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Ibrahim R, Pham HN, Ganatra S, Javed Z, Nasir K, Al-Kindi S. Social Phenotyping for Cardiovascular Risk Stratification in Electronic Health Registries. Curr Atheroscler Rep 2024; 26:485-497. [PMID: 38976220 DOI: 10.1007/s11883-024-01222-6] [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] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE OF REVIEW Evaluation of social influences on cardiovascular care requires a comprehensive analysis encompassing economic, societal, and environmental factors. The increased utilization of electronic health registries provides a foundation for social phenotyping, yet standardization in methodology remains lacking. This review aimed to elucidate the primary approaches to social phenotyping for cardiovascular risk stratification through electronic health registries. RECENT FINDINGS Social phenotyping in the context of cardiovascular risk stratification within electronic health registries can be separated into four principal approaches: place-based metrics, questionnaires, ICD Z-coding, and natural language processing. These methodologies vary in their complexity, advantages and limitations, and intended outcomes. Place-based metrics often rely on geospatial data to infer socioeconomic influences, while questionnaires may directly gather individual-level behavioral and social factors. Z-coding, a relatively new approach, can capture data directly related to social determinant of health domains in the clinical context. Natural language processing has been increasingly utilized to extract social influences from unstructured clinical narratives-offering nuanced insights for risk prediction models. Each method plays an important role in our understanding and approach to using social determinants data for improving population cardiovascular health. These four principal approaches to social phenotyping contribute to a more structured approach to social determinant of health research via electronic health registries, with a focus on cardiovascular risk stratification. Social phenotyping related research should prioritize refining predictive models for cardiovascular diseases and advancing health equity by integrating applied implementation science into public health strategies.
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Affiliation(s)
- Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Zulqarnain Javed
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Khurram Nasir
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Sadeer Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA.
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Lusk JB, Blass B, Mahoney H, Hoffman MN, Clark AG, Bae J, Mentz RJ, Wang TY, Patel M, Hammill BG. Neighborhood Socioeconomic Disadvantage and 30-Day Outcomes for Common Cardiovascular Conditions. J Am Heart Assoc 2024; 13:e036265. [PMID: 39119993 DOI: 10.1161/jaha.124.036265] [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: 04/25/2024] [Accepted: 06/14/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Understanding the relationship between neighborhood environment and cardiovascular outcomes is important to achieve health equity and implement effective quality strategies. We conducted a population-based cohort study to determine the association of neighborhood socioeconomic deprivation and 30-day mortality and readmission rate for patients admitted with common cardiovascular conditions. METHODS AND RESULTS We examined claims data from fee-for-service Medicare beneficiaries aged ≥65 years between 2017 and 2019 admitted for heart failure, valvular heart disease, ischemic heart disease, or cardiac arrhythmias. The primary exposure was the Area Deprivation Index; outcomes were 30-day all-cause death and unplanned readmission. More than 2 million admissions were included. After sequential adjustment for patient characteristics (demographics, dual eligibility, comorbidities), area health care resources (primary care clinicians, specialists, and hospital beds per capita), and admitting hospital characteristics (ownership, size, teaching status), there was a dose-dependent association between neighborhood socioeconomic deprivation and 30-day mortality rate for all conditions. In the fully adjusted model for death, estimated effect sizes of residence in the most disadvantaged versus least disadvantaged neighborhoods ranged from adjusted odds ratio 1.29 (95% CI, 1.22-1.36) for the heart failure group to adjusted odds ratio 1.63 (95% CI, 1.36-1.95) for the valvular heart disease group. Neighborhood deprivation was associated with increased adjusted 30-day readmission rates, with estimated effect sizes from adjusted odds ratio 1.09 (95% CI, 1.05-1.14) for heart failure to adjusted odds ratio 1.19 (95% CI, 1.13-1.26) for arrhythmia. CONCLUSIONS Neighborhood socioeconomic disadvantage was associated with 30-day mortality rate and readmission for patients admitted with common cardiovascular conditions independent of individual demographics, socioeconomic status, medical risk, care access, or admitting hospital characteristics.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine Durham NC USA
- Duke University Fuqua School of Business Durham NC USA
| | - Beau Blass
- Duke University School of Medicine Durham NC USA
| | - Hannah Mahoney
- Duke University Department of Population Health Sciences Durham NC USA
| | - Molly N Hoffman
- Duke University Department of Population Health Sciences Durham NC USA
| | - Amy G Clark
- Duke University Department of Population Health Sciences Durham NC USA
| | - Jonathan Bae
- Duke University Health System Durham NC USA
