1
|
Silva JBB, Howe CJ, Jackson JW, Bardenheier BH, Riester MR, van Aalst R, Loiacono MM, Zullo AR. Geospatial Distribution of Racial Disparities in Influenza Vaccination in Nursing Homes. J Am Med Dir Assoc 2024; 25:104804. [PMID: 37739348 PMCID: PMC10950839 DOI: 10.1016/j.jamda.2023.08.018] [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: 03/31/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES This study aimed to assess the distribution of racial disparities in influenza vaccination between White and Black short-stay and long-stay nursing home residents among states and hospital referral regions (HRRs). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We included short-stay and long-stay older adults residing in US nursing homes during influenza seasons between 2011 and 2018. Included residents were aged ≥65 years and enrolled in Traditional Medicare. Analyses were conducted using resident-seasons, whereby residents could contribute to one or more influenza seasons if they resided in a nursing home across multiple seasons. METHODS Our comparison of interest was marginalized vs privileged racial group membership measured as Black vs White race. We obtained influenza vaccination documentation from resident Minimum Data Set assessments from October 1 through June 30 of a particular influenza season. Nonparametric g-formula was used to estimate age- and sex-standardized disparities in vaccination, measured as the percentage point (pp) difference in the proportions of individuals vaccinated between Black and White nursing home residents within states and HRRs. RESULTS The study included 7,807,187 short-stay resident-seasons (89.7% White and 10.3% Black) in 14,889 nursing homes and 7,308,111 long-stay resident-seasons (86.7% White and 13.3% Black) in 14,885 nursing homes. Among states, the median age- and sex-standardized disparity between Black and White residents was 10.1 percentage points (pps) among short-stay residents and 5.3 pps among long-stay residents across seasons. Among HRRs, the median disparity was 8.6 pps among short-stay residents and 5.0 pps among long-stay residents across seasons. CONCLUSIONS AND IMPLICATIONS Our analysis revealed that the magnitudes of vaccination disparities varied substantially across states and HRRs, from no disparity in vaccination to disparities in excess of 25 pps. Local interventions and policies should be targeted to high-disparity geographic areas to increase vaccine uptake and promote health equity.
Collapse
Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Epidemiologic Research, Brown University School of Public Health, Providence, RI, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public health, Baltimore, MD, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Modelling, Epidemiology, and Data Science, Sanofi, Lyon, France; Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| |
Collapse
|
2
|
Burnazovic E, Yee A, Levy J, Gore G, Abbasgholizadeh Rahimi S. Application of Artificial intelligence in COVID-19-related geriatric care: A scoping review. Arch Gerontol Geriatr 2024; 116:105129. [PMID: 37542917 DOI: 10.1016/j.archger.2023.105129] [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: 12/20/2022] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Older adults have been disproportionately affected by the COVID-19 pandemic. This scoping review aimed to summarize the current evidence of artificial intelligence (AI) use in the screening/monitoring, diagnosis, and/or treatment of COVID-19 among older adults. METHOD The review followed the Joanna Briggs Institute and Arksey and O'Malley frameworks. An information specialist performed a comprehensive search from the date of inception until May 2021, in six bibliographic databases. The selected studies considered all populations, and all AI interventions that had been used in COVID-19-related geriatric care. We focused on patient, healthcare provider, and healthcare system-related outcomes. The studies were restricted to peer-reviewed English publications. Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated data extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. RESULTS Six databases were searched , yielding 3,228 articles, of which 10 were included. The majority of articles used a single AI model to assess the association between patients' comorbidities and COVID-19 outcomes. Articles were mainly conducted in high-income countries, with limited representation of females in study participants, and insufficient reporting of participants' race and ethnicity. DISCUSSION This review highlighted how the COVID-19 pandemic has accelerated the application of AI to protect older populations, with most interventions in the pilot testing stage. Further work is required to measure effectiveness of these technologies in a larger scale, use more representative datasets for training of AI models, and expand AI applications to low-income countries.
