap smear screening vs 87.80% in the unvaccinated group. Barriers to HPV vaccination included: 14.6% low-risk perception, 29.3% healthcare barriers, and 46.3% vaccine hesitancy and personal beliefs. Motivators t HPV vaccination included: risk perception and vaccine beliefs (71.42%), healthcare-related (60.71%) and social motivators (55.95%). In the first MLR, one-point increases in HPV score were significantly associated with higher odds of HPV vaccination until an HPV score of 16, and a one-year increase in age was associated with a 16% lower odds of HPV vaccination (aOR = 0.84, 95% CI [0.72, 0.99]; p = 0.035). Contraception use was also associated with HPV vaccination (aOR 8.36 (95% CI [1.41, 49.62]; p = 0.020). Race, ethnicity, college education status, and number of sexual partners were not significant predictors of HPV vaccination. In the second MLR evaluating vaccination motivators as predictors of HPV vaccination, we found that individuals who were motivated by healthcare had 3.03 (95% CI [1.02, 9.00]; p = 0.046) times the odds of HPV vaccination compared to individuals without healthcare-related motivators. CONCLUSION Findings suggest suboptimal HPV knowledge and low vaccination rates among women of reproductive age. Public health efforts should focus on increasing basic HPV knowledge among women with little-to-no HPV knowledge to increase vaccine uptake.
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Affiliation(s)
- Aasith Villavicencio
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gray Kelsey
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Nicholas F. Nogueira
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Julia Zukerberg
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Ana S. Salazar
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Lucila Hernandez
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Patricia Raccamarich
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Maria Luisa Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
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Moriya AS, Chakravarty S. Racial And Ethnic Disparities In Preventable Hospitalizations And ED Visits Five Years After ACA Medicaid Expansions. Health Aff (Millwood) 2023; 42:26-34. [PMID: 36623225 DOI: 10.1377/hlthaff.2022.00460] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Medicaid expansions under the Affordable Care Act (ACA) dramatically increased access to insurance coverage. We examined whether the 2014 ACA Medicaid expansions also mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. Using inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011-18, we found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults, possibly reflecting lower baseline differences and, separately, persisting coverage disparities. These findings highlight sustained improvements in community-level care for non-Hispanic Black populations, who historically lack access to care. Our findings also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
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Affiliation(s)
- Asako S Moriya
- Asako S. Moriya, Agency for Healthcare Research and Quality, Rockville, Maryland
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Rivera‐González AC, Roby DH, Stimpson JP, Bustamante AV, Purtle J, Bellamy SL, Ortega AN. The impact of Medicaid funding structures on inequities in health care access for Latinos in New York, Florida, and Puerto Rico. Health Serv Res 2022; 57 Suppl 2:172-182. [PMID: 35861151 PMCID: PMC9660415 DOI: 10.1111/1475-6773.14036] [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: 01/25/2023] Open
Abstract
OBJECTIVE To study the impact of Medicaid funding structures before and after the implementation of the Affordable Care Act (ACA) on health care access for Latinos in New York (Medicaid expansion), Florida (Medicaid non-expansion), and Puerto Rico (Medicaid block grant). DATA SOURCES Pooled state-level data for New York, Florida, and Puerto Rico from the 2011-2019 Behavioral Risk Factor Surveillance System and data from the 2011-2019 American Community Survey and Puerto Rico Community Survey. STUDY DESIGN Cross-sectional study using probit with predicted margins to separately compare four health care access measures among Latinos in New York, Florida, and Puerto Rico (having health insurance coverage, having a personal doctor, delayed care due to cost, and having a routine checkup). We also used difference-in-differences to measure the probability percent change of having any health insurance and any public health insurance before (2011-2013) and after (2014-2019) the ACA implementation among citizen Latinos in low-income households. DATA COLLECTION The sample consisted of Latinos aged 18-64 residing in New York, Florida, and Puerto Rico from 2011 to 2019. PRINCIPAL FINDINGS Latinos in Florida had the lowest probability of having health care access across all four measures and all time periods compared with those in New York and Puerto Rico. While Latinos in Puerto Rico had greater overall health care access compared with Latinos in both states, health care access in Puerto Rico did not change over time. Among citizen Latinos in low-income households, New York had the greatest post-ACA probability of having any health insurance and any public health insurance, with a growing disparity with Puerto Rico (9.7% any [1.6 SE], 5.2% public [1.8 SE]). CONCLUSIONS Limited Medicaid eligibility (non-expansion of Florida's Medicaid program) and capped Medicaid funds (Puerto Rico's Medicaid block grant) contributed to reduced health care access over time, particularly for citizen Latinos in low-income households.
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Affiliation(s)
| | - Dylan H. Roby
- Health, Society, and BehaviorUniversity of California Irvine Public HealthIrvineCaliforniaUSA
| | - Jim P. Stimpson
- Health Management and PolicyDrexel University Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Arturo Vargas Bustamante
- Health Policy and ManagementUniversity of California Los Angeles Jonathan and Karin Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Jonathan Purtle
- Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNew YorkUSA
| | - Scarlett L. Bellamy
- Epidemiology and BiostatisticsDornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Alexander N. Ortega
- Health Management and PolicyDrexel University Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
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