- Division of Cardiology Duke University Department of Medicine Durham NC USA
| | - Robert J Mentz
- Division of Cardiology Duke University Department of Medicine Durham NC USA
| | - Tracy Y Wang
- Patient Centered Outcomes Research Institute Durham NC USA
| | - Manesh Patel
- Division of Cardiology Duke University Department of Medicine Durham NC USA
| | - Bradley G Hammill
- Duke University School of Medicine Durham NC USA
- Duke University Department of Population Health Sciences Durham NC USA
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Meraz R, Osteen K, McGee J, Noblitt P, Viejo H. Influence of Neighborhood Disadvantage and Individual Sociodemographic Conditions on Heart Failure Self-care. J Cardiovasc Nurs 2024:00005082-990000000-00212. [PMID: 39102349 DOI: 10.1097/jcn.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND Residence in socioeconomically disadvantaged neighborhoods and individual sociodemographic conditions contribute to worse heart failure (HF) outcomes and may influence HF self-care. However, associations between neighborhood disadvantage, socioeconomic conditions, and HF self-care are unclear. OBJECTIVE The purpose of this secondary analysis was to investigate whether neighborhood disadvantage and individual socioeconomic conditions predicted worse HF self-care. METHODS This study was a secondary analysis of baseline data from a mixed-method study of 82 adults with HF. Participant zip codes were assigned a degree of neighborhood disadvantage using the Area Deprivation Index. Those in the top 20% most disadvantaged neighborhoods (Area Deprivation Index ≥ 80) were compared with those in the least disadvantaged neighborhoods. The Self-Care of Heart Failure Index was used to measure self-care maintenance and monitoring. Multiple linear regression was conducted. RESULTS Of all participants, 59.8% were male, 59.8% were persons of color, and the mean age was 64.87 years. Residing in a disadvantaged neighborhood and living alone predicted worse HF self-care maintenance and monitoring. Having no college education was also a predictor of worse HF self-care maintenance. Although persons of color were more likely to reside in disadvantaged neighborhoods, race was not associated with HF self-care. CONCLUSION Residing in a disadvantaged neighborhood and living alone may be important risk factors for worse HF self-care. Differences in self-care cannot be attributed solely to the individual sociodemographic determinants of race, gender, age, annual household income, or marital status. More research is needed to understand the connection between neighborhood disadvantage and HF self-care.
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Shaheen A, Medeiros FA, Swaminathan SS. Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery. Am J Ophthalmol 2024; 268:123-135. [PMID: 39089357 DOI: 10.1016/j.ajo.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/05/2024] [Accepted: 07/23/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE Timing of surgical intervention in glaucoma is crucial to preserving sight. While ocular characteristics that increase surgical risk are known, the impact of neighborhood-level social risk factors such as the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) on time to glaucoma surgery is unknown. The objective of this study was to evaluate the association between SVI or ADI scores and the timing of glaucoma surgical intervention. DESIGN Retrospective cohort study. METHODS Adult subjects with open-angle glaucoma were identified from the Bascom Palmer Glaucoma Repository using International Classification of Disease-10 codes. Subject demographics, ocular characteristics, and standard automated perimetry data were extracted. Geocoded data were obtained using subject residences and American Community Survey data. Univariable and multivariable time-to-event survival analyses using accelerated failure time models were completed to evaluate whether geocoded SVI and ADI scores accelerated or delayed time to glaucoma surgery from initial glaucoma diagnosis in the electronic health record. RESULTS A total of 10,553 eyes from 6934 subjects were evaluated, of which 637 eyes (6.0%) from 568 subjects (8.2%) underwent glaucoma surgery. Mean age was 68.3 ± 13.5 years, with 57.9% female, 21.5% Black, and 34.5% Hispanic subjects. Mean follow-up time was 5.0 ± 2.1 years, with time to surgery of 3.2 ± 1.9 years. Multivariable accelerated failure time models demonstrated that higher mean intraocular pressure (time ratio [TR] 0.27 per 5 mm Hg higher; 95% confidence interval [CI]: 0.23-0.31, P < .001), faster standard automated perimetry rate of progression (TR 0.74 per 0.5 dB/year faster; 95% CI: 0.69-0.78, P < .001), moderate (TR 0.69; 95% CI: 0.56-0.85, P < .001) or severe baseline severity (TR 0.39; 95% CI: 0.32-0.47, P < .001), and thinner central corneal thickness (TR 0.85 per 50 µm thinner; 95% CI: 0.77-0.95, P = .003) all accelerated time to surgery. In contrast, overall SVI delayed surgery (TR 1.11 per 25% increase; 95% CI: 1.03-1.20, P = .006). Specifically, SVI Themes 1 (TR 1.08; 95% CI: 1.01-1.17, P = .037) and 4 (TR 1.11; 95% CI: 1.03-1.19, P = .006) were significant. Patients from the most deprived neighborhoods (highest national ADI quartile) had a 68% increase in time to surgery compared to the least deprived quartile (TR 1.68; 95% CI: 1.20-2.36, P = .002). CONCLUSIONS Residence in areas with higher SVI or ADI scores was associated with delayed glaucoma surgery after controlling for demographic and ocular parameters. Awareness of such disparities can guide initiatives aimed at achieving parity in health outcomes.