Collapse
Affiliation(s)
- Emina Burnazovic
- Integrated Biomedical Engineering and Health Sciences, Department of Computing and Software, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Amanda Yee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Joshua Levy
- Department of Pharmacology and Therapeutics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, QC, Canada
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Mila-Quebec Artificial Intelligence Institute, Montreal, QC, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada.
| |
Collapse
|
3
|
Travers JL, Castle N, Weaver SH, Perera UG, Wu B, Dick AW, Stone PW. Environmental and structural factors driving poor quality of care: An examination of nursing homes serving Black residents. J Am Geriatr Soc 2023; 71:3040-3048. [PMID: 37306117 PMCID: PMC10592533 DOI: 10.1111/jgs.18459] [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: 06/20/2022] [Revised: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Poor quality of care in nursing homes (NHs) with high proportions of Black residents has been a problem in the US and even more pronounced during the COVID-19 pandemic. Federal and state agencies are devoting attention to identifying the best means of improving care in the neediest facilities. It is important to understand environmental and structural characteristics that may have led to poor healthcare outcomes in NHs serving high proportions of Black residents pre-pandemic. METHODS We conducted a cross-sectional observational study using multiple 2019 national datasets. Our exposure was the proportion of Black residents in a NH (i.e., none, <5%, 5%-19.9%, 20-49.9%, ≥50%). Healthcare outcomes examined were hospitalizations and emergency department (ED) visits, both observed and risk-adjusted. Structural factors included staffing, ownership status, bed count (0-49, 50-149, or ≥150), chain organization membership, occupancy, and percent Medicaid as a payment source. Environmental factors included region and urbanicity. Descriptive and multivariable linear regression models were estimated. RESULTS In the 14,121 NHs, compared to NHs with no Black residents, NHs with ≥50% Black residents tended to be urban, for-profit, located in the South, have more Medicaid-funded residents, and have lower ratios of registered-nurse (RN) and aide hours per resident per day (HPRD) and greater ratios of licensed practical nurse HPRD. In general, as the proportion of Black residents in a NH increased, hospitalizations and ED visits also increased. DISCUSSION/IMPLICATIONS As lower use of RNs has been associated with increased ED visits and hospitalizations in NHs generally, it is likely low RN use largely drove the differences in hospitalizations and ED visits in NHs with greater proportions of Black residents. Staffing is an area in which state and federal agencies should take action to improve the quality of care in NHs with larger proportions of Black residents.
Collapse
Affiliation(s)
- Jasmine L. Travers
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | | | - Susan H. Weaver
- New Jersey Collaborating Center for Nursing, Newark, NJ, 07102, USA
| | - Uduwanage G. Perera
- Columbia University School of Nursing, 560 West 168 St. New York, NY 10032, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | | | - Patricia W. Stone
- Columbia University School of Nursing, 560 West 168 St. New York, NY 10032, USA
| |
Collapse
|
4
|
Riester MR, Roberts AI, Silva JBB, Howe CJ, Bardenheier BH, van Aalst R, Loiacono MM, Zullo AR. Geographic Variation in Influenza Vaccination Disparities Between Hispanic and Non-Hispanic White US Nursing Home Residents. Open Forum Infect Dis 2022; 9:ofac634. [PMID: 36540392 PMCID: PMC9757686 DOI: 10.1093/ofid/ofac634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/22/2022] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Disparities in influenza vaccination exist between Hispanic and non-Hispanic White US nursing home (NH) residents, but the geographic areas with the largest disparities remain unknown. We examined how these racial/ethnic disparities differ across states and hospital referral regions (HRRs). METHODS This retrospective cohort study included >14 million short-stay and long-stay US NH resident-seasons over 7 influenza seasons from October 1, 2011, to March 31, 2018, where residents could contribute to 1 or more seasons. Residents were aged ≥65 years and enrolled in Medicare fee-for-service. We used the Medicare Beneficiary Summary File to ascertain race/ethnicity and Minimum Data Set assessments for influenza vaccination. We calculated age- and sex-standardized percentage point (pp) differences in the proportions vaccinated between non-Hispanic White and Hispanic (any race) resident-seasons. Positive pp differences were considered disparities, where the proportion of non-Hispanic White residents vaccinated was greater than the proportion of Hispanic residents vaccinated. States and HRRs with ≥100 resident-seasons per age-sex stratum per racial/ethnic group were included in analyses. RESULTS Among 7 442 241 short-stay resident-seasons (94.1% non-Hispanic White, 5.9% Hispanic), the median standardized disparities in influenza vaccination were 4.3 pp (minimum, maximum: 0.3, 19.2; n = 22 states) and 2.8 pp (minimum, maximum: -3.6, 10.3; n = 49 HRRs). Among 6 758 616 long-stay resident-seasons (93.7% non-Hispanic White, 6.5% Hispanic), the median standardized differences were -0.1 pp (minimum, maximum: -4.1, 11.4; n = 18 states) and -1.8 pp (minimum, maximum: -6.5, 7.6; n = 34 HRRs). CONCLUSIONS Wide geographic variation in influenza vaccination disparities existed across US states and HRRs. Localized interventions targeted toward areas with high disparities may be a more effective strategy to promote health equity than one-size-fits-all national interventions.
