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Emezue CN, Bishop-Royse J, Udmuangpia T, Dan-Irabor D, Anakwe A, Julion WA, Karnik NS. Risky Weapon Carrying Behaviors, Youth Violence, and Substance Use Among Young Black Males in Chicago: A Cross-sectional Analysis. RESEARCH SQUARE 2024:rs.3.rs-4713374. [PMID: 39184099 PMCID: PMC11343294 DOI: 10.21203/rs.3.rs-4713374/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Objectives . The study evaluates the prevalence of risky weapon-carrying behaviors (WCB) among YBM in Chicago and examines their associations with various forms of direct and vicarious violence-youth violence, community violence, and partner abuse-as well as substance use and substance-related aggression. Methods . We performed Pearson Chi-square tests and multivariable negative binomial regression analysis on cross-sectional data from 266 violence-involved young Black males (YBM) in Chicago. This data was collected using a modified version of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. Our dependent variable, weapon-carrying behavior, was measured by the frequency of weapon carrying, including items such as guns, knives, and clubs, over the past year. Results . In a sample of 266 YBM (ages 15-24, 99% African American), the mean age was 18.32 ± 3.10 years, and 42.7% had some high school education. The 30-day weapon-carrying incidence was 17.3%, with 19.1% threatening someone with a weapon ≥ 2-3 times in the past year. About one-third engaged in partner violence (30.4%), primarily psychological (36.7%) and physical (28.3%) abuse. Approximately 64.8% experienced some form of violence or aggression in the past year, and 76.4% witnessed community violence. Over 20.8% reported binge drinking, and 43.6% engaged in illicit drug use, with 37.2% participating in or initiating violent acts following alcohol or drug consumption. Negative binomial regression results revealed that exposure to direct and vicarious violence, along with substance use, significantly increased the likelihood of carrying weapons. Specific risk factors such as recent threats or injuries, witnessing violence, involvement in physical altercations, and substance-related aggression significantly predict WCB. Age and relationship dynamics also critically influence these behaviors. Additionally, for each year of age, the risk for WCB increased by 22%. Conclusions . This study identified significant associations between different types of violence, substance use, and risky WCB among YBM in Chicago. The results underscore the need for comprehensive, culturally sensitive, multifaceted interventions addressing both individual and psychosocial factors behind risky WCB. These interventions are crucial for reducing gun violence and improving urban community safety, offering vital data to inform policies and interventions for youth protection in similar environments.
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Emezue CN, Dan-Irabor D, Anakwe A, Froilan AP, Dunlap A, Karnik NS, Julion WA. "I Have More Friends That Died Than Fingers and Toes": Service Utilization Needs and Preferences for Violence and Substance Use Prevention Among Young Black Boys and Men. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241262256. [PMID: 39126161 DOI: 10.1177/08862605241262256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Young Black men (YBM) disproportionately face the most severe forms and consequences of youth violence (YV) and substance use disorders, but are less likely to access and be retained in services for these high-risk behaviors. Investigating service uptake disparities and the role of barrier-reducing intervention delivery models is essential; so is understanding the service needs and preferences of YBM. This study explores the experiences of violence-involved and substance-disordered YBM and service providers working with them from racially and economically diverse communities, focusing on their service needs and preferences. Additionally, we examine the potential benefits and drawbacks of digital health interventions in addressing crucial structural barriers to service access and promoting equity for Black boys in high-violence environments. Individual interviews were conducted with 16 YBM (selected from a larger pool of 300 participants from a pilot study) and 7 service providers (four females, three males). Data analysis utilized an Interpretive Description (ID) approach guided by the Phenomenological Variant of Ecological Systems Theory (PVEST). Four themes emerged: (1) Revolving Doors and Histories of Violence; (2) Benefits of Violence: "You Do Something to Me, I Do Something to You"; (3) Positive and Negative Perceptions of Violence and Substance Use Prevention Programs; and (4) Need for Equity-Focused and Barrier-Mitigating Digital Health Interventions. Our findings identified avoidance mechanisms utilized by YBM at both individual and community levels and highlighted perceptions of existing community-based programs and digital interventions as crucial tools for mitigating barriers to care. This study also confirms the prevalence of critical service gaps and program uptake issues, even in cities with abundant programs. Thus emphasizing the need for equity-focused interventions co-designed with and for YBM in high-violence and substance use contexts.