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Affiliation(s)
- Abdulla Shaheen
- From the Department of Ophthalmology, Bascom Palmer Eye Institute (A.S., F.A.M., S.S.S.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Felipe A Medeiros
- From the Department of Ophthalmology, Bascom Palmer Eye Institute (A.S., F.A.M., S.S.S.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Swarup S Swaminathan
- From the Department of Ophthalmology, Bascom Palmer Eye Institute (A.S., F.A.M., S.S.S.), University of Miami Miller School of Medicine, Miami, Florida, USA.
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Setia K, Otoya D, Boyd S, Fong K, Amendola MF, Lavingia KS. Socioeconomic Status Based on Area Deprivation Index Does Not Affect Postoperative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Health-Care System. Ann Vasc Surg 2024; 109:245-255. [PMID: 39067846 DOI: 10.1016/j.avsg.2024.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/09/2024] [Accepted: 06/02/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Living conditions and socioeconomic status are known to impact individual health and access to medical care. Prior research has validated the Area Deprivation Index (ADI) tool as a measure of socioeconomic disadvantage for a given locality. Living in a neighborhood with a higher ADI score has been associated with increased rates of hospital readmission due to complications following surgery. We set forth to identify the possible associations between a patient's ADI score and postoperative endovascular aneurysm repair (EVAR) outcomes in the Veterans Health Care Administration (VHA). METHODS We retrospectively analyzed the outcomes of patients who underwent EVAR from January 2010 to December 2021 at a level 1A VHA Hospital. Patient demographics and intraoperative variables were obtained. ADI score was calculated based on home addresses and resulted in a local score on a scale of 1-10 and a national percentile on a scale of 1-100. We then further stratified these patients into local and national quintile groups. Local ADI 1 included scores of 1-2, and local ADI 5 included scores of 9-10. National ADI 1 comprised scores 1-20, and national ADI 5 scored 81-100. The other scores were equally divided into ADI 2, 3, and 4. Higher ADI scores were associated with lower socioeconomic status. We identified clinical outcomes, including wound infection, respiratory failure, urinary tract infection, acute kidney injury, limb stenosis, readmission, length of stay, and subsequent reintervention rates. RESULTS 241 patients underwent EVAR over the time period examined. 57.3% (n = 138) of patients were in quintiles 4 and 5 for local ADI; when national ADI percentiles organized these same patients, 47.3% (n = 114) were in quintiles 4 and 5. Patient demographics did not vary between the local and national groups. We saw no statistically significant difference in intraoperative variables, postoperative complications, readmission, loss to follow-up, or 1-year mortality rates across ADI quintiles at the local or national level. Binary Logistic Regression showed no statistical significance for local and national ADI quintiles for hospital readmission and overall postoperative complications. CONCLUSIONS We found that there was no statistical significance between hospital readmission rates or worse surgical outcomes across local and national ADI quintiles. This suggests that the VHA resources and multidisciplinary support may improve care across neighborhoods. This comprehensive care provided at VHA may mitigate postoperative complications in patients undergoing EVARs. Further research is warranted to investigate the role of area deprivation in health care and EVAR outcomes in a veteran population.