Collapse
Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Anthony I Roberts
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Epidemiologic Research, Brown University, Providence, Rhode Island, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Westat LLC, Rockville, Maryland, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Modelling, Epidemiology, and Data Science, Global Medical Affairs, Sanofi, Lyon, France
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Matthew M Loiacono
- Global Medical Evidence Generation, Sanofi, Swiftwater, Pennsylvania, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| |
Collapse
|
5
|
Travers JL, D’Arpino S, Bradway C, Kim SJ, Naylor MD. Minority Older Adults' Access to and Use of Programs of All-Inclusive Care for the Elderly. J Aging Soc Policy 2022; 34:976-1002. [PMID: 35125064 PMCID: PMC9357232 DOI: 10.1080/08959420.2021.2024411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/26/2021] [Indexed: 10/19/2022]
Abstract
Programs of All-Inclusive Care for the Elderly (PACE) are an effective approach to improve care quality and delay institutional admissions especially for Black and Hispanic older adults who have seen a disproportionate rise in nursing home use. Guided by Andersen's Behavioral Model of Health Services Use and employing focus groups and one-on-one interviews, we qualitatively examined factors influencing access to and use of PACE by Black and Hispanic older adults. The study sample consisted of thirty-two PACE enrollees, six marketing-team members, and four family-caregivers from three PACE sites in a northeast urban city. Informed knowledge, cultural beliefs, and attitudes toward PACE were found to affect access. Community resources, available services, and care quality facilitated enrollment/participation. Barriers identified included poor dissemination of information and inadequate emphasis on staff's sensitivity to enrollees' cultural and disability differences. Findings will help healthcare leaders capitalize on facilitators and address barriers to enhance access and use of PACE by racial and ethnic minority older adults.
Collapse
Affiliation(s)
- Jasmine L. Travers
- New York University Rory Meyers College of Nursing, 433 1 Avenue, New York, NY 10010
| | | | | | | | | |
Collapse
|
6
|
Wilkins K. Intersectional Immunity? Examining How Race/Ethnicity and Sexual Orientation Combine to Shape Influenza Vaccination Among US Adults. POPULATION RESEARCH AND POLICY REVIEW 2022; 41:2585-2612. [PMID: 36160377 PMCID: PMC9483472 DOI: 10.1007/s11113-022-09739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
Influenza vaccination is a critical preventive healthcare behavior designed to prevent spread of seasonal flu. This paper contributes to existing scholarship by applying an intersectional perspective to examine how influenza vaccination differs across specific intersections of racial/ethnic and sexual identity. Drawing on aggregated state-level data from Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2020, I examine how flu vaccination differs across 18 racial/ethnic-by-sexual orientation groups (N = 1,986,432). Findings from descriptive analyses and logistic regression modeling demonstrate three key findings. First, it corroborates previous studies of vaccination, finding lower rates of flu vaccination among black adults relative to whites; gays/lesbians vaccinate at higher rates than heterosexuals and bisexuals, with bisexuals reporting lower vaccination relative to both heterosexuals and gays/lesbians. Second, it demonstrates how sexual orientation complicates established patterns between race/ethnicity and vaccination (e.g., influenza vaccination is more racially stratified among heterosexuals, with patterns more variable among gays/lesbians) and how race/ethnicity complicates previous patterns of vaccination by sexual orientation (e.g., Asian bisexuals vaccinate more than both heterosexuals). Third, findings pinpoint identities (e.g., black heterosexuals relative to their white peers and white bisexuals relative to their gay/lesbian peers) most in need of influenza vaccination outreach efforts. Implications for findings suggest that heterosexuals, especially black, may be less likely to vaccinate against influenza thus may need more encouragement from clinicians to vaccinate. Additionally, influenza vaccination should be free for all persons to lessen the barrier of access for this preventative healthcare.