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Affiliation(s)
| | | | | | | | - Aaron Dunlap
- Rush University Medical Center, Chicago, IL, USA
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Garcia L, Feinglass J, Marfatia H, Adekola K, Moreira J. Evaluating Socioeconomic, Racial, and Ethnic Disparities in Survival Among Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplants. J Racial Ethn Health Disparities 2024; 11:1330-1338. [PMID: 37126157 PMCID: PMC10618412 DOI: 10.1007/s40615-023-01611-8] [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: 02/21/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
This study was undertaken to monitor potential disparities in survival after allogeneic hematopoietic stem cell transplantation (HSCT) with the aim of optimizing access and outcomes for minority and low-income patients. We analyzed 463 patients transplanted over a 72-month study period with a median 19-month follow-up, focused on differences by individual patient race/ethnicity and patients' household income derived from geocoded addresses at the census block group level. Patient sociodemographic and clinical characteristics were abstracted from electronic health records and our HSCT registry, including disease category and status, donor age, transplant type, and conditioning. Approximately, 15% of HSCT patients were non-Hispanic Black or Hispanic with a similar proportion from block groups below the median metropolitan Index of Concentration at the Extremes income score. The overall survival probability was 61.8% at 36 months. Non-Hispanic white (63.6%) and especially Hispanic patients (49.2%) had lower survival probabilities at 36 months than non-Hispanic Black patients (75.6%, p = 0.04). There were no other patient characteristics significantly associated with survival at the p < 0.01 level. The lack of significant differences likely reflects the careful selection of patients for transplants. However, the proportion of minority and low-income patients relative to expected disease prevalence in our area population raises important considerations about which patients successfully make it to transplant. We conclude with recommendations to increase the diversity of patients who receive HSCT by reviewing potential barriers in the transplant referral and selection process and advocating for needed psychosocial and community resources.
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Affiliation(s)
- Lawrence Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 Lakeshore Dr., 10th Floor, Chicago, IL, 60611, USA.
| | - Hardik Marfatia
- Economics Department, Northeastern Illinois University, Chicago, IL, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Moreira
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Xu Y, McClure LA, Quick H, Jahn JL, Zakeri I, Headen I, Tabb LP. A two-stage bayesian model for assessing the geography of racialized economic segregation and premature mortality across US counties. Spat Spatiotemporal Epidemiol 2024; 49:100652. [PMID: 38876565 DOI: 10.1016/j.sste.2024.100652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 06/16/2024]
Abstract
Racialized economic segregation, a key metric that simultaneously accounts for spatial, social and income polarization in communities, has been linked to adverse health outcomes, including morbidity and mortality. Due to the spatial nature of this metric, the association between health outcomes and racialized economic segregation could also change with space. Most studies assessing the relationship between racialized economic segregation and health outcomes have always treated racialized economic segregation as a fixed effect and ignored the spatial nature of it. This paper proposes a two-stage Bayesian statistical framework that provides a broad, flexible approach to studying the spatially varying association between premature mortality and racialized economic segregation while accounting for neighborhood-level latent health factors across US counties. The two-stage framework reduces the dimensionality of spatially correlated data and highlights the importance of accounting for spatial autocorrelation in racialized economic segregation measures, in health equity focused settings.
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Affiliation(s)
- Yang Xu
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA.
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA; College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave., St. Louis, MO 63104, USA
| | - Harrison Quick
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA; Division of Biostatistics & Health Data Science, University of Minnesota, 2221 University Ave SE, Suite 200, Minneapolis, MN 55414, USA
| | - Jaquelyn L Jahn
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA; The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA
| | - Issa Zakeri
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA
| | - Irene Headen
- Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA
| | - Loni Philip Tabb
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia 19104, PA, USA.
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Abdel Magid HS, Jaros S, Li Y, Steinman MA, Lee S, Jing B, Fung K, Liu CK, Liu X, Graham LA, Odden MC. Effects of residential socioeconomic polarization on high blood pressure among nursing home residents. Health Place 2024; 87:103243. [PMID: 38663339 PMCID: PMC11102837 DOI: 10.1016/j.healthplace.2024.103243] [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: 08/13/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE Neighborhood concentration of racial, income, education, and housing deprivation is known to be associated with higher rates of hypertension. The objective of this study is to examine the association between tract-level spatial social polarization and hypertension in a cohort with relatively equal access to health care, a Veterans Affairs nursing home. METHODS 41,973 long-term care residents aged ≥65 years were matched with tract-level Indices of Concentration at the Extremes across four socioeconomic domains. We modeled high blood pressure against these indices controlling for individual-level cardiovascular confounders. RESULTS We found participants who had resided in the most disadvantaged quintile had a 1.10 (95% 1.01, 1.19) relative risk of high blood pressure compared to those in the other quintiles for the joint measuring race/ethnicity and income domain. CONCLUSIONS We achieved our objective by demonstrating that concentrated deprivation is associated with worse cardiovascular outcomes even in a population with equal access to care. Measures that jointly consider economic and racial/ethnic polarization elucidate larger disparities than single domain measures.