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Affiliation(s)
- Karishma Setia
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Diana Otoya
- Virginia Commonwealth University Healthcare System, Richmond, VA
| | - Sally Boyd
- Virginia Commonwealth University Healthcare System, Richmond, VA
| | - Kathryn Fong
- Virginia Commonwealth University School of Medicine, Richmond, VA; Central Virginia VA Healthcare System, Richmond, VA
| | - Michael F Amendola
- Virginia Commonwealth University School of Medicine, Richmond, VA; Central Virginia VA Healthcare System, Richmond, VA
| | - Kedar S Lavingia
- Virginia Commonwealth University School of Medicine, Richmond, VA; Central Virginia VA Healthcare System, Richmond, VA.
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Kiwinda LVM, Mahoney HR, Bethell MA, Clark AG, Hammill BG, Seyler TM, Pean CA. The Effect of Social Drivers of Health on 90-Day Readmission Rates and Costs After Primary Total Hip and Total Knee Arthroplasty. J Am Acad Orthop Surg 2024:00124635-990000000-01050. [PMID: 39029098 DOI: 10.5435/jaaos-d-24-00284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/06/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION The effect of social drivers of health (SDOH) on readmissions and costs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is poorly understood. Policies such as the Hospital Readmissions Reduction Program have targeted overall readmission reduction, using value-based strategies to improve healthcare quality. However, the implications of SDOH on these outcomes are not yet understood. We hypothesized that the area deprivation index (ADI) as a surrogate for SDOH would markedly influence readmission rates and healthcare costs in the 90-day postprocedural period for THA and TKA. METHODS We used the 100% US fee-for-service Medicare claims data from 2019 to 2021. Patients were identified using diagnosis-related groups. Our primary outcomes included 90-day unplanned readmission after hospital discharge and cost of care, treated as "high cost" if > 1 standard deviation above the mean. The relationships between ADI and primary outcomes were estimated with logistic regression models. RESULTS A total of 628,399 patients were included in this study. The mean age of patients was 75.6, 64% were female, and 7.8% were dually eligible for Medicaid. After full covariate adjustment, readmission was higher for patients in more deprived areas (high Area Deprivation Index (ADI)) (low socioeconomic status (SES) group OR: 1.30 [95% confidence intervals 1.23, 1.38]). ADI was associated with high cost before adjustment (low SES group odds ratio 1.08 [95% confidence intervals 1.04, 1.11], P < 0.001), although, after adjustment, this association was lost. DISCUSSION This analysis highlights the effect of SDOH on readmission rates after THA and TKA. A nuanced understanding of neighborhood-level disparities may facilitate targeted strategies to reduce avoidable readmissions in orthopaedic surgery. Regarding cost, although there is some association between ADI and cost, this study may illustrate that ADI for THA and TKA is not sufficiently granular to identify the contribution of social drivers to elevated costs.
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Affiliation(s)
- Lulla V Mr Kiwinda
- From the Department of Orthopaedic Surgery (Kiwinda, Bethell, Seyler, and Pean), the Department of Population Health Sciences (Mahoney, Clark, Hammill), Duke University School of Medicine, Durham, NC
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Cornell PY, Hua CL, Buchalksi ZM, Chmelka GR, Cohen AJ, Daus MM, Halladay CW, Harmon A, Silva JW, Rudolph JL. Using social risks to predict unplanned hospital readmission and emergency care among hospitalized Veterans. Health Serv Res 2024. [PMID: 38972911 DOI: 10.1111/1475-6773.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVES (1) To estimate the association of social risk factors with unplanned readmission and emergency care after a hospital stay. (2) To create a social risk scoring index. DATA SOURCES AND SETTING We analyzed administrative data from the Department of Veterans Affairs (VA) Corporate Data Warehouse. Settings were VA medical centers that participated in a national social work staffing program. STUDY DESIGN We grouped socially relevant diagnoses, screenings, assessments, and procedure codes into nine social risk domains. We used logistic regression to examine the extent to which domains predicted unplanned hospital readmission and emergency department (ED) use in 30 days after hospital discharge. Covariates were age, sex, and medical readmission risk score. We used model estimates to create a percentile score signaling Veterans' health-related social risk. DATA EXTRACTION We included 156,690 Veterans' admissions to a VA hospital with discharged to home from 1 October, 2016 to 30 September, 2022. PRINCIPAL FINDINGS The 30-day rate of unplanned readmission was 0.074 and of ED use was 0.240. After adjustment, the social risks with greatest probability of readmission were food insecurity (adjusted probability = 0.091 [95% confidence interval: 0.082, 0.101]), legal need (0.090 [0.079, 0.102]), and neighborhood deprivation (0.081 [0.081, 0.108]); versus no social risk (0.052). The greatest adjusted probabilities of ED use were among those who had experienced food insecurity (adjusted probability 0.28 [0.26, 0.30]), legal problems (0.28 [0.26, 0.30]), and violence (0.27 [0.25, 0.29]), versus no social risk (0.21). Veterans with social risk scores in the 95th percentile had greater rates of unplanned care than those with 95th percentile Care Assessment Needs score, a clinical prediction tool used in the VA. CONCLUSIONS Veterans with social risks may need specialized interventions and targeted resources after a hospital stay. We propose a scoring method to rate social risk for use in clinical practice and future research.