Collapse
Affiliation(s)
- Kiana Wilkins
- Department of Sociology, Rice University, 6100 Main Street, Houston, TX MS-2877005 USA
| |
Collapse
|
7
|
Nasreen S, Gebretekle GB, Lynch M, Kurdina A, Thomas M, Fadel S, Houle SKD, Waite NM, Crowcroft NS, Allin S. Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review. Vaccine 2022; 40:4380-4393. [PMID: 35781171 DOI: 10.1016/j.vaccine.2022.06.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries. OBJECTIVES We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research. METHODS We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately. RESULTS We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults. CONCLUSIONS We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.
Collapse
Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Gebremedhin B Gebretekle
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Meghan Lynch
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna Kurdina
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madeleine Thomas
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shaza Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
McCauley L, Hayes R. From Florence to fossil fuels: Nursing has always been about environmental health. Nurs Outlook 2021; 69:720-731. [PMID: 34462138 DOI: 10.1016/j.outlook.2021.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since its founding, professional nursing has applied an environmental lens to healing. METHODS This CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice. FINDINGS The paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice. CONCLUSION This call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).
Collapse
Affiliation(s)
- Linda McCauley
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Rose Hayes
- Executive Communications and Engagement, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA.
| |
Collapse
|
9
|
Abstract
Widespread vaccination acceptance is of critical import to society dealing with the continuing aftermath of the COVID-19 pandemic. The risky behaviours that predict whether individuals vaccinate for seasonal influenza can help policymakers fashion plans to improve vaccination rates and more reliably establish herd immunity. To this end, Canadian Community Health Survey (CCHS) data were employed to determine how an individual’s choice to engage in various risky behaviours relates with the likelihood that the same individual gets the seasonal influenza vaccine. Controls were included for demographic, geographic, and health insurance factors. In addition to controlling for these factors, regressions were further stratified based upon gender, the presence of children in the home, and age. I found that excess sun exposure, poor oral hygiene, smoking, and unhealthy diet choices correlated with reduced vaccination probability—both over the subsequent year and for that individual’s lifetime. These results have important implications for properly targeting individuals for widespread vaccinations.
Collapse
Affiliation(s)
- Florence Neymotin
- Huizenga College of Business, Nova Southeastern University, 3301 College Ave., Fort Lauderdale, FL 33314 USA
- Sprott School of Business, Carleton University, Ottawa, Canada
| |
Collapse
|
10
|
Riester MR, Bosco E, Bardenheier BH, Moyo P, Baier RR, Eliot M, Silva JB, Gravenstein S, van Aalst R, Chit A, Loiacono MM, Zullo AR. Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination. J Am Med Dir Assoc 2021; 22:1271-1278.e3. [PMID: 33838115 DOI: 10.1016/j.jamda.2021.03.003] [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: 12/23/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Quantify how observable characteristics contribute to influenza vaccination disparities among White, Black, and Hispanic nursing home (NH) residents. DESIGN Retrospective cohort. SETTING AND PARTICIPANTS Short- and long-stay U.S. NH residents aged ≥65 years. METHODS We linked Minimum Data Set (MDS) and Medicare data to LTCFocUS and other facility data. We included residents with 6-month continuous enrollment in Medicare and an MDS assessment between October 1, 2013, and March 31, 2014. Residents were classified as short-stay (<100 days in NH) or long-stay (≥100 days in NH). We fit multivariable logistic regression models to assess the relationships between 27 resident and NH-level characteristics and receipt of influenza vaccination. Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparity in influenza vaccination between White versus Black and White versus Hispanic NH residents. Analyses were repeated separately for short- and long-stay residents. RESULTS Our study included 630,373 short-stay and 1,029,593 long-stay residents. Proportions vaccinated against influenza included 67.2% of White, 55.1% of Black, and 54.5% of Hispanic individuals among short-stay residents and 84.2%, 76.7%, and 80.8%, respectively among long-stay residents. Across 4 comparisons, the crude disparity in influenza vaccination ranged from 3.4 to 12.7 percentage points. By equalizing 27 prespecified characteristics, these disparities could be reduced 37.7% to 59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors across all analyses. Characteristics unmeasured in our data (eg, NH staff attitudes and beliefs) may have also contributed significantly to the disparity. CONCLUSIONS AND IMPLICATIONS The racial/ethnic disparity in influenza vaccination was most dramatic among short-stay residents. Intervening on factors associated with NH quality would likely reduce these disparities; however, future qualitative research is essential to explore potential contributors that were unmeasured in our data and to understand the degree to which these factors contribute to the overall disparity in influenza vaccination.