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Affiliation(s)
- Hoda S Abdel Magid
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Samuel Jaros
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Yongmei Li
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael A Steinman
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA
| | - Sei Lee
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA
| | - Bocheng Jing
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA
| | - Kathy Fung
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA; Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Christine K Liu
- Section of Geriatric Medicine, Division of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Xiaojuan Liu
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Laura A Graham
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University, Stanford, CA, USA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Bishop-Royse J, Saiyed NS, Schober DJ, Laflamme E, Lange-Maia BS, Ferrera M, Benjamins MR. Cause-Specific Mortality and Racial Differentials in Life Expectancy, Chicago 2018-2019. J Racial Ethn Health Disparities 2024; 11:846-852. [PMID: 36973497 PMCID: PMC10042425 DOI: 10.1007/s40615-023-01566-w] [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: 10/24/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND In Chicago in 2018, the average life expectancy (ALE) for NH Blacks was 71.5 years, 9.1 fewer years than for NH Whites (80.6 years). Inasmuch as some causes of death are increasingly recognized products of structural racism, in urban areas, such causes may have potential for reducing racial inequities through public health intervention. Our purpose is to allocate racial inequities in ALE in Chicago to differentials in cause-specific mortality. METHODS Using multiple decrement processes and decomposition analysis, we examine cause-specific mortality in Chicago to determine the causes of death that contribute to the gap in life expectancy between NH Blacks and NH Whites. RESULTS Among females, the racial difference in ALE was 8.21 years; for males, it was 10.53 years. We find that cancer and heart disease mortality account for 3.03 years or 36% of the racial gap in average life expectancy among females. Differences in homicide and heart disease mortality rates comprised over 45% of the disparity among males. CONCLUSIONS Strategies for improving inequities in life expectancy should account for differences between males and females in cause-specific mortality rates. In urban areas with high levels of segregation, reducing inequities in ALE may be possible by dramatically reducing mortality rates from some causes. CONTRIBUTION This paper illustrates the state of inequities in ALE between NH Blacks and NH Whites in Chicago for the period just prior to the onset of the COVID-19 pandemic, using a well-established method of decomposing mortality differentials for sub-populations.
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Affiliation(s)
| | | | - Daniel J. Schober
- Master of Public Health Program, Center for Community Health Equity, DePaul University, Chicago, IL USA
| | - Emily Laflamme
- American Medical Association, Center for Health Equity, Center Community Health Equity, Chicago, IL USA
| | - Brittney S. Lange-Maia
- Department of Family and Preventive Medicine, Center for Community Health Equity, Rush Alzheimer’s Disease Center, Rush University, Chicago, IL USA
| | - Maria Ferrera
- Department of Social Work, Center for Community Health Equity, DePaul University, Chicago, IL USA
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7
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Stiles-Shields C, Reyes KM, Lennan N, Zhang J, Archer J, Julion WA, Shalowitz MU. Community Teens' COVID-19 Experience: Implications for Engagement Moving Forward. J Clin Psychol Med Settings 2024; 31:143-152. [PMID: 37803094 PMCID: PMC11174976 DOI: 10.1007/s10880-023-09975-z] [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] [Accepted: 09/07/2023] [Indexed: 10/08/2023]
Abstract
Data collected from pediatric primary care settings during the pandemic suggest an increase in internalizing symptoms and disparities in care based upon minoritized identity status(es). To inform care moving forward, the current study characterized the pandemic and related technology usage experiences of teenaged pediatric patients from communities with high hardship indexes. As part of a larger mixed-methods study, 17 teens (Mean age = 15.99 ± .99) and 10 caregivers independently voiced experiences related to the pandemic during remote focus group and interview sessions. Thematic analyses were used to assess qualitative data; descriptive analyses were used to characterize qualitative data. Despite no direct queries about the pandemic, 41% of teens and 40% of caregivers described their lived experiences during the pandemic. Two subthemes emerged within the primary theme of COVID-19: (1) Wellness/Mental Health and (2) Smartphone Use and Utility. Although distress and negative effects were voiced, questionnaire data indicated normative psychosocial functioning for both teen self-report and caregiver proxy report. Informed by the voiced experiences of teens and their caregivers from communities with high hardship indexes, methods for better assessing and managing internalizing symptoms in teen patients are presented. A multi-modal and multi-informant approach that leverages technology to garner information about teens' experiences and deliver care may help improve the well-being of teens in communities systemically burdened with disparities.
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Affiliation(s)
- Colleen Stiles-Shields
- Institute for Juvenile Research, Department of Psychiatry, The University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA.