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Affiliation(s)
- Portia Y Cornell
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Centre for the Digital Transformation of Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Cassandra L Hua
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Zachary M Buchalksi
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Gina R Chmelka
- National Social Work Program, Care Management and Social Work, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- Tomah VA Medical Center, Tomah, Wisconsin, USA
| | - Alicia J Cohen
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Christopher W Halladay
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Alita Harmon
- National Social Work Program, Care Management and Social Work, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- Gulf Coast Veterans Health Care System, Biloxi, Mississippi, USA
| | - Jennifer W Silva
- National Social Work Program, Care Management and Social Work, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - James L Rudolph
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Althans AR, Meshkin D, Holder-Murray J, Cunningham K, Celebrezze J, Medich D, Tessler RA. Deprivation and Rurality Mediate Income Inequality's Association with Colorectal Cancer Outcomes. Am J Prev Med 2024:S0749-3797(24)00192-2. [PMID: 38866078 DOI: 10.1016/j.amepre.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/01/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Income inequality is associated with poor health outcomes, but its association with colorectal cancer is not well-studied. The authors aimed to determine the association between income inequality and colorectal cancer incidence/mortality in U.S. counties, and hypothesized that this association was mediated by deprivation. METHODS The authors performed a cross-sectional study of U.S. counties from 2015-2019 using statewide cancer registries and the Centers for Disease Control and Prevention WONDER database. Generalized linear negative binomial regression was performed in 2024 to estimate the association between Gini coefficient (income inequality) and colorectal cancer incidence/mortality using incidence rate ratios (IRRs) for the entire cohort and stratified by rurality. RESULTS A total of 697,981 colorectal cancer cases were diagnosed in the 5-year study period. On adjusted regression, for every 0.1 higher Gini coefficient, there was an 11% higher risk of both colorectal cancer incidence and mortality (IRR 1.11, 95%CI 1.03,1.19 and IRR 1.11, 95%CI 1.05, 1.18 respectively). The association between income inequality and incidence/mortality peaked in more rural counties, however there was not an overall dose-dependent relationship between rurality and these associations. Deprivation mediated the association between income inequality and colorectal cancer incidence (indirect effect B coefficient 0.088, p<0.001) and mortality (B coefficient 0.088, p<0.001). The magnitude and direction of the direct, indirect, and total effects differed in each rurality strata. CONCLUSIONS Much of income inequality's association with colorectal cancer outcomes operates through deprivation. Rural counties have a stronger association between higher income inequality and higher mortality, which works in tandem with deprivation.
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Affiliation(s)
- Alison R Althans
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213.