Collapse
Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Rosa R Baier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joe B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Robertus van Aalst
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, PA, USA; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ayman Chit
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada
| | - Matthew M Loiacono
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| |
Collapse
|
11
|
Travers JL, Agarwal M, Estrada LV, Dick AW, Gracner T, Wu B, Stone PW. Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents. J Am Med Dir Assoc 2021; 22:893-898.e2. [PMID: 33762185 PMCID: PMC7898962 DOI: 10.1016/j.jamda.2021.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) has disproportionately impacted nursing homes (NHs) with large shares of Black residents. We examined the associations between the proportion of Black residents in NHs and COVID-19 infections and deaths, accounting for structural bias (operationalized as county-level factors) and stratifying by urbanicity/rurality. DESIGN This was a cross-sectional observational cohort study using publicly available data from the LTCfocus, Centers for Disease Control and Prevention Long-Term Care Facility COVID-19 Module, and the NYTimes county-level COVID-19 database. Four multivariable linear regression models omitting and including facility characteristics, COVID-19 burden, and county-level fixed effects were estimated. SETTING AND PARTICIPANTS In total, 11,587 US NHs that reported data on COVID-19 to the Centers for Disease Control and Prevention and had data in LTCfocus and NYTimes from January 20, 2020 through July 19, 2020. MEASURES Proportion of Black residents in NHs (exposure); COVID-19 infections and deaths (main outcomes). RESULTS The proportion of Black residents in NHs were as follows: none= 3639 (31.4%), <20% = 1020 (8.8%), 20%-49.9% = 1586 (13.7%), ≥50% = 681 (5.9%), not reported = 4661 (40.2%). NHs with any Black residents showed significantly more COVID-19 infections and deaths than NHs with no Black residents. There were 13.6 percentage points more infections and 3.5 percentage points more deaths in NHs with ≥50% Black residents than in NHs with no Black residents (P < .001). Although facility characteristics explained some of the differences found in multivariable analyses, county-level factors and rurality explained more of the differences. CONCLUSIONS AND IMPLICATIONS It is likely that attributes of place, such as resources, services, and providers, important to equitable care and health outcomes are not readily available to counties where NHs have greater proportions of Black residents. Structural bias may underlie these inequities. It is imperative that support be provided to NHs that serve greater proportions of Black residents while considering the rurality of the NH setting.
Collapse
Affiliation(s)
- Jasmine L Travers
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | - Mansi Agarwal
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Leah V Estrada
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | - Andrew W Dick
- Health Unit and Economics, Sociology and Statistics Group, Rand Corporation, Boston, MA, USA
| | | | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| |
Collapse
|
12
|
Addressing Systemic Racism in Nursing Homes: A Time for Action. J Am Med Dir Assoc 2021; 22:886-892. [PMID: 33775548 DOI: 10.1016/j.jamda.2021.02.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022]
Abstract
Long-term services and supports for older persons in the United States are provided in a complex, racially segregated system, with striking racial disparities in access, process, and outcomes of care for residents, which have been magnified during the Coronavirus Disease 2019 pandemic. These disparities are in large measure the result of longstanding patterns of structural, interpersonal, and cultural racism in US society, which in aggregate represent an underpinning of systemic racism that permeates the long-term care system's organization, administration, regulations, and human services. Mechanisms underlying the role of systemic racism in producing the observed disparities are numerous. Long-term care is fundamentally tied to geography, thereby reflecting disparities associated with residential segregation. Additional foundational drivers include a fragmented payment system that advantages persons with financial resources, and reimbursement policies that systematically undervalue long-term care workers. Eliminating disparities in health outcomes in these settings will therefore require a comprehensive approach to eliminating the role of systemic racism in promoting racial disparities.