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA.
| | - Karen M Reyes
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Nia Lennan
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Jim Zhang
- Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Joseph Archer
- School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Wrenetha A Julion
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, USA
| | - Madeleine U Shalowitz
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
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Kruzan KP, Ng A, Stiles-Shields C, Lattie EG, Mohr DC, Reddy M. The Perceived Utility of Smartphone and Wearable Sensor Data in Digital Self-tracking Technologies for Mental Health. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2023; 2023:88. [PMID: 38873656 PMCID: PMC11174977 DOI: 10.1145/3544548.3581209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Mental health symptoms are commonly discovered in primary care. Yet, these settings are not set up to provide psychological treatment. Digital interventions can play a crucial role in stepped care management of patients' symptoms where patients are offered a low intensity intervention, and treatment evolves to incorporate providers if needed. Though digital interventions often use smartphone and wearable sensor data, little is known about patients' desires to use these data to manage mental health symptoms. In 10 interviews with patients with symptoms of depression and anxiety, we explored their: symptom self-management, current and desired use of sensor data, and comfort sharing such data with providers. Findings support the use digital interventions to manage mental health, yet they also highlight a misalignment in patient needs and current efforts to use sensors. We outline considerations for future research, including extending design thinking to wraparound services that may be necessary to truly reduce healthcare burden.
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Affiliation(s)
| | - Ada Ng
- Northwestern University, Illinois, USA
| | | | | | | | - Madhu Reddy
- University of California Irvine, Irvine, USA
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9
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Llanos AAM, Ashrafi A, Ghosh N, Tsui J, Lin Y, Fong AJ, Ganesan S, Heckman CJ. Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection. JAMA Netw Open 2023; 6:e2251165. [PMID: 36637818 PMCID: PMC9856904 DOI: 10.1001/jamanetworkopen.2022.51165] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE There is a disproportionately greater burden of COVID-19 among Hispanic and non-Hispanic Black individuals, who also experience poorer cancer outcomes. Understanding individual-level and area-level factors contributing to inequities at the intersection of COVID-19 and cancer is critical. OBJECTIVE To evaluate associations of individual-level and area-level social determinants of health (SDOH) with delayed or discontinued cancer treatment following SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This retrospective, registry-based cohort study used data from 4768 patients receiving cancer care who had positive test results for SARS-CoV-2 and were enrolled in the American Society for Clinical Oncology COVID-19 Registry. Data were collected from April 1, 2020, to September 26, 2022. EXPOSURES Race and ethnicity, sex, age, and area-level SDOH based on zip codes of residence at the time of cancer diagnosis. MAIN OUTCOMES AND MEASURES Delayed (≥14 days) or discontinued cancer treatment (any cancer treatment, surgery, pharmacotherapy, or radiotherapy) and time (in days) to restart pharmacotherapy. RESULTS A total of 4768 patients (2756 women [57.8%]; 1558 [32.7%] aged ≥70 years at diagnosis) were included in the analysis. There were 630 Hispanic (13.2%), 196 non-Hispanic Asian American or Pacific Islander (4.1%), 568 non-Hispanic Black (11.9%), and 3173 non-Hispanic White individuals (66.5%). Compared with non-Hispanic White individuals, Hispanic and non-Hispanic Black individuals were more likely to experience a delay of at least 14 days or discontinuation of any treatment and drug-based treatment; only estimates for non-Hispanic Black individuals were statistically significant, with correction for multiple comparisons (risk ratios [RRs], 1.35 [95% CI, 1.22-1.49] and 1.37 [95% CI, 1.23-1.52], respectively). Area-level SDOH (eg, geography, proportion of residents without health insurance or with only a high school education, lower median household income) were associated with delayed or discontinued treatment. In multivariable Cox proportinal hazards regression models, estimates suggested that Hispanic (hazard ratio [HR], 0.87 [95% CI, 0.71-1.05]), non-Hispanic Asian American or Pacific Islander (HR, 0.79 [95% CI, 0.46-1.35]), and non-Hispanic Black individuals (HR, 0.81 [95% CI, 0.67-0.97]) experienced longer delays to restarting pharmacotherapy compared with non-Hispanic White individuals. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that race and ethnicity and area-level SDOH were associated with delayed or discontinued cancer treatment and longer delays to the restart of drug-based therapies following SARS-CoV-2 infection. Such treatment delays could exacerbate persistent cancer survival inequities in the United States.