| | - Dana Meshkin
- University of Pittsburgh, School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213
| | - Jennifer Holder-Murray
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - Kellie Cunningham
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - James Celebrezze
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - David Medich
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - Robert A Tessler
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
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Duarte M, Salamanca M, Gonzalez JM, Roman Laporte R, Gattamorta K, Lopez Martinez FE, Clochesy J, Rincon Acuna JC. Prediction of Positive Patient Health Questionnaire-2 Screening Using Area Deprivation Index in Primary Care. Clin Nurs Res 2024; 33:355-369. [PMID: 38801166 DOI: 10.1177/10547738241252887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Depression is recognized as a significant public health issue in the United States. The National Survey on Drug Use and Health reports that 21.0 million adults aged 18 or older had major depressive disorder in 2020, including 14.8 million experiencing a major depressive episode with severe impairment. The aim is to predict the positivity of Patient Health Questionnaire-2 (PHQ-2) outcomes among patients in primary care settings by analyzing a range of variables, including socioeconomic status, demographic characteristics, and health behaviors, thereby identifying those at increased risk for depression. Employing a machine learning approach, the study utilizes retrospective data from electronic health records across 15 primary care clinics in South Florida to explore the relationship between social determinants of health (SDoH), including area of deprivation index (ADI) and PHQ-2 positivity. The study encompasses 15 primary care clinics located in South Florida, where a diverse patient population receives care. Analysis included 94,572 patient visits; 74,636 records were included in the study. If a zip+4 was not available or an ADI score did not exist, the visit was not included in the final analysis. Screening involved the PHQ-2, assessing depressed mood and anhedonia, with a cutoff >2 indicating positive screening. ADI was used to assess SDoH by matching patients' residential postal codes to ADI national percentiles. Demographics, sexual history, tobacco use, caffeine intake, and community involvement were also evaluated in the study. Over 40 machine learning algorithms were explored for their accuracy in predicting PHQ-2 outcomes, using software tools including Scikit-learn and stats models in Python. Variables were normalized, scored, and then subjected to predictive regression models, with Random Forest showing outstanding performance. Feature engineering and correlation analysis identified ADI, age, education, visit type, coffee intake, and marital status as significant predictors of PHQ-2 positivity. The area under the curve and model accuracies varied across clinics, with specific clinics showing higher predictive accuracy and others (p > .05). The study concludes that the ADI, as a proxy for SDoH, alongside other individual factors, can predict PHQ-2 positivity. Health organizations can use this information to anticipate health needs and resource allocation.
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Affiliation(s)
| | | | - Juan M Gonzalez
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | | | - Karina Gattamorta
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | | | - John Clochesy
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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Ramesh T, Wozniak GD, Yu H. County-Level Disparities in Heat-Related Emergencies. JAMA Netw Open 2024; 7:e242845. [PMID: 38502129 PMCID: PMC10951733 DOI: 10.1001/jamanetworkopen.2024.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/25/2024] [Indexed: 03/20/2024] Open
Abstract
This cross-sectional study examines the distribution of emergency medical service activation across US countries during the heat wave in July 2023.
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Affiliation(s)
- Tarun Ramesh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Abed V, Kapp S, Bradley T, Homen DT, Landy DC, Dasa V, Conley C, Stone AV. Orthopaedic Sports Medicine Randomized Controlled Trials Infrequently Report on the Social Determinants of Health Factors of Their Patient Cohorts. Arthroscopy 2024; 40:922-927. [PMID: 37879516 DOI: 10.1016/j.arthro.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE To describe the prevalence of randomized controlled trials (RCTs) in orthopaedic sports medicine-related journals reporting on the social determinants of health (SDOH) of their patient cohorts, including factors receiving less attention, such as education level, employment status, insurance status, and socioeconomic status. METHODS The PubMed/MEDLINE database was used to search for RCTs between 2020 and 2022 from 3 high-impact orthopaedic sports medicine-related journals: American Journal of Sports Medicine, Arthroscopy, and Journal of Shoulder and Elbow Surgery. The following information was extracted from each article: age, sex/gender, body mass index, year published, corresponding author country, and self-reported SDOH factors (race, ethnicity, education level, employment status, insurance status, and socioeconomic status). RESULTS A total of 189 articles were analyzed. Articles originated from 34 different countries, with the United States (n = 66) producing the greatest number of articles. Overall, age (n = 186; 98.4%) and sex/gender (n = 184; 97.4%) were the factors most commonly reported, followed by body mass index (n = 112; 59.3%), race (n = 17; 9.0%), ethnicity (n = 10; 5.3%), employment status (n = 9; 4.8%), insurance status (n = 7; 3.7%), and education level (n = 5; 2.6%). Socioeconomic status was not reported in any of the articles analyzed. Articles from the United States report on SDOH factors more frequently than international articles, most notably race (24.2% vs 0.8%, respectively) and ethnicity (15.2% and 0%, respectively). CONCLUSIONS RCTs from 3 high-impact orthopaedic sports medicine journals infrequently report on SDOH. CLINICAL RELEVANCE Better understanding patient SDOH factors in RCTs is important to help orthopaedic surgeons and other practitioners best apply study results to their patients, as well as help researchers and our field ensure that research is being done transparently with relevance to as many patients as possible.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Sabryn Kapp
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Taylor Bradley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Dylan T Homen
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - David C Landy
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Vinod Dasa
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A
| | - Caitlin Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A..