Collapse
|
13
|
Gravenstein S, McConeghy KW, Saade E, Davidson HE, Canaday DH, Han L, Rudolph J, Joyce N, Dahabreh IJ, Mor V. Adjuvanted influenza vaccine and influenza outbreaks in U.S. nursing homes: Results from a pragmatic cluster-randomized clinical trial. Clin Infect Dis 2021; 73:e4229-e4236. [PMID: 33400778 DOI: 10.1093/cid/ciaa1916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza outbreaks in nursing homes pose a threat to frail residents and occur even in vaccinated populations. We conducted a pragmatic cluster-randomized trial comparing adjuvanted trivalent influenza vaccine (aTIV) versus trivalent influenza vaccine (TIV). Here, we report an exploratory analysis to compare the effect of aTIV versus TIV on facility-reported influenza outbreaks. METHODS Nursing homes were randomized to offer older residents either aTIV or TIV for the 2016-17 influenza season. The impact of the intent-to-treat vaccine assignment was evaluated for the total number of outbreaks reported from November-March. We collected data according to standard CDC definitions for both suspected outbreaks and those with a laboratory-confirmed case in nursing homes, and adjusted for facility-level vaccination rates and resident characteristics. RESULTS Of 823 randomized nursing homes, 777 (aTIV, n=387; TIV, n=390) reported information on influenza outbreaks. The treatment groups had similar characteristics at baseline except for race/ethnicity: homes assigned to TIV had a higher percentage of African-American residents (18.0% versus 13.7%). There were 133 versus 162 facility-reported suspected influenza outbreaks in aTIV versus TIV facilities respectively, of these 115 versus 140 were laboratory confirmed. The aTIV group experienced a 17% reduction in suspected (rate ratio, RR, 0.83, 95% confidence interval, CI: 0.65, 1.05) and laboratory-confirmed influenza outbreaks (RR 0.83, 95%CI: 0.63, 1.06). Covariate adjustment increased the estimated reduction for suspected outbreaks to 21% (RR 0.79, 95%CI: 0.61, 0.99) and 22% for laboratory confirmed (RR 0.78, 95%CI: 0.60, 1.02). CONCLUSIONS In an exploratory analysis of a cluster-RCT we observed 17-21% fewer outbreaks with aTIV than TIV.ClinicalTrials.gov number, NCT02882100.
Collapse
Affiliation(s)
- Stefan Gravenstein
- Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States
| | - Kevin W McConeghy
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Elie Saade
- University Hospitals Cleveland Medical Center, Cleveland Ohio, United States.,Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States
| | | | - David H Canaday
- University Hospitals Cleveland Medical Center, Cleveland Ohio, United States.,Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States
| | - Lisa Han
- Insight Therapeutics, LLC, Norfolk, Virginia, United States
| | - James Rudolph
- Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Nina Joyce
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Issa J Dahabreh
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Vince Mor
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island, United States.,Center for Long-Term Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island, United States
| |
Collapse
|
14
|
Mauldin RL, Lee K, Tang W, Herrera S, Williams A. Supports and gaps in federal policy for addressing racial and ethnic disparities among long-term care facility residents. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:354-370. [PMID: 32338585 DOI: 10.1080/01634372.2020.1758270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
Older adults from racial and ethnic minority groups are likely to face disparities in their health as well as care experiences in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. Policymakers in the United States face concerns around long-term services and supports to address the growing demands of a rapidly aging population through public and private sector initiatives. It is important to create inclusive and culturally responsive environments to meet the needs of diverse groups of older adults. In spite of federal policy that supports minority health and protects the well-being of long-term care facility residents, racial and ethnic disparities persist in long-term care facilities. This manuscript describes supports and gaps in the current United States' federal policy to reduce racial and ethnic disparities in long-term care facilities. Implications for social workers are discussed and recommendations include efforts to revise portions of the Patient Protection and Affordable Care Act of 2010, amending regulations regarding long-term care facilities' training and oversight, and tailoring the Long-Term Care Ombudsman Program's data collection, analysis, and reporting requirements to include racial and ethnic demographic data.
Collapse
Affiliation(s)
- Rebecca L Mauldin
- School of Social Work, University of Texas at Arlington , Arlington, Texas, USA
| | - Kathy Lee
- School of Social Work, University of Texas at Arlington , Arlington, Texas, USA
| | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California , Los Angeles, California, USA
| | - Sarah Herrera
- School of Social Work, University of Texas at Arlington , Arlington, Texas, USA
| | - Antwan Williams
- School of Social Work, University of Texas at Arlington , Arlington, Texas, USA
| |
Collapse
|