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Affiliation(s)
- Adana A. M. Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Adiba Ashrafi
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Nabarun Ghosh
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Jennifer Tsui
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Yong Lin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Angela J. Fong
- Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine and Pharmacology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Carolyn J. Heckman
- Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Stiles-Shields C, Reyes KM, Archer J, Lennan N, Zhang J, Julion WA, Karnik NS. mHealth Uses and Opportunities for Teens from Communities with High Health Disparities: A Mixed-Methods Study. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-13. [PMID: 36117748 PMCID: PMC9470238 DOI: 10.1007/s41347-022-00278-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022]
Abstract
Despite widespread access to smartphones, teens from communities facing significant behavioral health disparities typically have low mobile health (mHealth) engagement. The purpose of this study was to characterize teen and caregiver perspectives about smartphone use and access, mHealth, and how mHealth could address teens' behavioral health needs during the pandemic and beyond. Remote recruitment and methodologies were used to engage 17 teens (M age = 15.9 ± 0.9) and 10 caregivers living in urban communities with significant socioeconomic and health disparities. Participants completed a focus group or interview session (based on preference) and self-report questionnaires (e.g., behavioral health history, pandemic impacts, technology use). Qualitative and quantitative data were analyzed using thematic and descriptive analyses, respectively. Both quantitative and qualitative data indicated relevant behavioral health concerns for teens and their families, impacts from the pandemic, and frequent smartphone use. Primary teen and caregiver themes included (1) health and wellness concerns, (2) barriers, (3) use of smartphones, (4) impacts of smartphones, and (5) opinions/suggestions for mHealth. This multi-method and multi-informant study highlighted the lived experiences of teens from marginalized communities and offered key insights to increase the acceptability and real-world engagement of mHealth tools. To address barriers to care for this population beyond the pandemic, clear messaging must be used for mHealth tools (e.g., data privacy, expectations of use). These findings testify to the importance of collaboration with teens and caregivers from communities facing large health disparities in future mHealth design, development, and deployment.
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Affiliation(s)
- Colleen Stiles-Shields
- Rush University Medical Center, Chicago, IL USA
- Present Address: University of Illinois at Chicago, Chicago, IL USA
| | | | - Joseph Archer
- Present Address: University of Illinois at Chicago, Chicago, IL USA
| | - Nia Lennan
- Rush University Medical Center, Chicago, IL USA
| | - Jim Zhang
- Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | | | - Niranjan S. Karnik
- Rush University Medical Center, Chicago, IL USA
- Present Address: University of Illinois at Chicago, Chicago, IL USA
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11
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Stiles-Shields C, Batts KR, Reyes KM, Archer J, Crosby S, Draxler JM, Lennan N, Held P. Digital Screening and Automated Resource Identification System to Address COVID-19-Related Behavioral Health Disparities: Feasibility Study. JMIR Form Res 2022; 6:e38162. [PMID: 35696607 PMCID: PMC9221976 DOI: 10.2196/38162] [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: 03/21/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. OBJECTIVE This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant's responses. METHODS Individuals aged ≥15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant's responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. RESULTS A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). CONCLUSIONS This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use.
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Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Kathryn R Batts
- Community Health Research Division, RTI International, Research Triangle Park, NC, United States
| | - Karen M Reyes
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Joseph Archer
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Sharad Crosby
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Institute for Translational Medicine, University of Chicago, Chicago, IL, United States
| | - Janel M Draxler
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Nia Lennan
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Philip Held
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Nordenskiöld KY, Olsson JE, Bertilson BC. Diagnosis and treatment of vulnerable migrants: a retrospective study at a Doctors of the World clinic in Stockholm. BMC Health Serv Res 2022; 22:212. [PMID: 35177047 PMCID: PMC8851765 DOI: 10.1186/s12913-021-07410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background At Doctors of the World Medical Clinic in Stockholm (DWMCS), medical care is offered to migrants who live under particularly vulnerable conditions and who lack access to subsidized care. The demographic, diagnostic and therapeutic panorama of vulnerable migrants is unknown. Methods A quantitative, retrospective study mapping gender, age, diagnostic group, primary diagnosis, therapeutics, referrals, and session timing (whether the care session took place in summer -April to September, or winter - October to March) by reading all patients’ electronic journals at DWMCS between 2014-04-01 and 2017-12-31. Diagnostic groups were classified according to the classification system ICPC-2 which contains six diagnostic groups: symptoms/complaints, infections, neoplasms, injuries, congenital anomalies and other diagnoses. Primary diagnosis was defined as the diagnosis that was first in the diagnosis list for the visit. Difference in median age was calculated with the Mann-Whitney test (MW), and two-group analysis of nominal data was performed with Monte Carlo simulations (MC) and chi square test´s (X2). Results The study included 1323 patients: 838 women and 485 men. The median age for women 37 years (29-47) was slightly lower than for men, 40 years (31-47) MW (p = 0.002). The largest diagnostic group was symptoms / complaints. The five most common primary diagnoses were cough (4%), back symptom / complaint (4%), cystitis (3%), upper respiratory infection acute (3%) and abdominal pain epigastric (2%). The most common therapeutic (55%) was pharmaceutical. Referrals accounted for 12% of the therapeutics and 25% of the referrals were to an emergency room. Tests of significance indicated an uneven distribution of diagnostic groups MC (p = 0.003), infectious primary diagnoses MC (p = 0.0001) and referrals MC (p = 0.006) between men and women and an uneven seasonal distribution among the Other diagnoses MC (0.04) and ten most common drug treatments MC (p=0.002). Conclusions The demographic, diagnostic and therapeutic panorama of vulnerable migrants at DWMCS was elucidated. Vulnerable migrants have differences in morbidity depending on gender and season, differences in therapeutics depending on gender and differences among their most common drug treatments depending on season. This knowledge is important when addressing the health problems of vulnerable migrants.
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Affiliation(s)
- Klas Ytterbrink Nordenskiöld
- Academic Primary Care Center, Stockholm Health Care Services (SLSO), Solnavägen 1 E, 11365, Stockholm, Sweden.,Doctors of the World Sweden, Hantverkargatan 2c, 11221, Stockholm, Sweden
| | - Jan-Eric Olsson
- Academic Primary Care Center, Stockholm Health Care Services (SLSO), Solnavägen 1 E, 11365, Stockholm, Sweden
| | - Bo C Bertilson
- Academic Primary Care Center, Stockholm Health Care Services (SLSO), Solnavägen 1 E, 11365, Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden.
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Khanijahani A, Tomassoni L. Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA. J Racial Ethn Health Disparities 2022; 9:367-375. [PMID: 33469872 PMCID: PMC7815201 DOI: 10.1007/s40615-021-00965-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study's objective was to examine the association of the percentage of county population residing in concentrated disadvantage and Black-concentrated census tracts with county-level confirmed COVID-19 deaths in the USA, concentrated disadvantage and Black concentration at census tract-level measure socioeconomic segregation and racial segregation, respectively. METHODS We performed secondary data analysis using tract (N = 73,056) and county (N = 3142) level data from the US Census Bureau and other sources for the USA. Confirmed COVID-19 deaths per 100,000 population was our outcome measure. We performed mixed-effect negative binomial regression to examine the association of county population's percentage residing in concentrated disadvantage and Black-concentrated tracts with COVID-19 deaths while controlling for several other characteristics. RESULTS For every 10% increase in the percentage of county population residing in concentrated disadvantage and Black-concentrated tracts, the rate for confirmed COVID-19 deaths per 100,000 population increases by a factor of 1.14 (mortality rate ratio [MMR] = 1.14; 95% confidence interval [CI]:1.11, 1.18) and 1.11 (MMR = 1.11; 95% CI:1.08, 1.14), respectively. These relations stayed significant in all models in further sensitivity analyses. Moreover, a joint increase in the percentage of county population residing in racial and socioeconomic segregation was associated with a much greater increase in COVID-19 deaths. CONCLUSIONS It appears that people living in socioeconomically and racially segregated neighborhoods may be disproportionately impacted by COVID-19 deaths. Future multilevel and longitudinal studies with data at both individual and aggregated tract level can help isolate the potential impacts of the individual-level characteristics and neighborhood-level socioeconomic and racial segregation with more precision and confidence.
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Affiliation(s)
- Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282 USA
| | - Larisa Tomassoni
- Rollins School of Public Health, Emory University, Atlanta, GA USA
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Larrabee Sonderlund A, Charifson M, Schoenthaler A, Carson T, Williams NJ. Racialized economic segregation and health outcomes: A systematic review of studies that use the Index of Concentration at the Extremes for race, income, and their interaction. PLoS One 2022; 17:e0262962. [PMID: 35089963 PMCID: PMC8797220 DOI: 10.1371/journal.pone.0262962] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022] Open
Abstract
Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.
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Affiliation(s)
- Anders Larrabee Sonderlund
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mia Charifson
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
| | - Traci Carson
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
| | - Natasha J. Williams
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
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Bailey M, Anderson S, Hall DA. Parkinson's Disease in African Americans: A Review of the Current Literature. JOURNAL OF PARKINSONS DISEASE 2021; 10:831-841. [PMID: 32417794 PMCID: PMC7458499 DOI: 10.3233/jpd-191823] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease, though evidence suggests that this disorder does not affect all racial groups similarly. Research in African Americans, in particular, has been conflicting. Some studies have found similar prevalence rates in African Americans and whites whereas other studies have found much lower prevalence and incidence rates in African Americans. A few studies identify potential factors underlying these discrepancies, including biologic differences as well as disparities in healthcare access. However, African Americans remain underrepresented in research studies, which make understanding the underlying reasons for these differences difficult. The purpose of this paper is to summarize existing research in African Americans with PD, highlight some of the reasons why differences exist in diagnostic rates of PD in this population, and briefly discuss interventions that may need to be made in order to ensure adequate care is provided to these patients.
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Affiliation(s)
- Meagan Bailey
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Sharlet Anderson
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Deborah A Hall
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
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16
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Liao TF, De Maio F. Association of Social and Economic Inequality With Coronavirus Disease 2019 Incidence and Mortality Across US Counties. JAMA Netw Open 2021; 4:e2034578. [PMID: 33471120 PMCID: PMC7818127 DOI: 10.1001/jamanetworkopen.2020.34578] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE It is now established that across the United States, minoritized populations have borne a disproportionate burden from coronavirus disease 2019 (COVID-19). However, little is known about the interaction among a county's racial/ethnic composition, its level of income inequality, political factors, and COVID-19 outcomes in the population. OBJECTIVE To quantify the association of economic inequality, racial/ethnic composition, political factors, and state health care policy with the incidence and mortality burden associated with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the 3142 counties in the 50 US states and for Washington, DC. Data on the first 200 days of the COVID-19 pandemic, from the first confirmed US case on January 22 to August 8, 2020, were gathered from the Centers for Disease Control and Prevention and USAFacts.org, the US Census Bureau, the American Community Survey, GitHub, the Kaiser Family Foundation, the Council of State Governments, and the National Governors Association. EXPOSURES Racial/ethnic composition was determined as percentage of the population that is Black or Hispanic; income inequality, using the Gini index; politics, political affiliation and sex of the state governor, gubernatorial term limits, and percentage of the county's population that voted Republican in 2016; and state health care policy, participation in the expansion of Medicaid under the Affordable Care Act. Six additional covariates were assessed. MAIN OUTCOMES AND MEASURES Cumulative COVID-19 incidence and mortality rates for US counties during the first 200 days of the pandemic. Main measures include percentage Black and Hispanic population composition, income inequality, and a set of additional covariates. RESULTS This study included 3141 of 3142 US counties. The mean Black population was 9.365% (range, 0-86.593%); the mean Hispanic population was 9.754% (range, 0.648%-96.353%); the mean Gini ratio was 44.538 (range, 25.670-66.470); the proportion of counties within states that implemented Medicaid expansion was 0.577 (range, 0-1); the mean number of confirmed COVID-19 cases per 100 000 population was 1093.882 (range, 0-14 019.852); and the mean number of COVID-19-related deaths per 100 000 population was 26.173 (range, 0-413.858). A 1.0% increase in a county's income inequality corresponded to an adjusted risk ratio (RR) of 1.020 (95% CI, 1.012-1.027) for COVID-19 incidence and adjusted RR of 1.030 (95% CI, 1.012-1.047) for COVID-19 mortality. Inequality compounded the association of racial/ethnic composition through interaction, with higher income inequality raising the intercepts of the incidence curve RR by a factor of 1.041 (95% CI, 1.031-1.051) and that of the mortality curve RR by a factor of 1.068 (95% CI, 1.042-1.094) but slightly lowering their curvatures, especially for Hispanic composition. When state-level specificities were controlled, none of the state political factors were associated with COVID-19 incidence or mortality. However, a county in a state with Medicaid expansion implemented would see the incidence rate RR decreased by a multiplicative factor of 0.678 (95% CI, 0.501-0.918). CONCLUSIONS AND RELEVANCE This county-level ecological analysis suggests that COVID-19 surveillance systems should account for county-level income inequality to better understand the social patterning of COVID-19 incidence and mortality. High levels of income inequality may harm population health irrespective of racial/ethnic composition.
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Affiliation(s)
- Tim F. Liao
- Department of Sociology, University of Illinois at Urbana-Champaign
| | - Fernando De Maio
- Center for Health Equity, American Medical Association, Chicago, Illinois
- Department of Sociology, DePaul University, Chicago, Illinois
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17
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Bishop-Royse J, Lange-Maia B, Murray L, Shah RC, DeMaio F. Structural racism, socio-economic marginalization, and infant mortality. Public Health 2020; 190:55-61. [PMID: 33348089 DOI: 10.1016/j.puhe.2020.10.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/02/2020] [Accepted: 10/29/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We examine associations between infant mortality rates (IMRs) and measures of structural racism and socio-economic marginalization in Chicago, Illinois. Our purpose was to determine whether the Index of Concentration at the Extremes (ICE) was significantly related to community-level IMRs. STUDY DESIGN We use a cross-sectional ecological public health design to examine community-level factors related to IMRs in Chicago neighborhoods. METHODS We use data from the Chicago Department of Public Health and the American Community Survey to examine IMR inequities during the period 2012-2016. Calculations of the ICE for race and income were undertaken. In addition, we calculated racialized socio-economic status, which is the concentration of affluent Whites relative to poor Blacks in a community area. We present these ICE measures, as well as hardship, percent of births with inadequate prenatal care (PNC), and the percent of single-parent households as quintiles so that we can compare neighborhoods with the most disadvantage with neighborhoods with the least. Negative binomial regression was used to determine whether the ICE measures were independently related to community IMRs, net of hardship scores, PNC, and single-parent households. RESULTS Spearman correlation results indicate significant associations in Chicago communities between measures of racial segregation and economic marginalization and IMRs. Community areas with the lowest ICERace scores (those with the largest concentrations of Black residents, compared with White) had IMRs that were 3.63 times higher than those communities with the largest concentrations of White residents. Most associations between community IMRS and measures of structural racism and socioeconomic marginalization are accounted for in fully adjusted negative binomial regression models. Only ICERace remained significantly related to IMRs. CONCLUSIONS We show that structural racism as represented by the ICE is independently related to IMRs in Chicago; community areas with the largest concentrations of Blacks residents compared with Whites are those with the highest IMRs. This relationship persists even after controlling for socio-economic marginalization, hardship, household composition/family support, and healthcare access. Interventions to improve birth outcomes must address structural determinants of health inequities.
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Affiliation(s)
- J Bishop-Royse
- Faculty Scholarship Collaborative, DePaul University, Chicago, IL 60614, USA; Center for Community Health Equity, Chicago, IL, USA.
| | - B Lange-Maia
- Department of Preventative Medicine, Rush University Medical Center, Chicago, IL 60612, USA; Center for Community Health Equity, Chicago, IL, USA.
| | - L Murray
- Center for Community Health Equity, Chicago, IL, USA.
| | - R C Shah
- Center for Community Health Equity, Chicago, IL, USA; Department of Family Medicine, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA.
| | - F DeMaio
- Center for Community Health Equity, Chicago, IL, USA; Center for Health Equity, American Medical Association, Chicago, IL 60611, USA; Department of Sociology, DePaul University, Chicago, IL 60614, USA.
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18
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Fong KC, Yitshak-Sade M, Lane KJ, Fabian MP, Kloog I, Schwartz JD, Coull BA, Koutrakis P, Hart JE, Laden F, Zanobetti A. Racial Disparities in Associations between Neighborhood Demographic Polarization and Birth Weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3076. [PMID: 32354151 PMCID: PMC7246784 DOI: 10.3390/ijerph17093076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/13/2020] [Accepted: 04/25/2020] [Indexed: 12/02/2022]
Abstract
Neighborhood demographic polarization, or the extent to which a privileged population group outnumbers a deprived group, can affect health by influencing social dynamics. While using birth records from 2001 to 2013 in Massachusetts (n = 629,675), we estimated the effect of two demographic indices, racial residential polarization (RRP) and economic residential polarization (ERP), on birth weight outcomes, which are established predictors of the newborn's future morbidity and mortality risk. Higher RRP and ERP was each associated with higher continuous birth weight and lower odds for low birth weight and small for gestational age, with evidence for effect modification by maternal race. On average, per interquartile range increase in RRP, the birth weight was 10.0 g (95% confidence interval: 8.0, 12.0) higher among babies born to white mothers versus 6.9 g (95% CI: 4.8, 9.0) higher among those born to black mothers. For ERP, it was 18.6 g (95% CI: 15.7, 21.5) higher among those that were born to white mothers versus 1.8 g (95% CI: -4.2, 7.8) higher among those born to black mothers. Racial and economic polarization towards more privileged groups was associated with healthier birth weight outcomes, with greater estimated effects in babies that were born to white mothers than those born to black mothers.
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Affiliation(s)
- Kelvin C. Fong
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- School of Forestry and Environmental Studies, Yale University, New Haven, CT 06511, USA
| | - Maayan Yitshak-Sade
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
| | - Kevin J. Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02218, USA; (K.J.L.); (M.P.F.)
| | - M. Patricia Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02218, USA; (K.J.L.); (M.P.F.)
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, 8410501 Beer Sheva, Israel;
| | - Joel D. Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
| | - Brent A. Coull
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
| | - Jaime E. Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Francine Laden
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
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Rushovich T, Arwady MA, Salisbury-Afshar E, Arunkumar P, Aks S, Prachand N. Opioid-related overdose deaths by race and neighborhood economic hardship in Chicago. J Ethn Subst Abuse 2020; 21:22-35. [PMID: 31990245 DOI: 10.1080/15332640.2019.1704335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Compared to national findings, Chicago has both a higher rate of opioid-related overdose death and a markedly different distribution by demographics. The Chicago Department of Public Health analyzed fatal overdoses by level of neighborhood economic hardship. The highest rate of opioid-related deaths occurred in neighborhoods with high economic hardship (36.9 per 100,000 population) compared to medium- (20.5) and low- (12.3) hardship neighborhoods. However, these patterns were not consistent across racial/Hispanic ethnicity subgroups. These data support the need to consider the role of racism and other structural, social, and economic factors when designing interventions to reduce opioid-related overdose deaths.
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Affiliation(s)
- Tamara Rushovich
- Chicago Department of Public Health, Harvard University, Chicago, Illinois
| | - M Allison Arwady
- Chicago Department of Public Health, Harvard University, Chicago, Illinois
| | | | | | | | - Nikhil Prachand
- Chicago Department of Public Health, Harvard University, Chicago, Illinois
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