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Suzuki T, Mizuno A, Yasui H, Noma S, Ohmori T, Rewley J, Kawai F, Nakayama T, Kondo N, Tsukada YT. Scoping Review of Screening and Assessment Tools for Social Determinants of Health in the Field of Cardiovascular Disease. Circ J 2024; 88:390-407. [PMID: 38072415 DOI: 10.1253/circj.cj-23-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Despite the importance of implementing the concept of social determinants of health (SDOH) in the clinical practice of cardiovascular disease (CVD), the tools available to assess SDOH have not been systematically investigated. We conducted a scoping review for tools to assess SDOH and comprehensively evaluated how these tools could be applied in the field of CVD. METHODS AND RESULTS We conducted a systematic literature search of PubMed and Embase databases on July 25, 2023. Studies that evaluated an SDOH screening tool with CVD as an outcome or those that explicitly sampled or included participants based on their having CVD were eligible for inclusion. In addition, studies had to have focused on at least one SDOH domain defined by Healthy People 2030. After screening 1984 articles, 58 articles that evaluated 41 distinct screening tools were selected. Of the 58 articles, 39 (67.2%) targeted populations with CVD, whereas 16 (27.6%) evaluated CVD outcome in non-CVD populations. Three (5.2%) compared SDOH differences between CVD and non-CVD populations. Of 41 screening tools, 24 evaluated multiple SDOH domains and 17 evaluated only 1 domain. CONCLUSIONS Our review revealed recent interest in SDOH in the field of CVD, with many useful screening tools that can evaluate SDOH. Future studies are needed to clarify the importance of the intervention in SDOH regarding CVD.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital
- Leonard Davis Institute for Health Economics, University of Pennsylvania
| | - Haruyo Yasui
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Satsuki Noma
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Jeffrey Rewley
- Leonard Davis Institute for Health Economics, University of Pennsylvania
- The MITRE Corporation
| | - Fujimi Kawai
- Department of Academic Resources, St. Luke's International University
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University
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13
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Rahman TM, Shaw JH, Mehaidli A, Hennekes M, Hansen L, Castle JP, Kulkarni M, Silverton CD. The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty: An Analysis of Neighborhood Deprivation Indices. J Bone Joint Surg Am 2024; 106:288-303. [PMID: 37995211 DOI: 10.2106/jbjs.23.00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Social determinants of health (SDOH) are important factors in the delivery of orthopaedic care. The purpose of this study was to investigate the relationship between outcomes following total knee arthroplasty (TKA) and both the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI). METHODS The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was utilized to identify TKA cases for inclusion. Demographic characteristics and medical history were documented. The SVI, its subthemes, and the ADI were analyzed. Outcome data included length of stay, discharge disposition, postoperative change in the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), 90-day incidences of emergency department (ED) visits, readmission, death, deep venous thrombosis (DVT) and/or pulmonary embolism (PE), periprosthetic fracture, implant failure, periprosthetic joint infection (PJI), and all-cause reoperation. Database cross-referencing was completed to document aseptic and septic revisions beyond 90 days postoperatively. Bivariate quartile-stratified and multivariable analyses were used to associate deprivation metrics with outcomes. RESULTS A total of 19,321 TKA cases met inclusion criteria. Baseline patient characteristics varied among the SVI and/or ADI quartiles, with patients of non-White race and with a greater number of comorbidities noted in higher deprivation quartiles. Higher SVI and/or ADI quartiles were correlated with an increased rate of discharge to a skilled nursing facility (p < 0.05). A higher SVI and/or ADI quartile was associated with increased incidences of ED visits and readmissions postoperatively (p < 0.05). DVT and/or PE and long-term aseptic revision were the complications most strongly associated with higher deprivation metrics. Upon multivariable analysis, greater length of stay and greater incidences of ED visits, readmissions, DVT and/or PE, and aseptic revision remained significantly associated with greater deprivation based on multiple metrics. CONCLUSIONS Greater deprivation based on multiple SVI subthemes, the composite SVI, and the ADI was significantly associated with increased length of stay, non-home discharge ED visits, and readmissions. The SVI and the ADI may be important considerations in the perioperative assessment of patients who undergo TKA. LEVEL OF EVIDENCE Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tahsin M Rahman
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
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14
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 175] [Impact Index Per Article: 175.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Li C, Mowery DL, Ma X, Yang R, Vurgun U, Hwang S, Donnelly HK, Bandhey H, Akhtar Z, Senathirajah Y, Sadhu EM, Getzen E, Freda PJ, Long Q, Becich MJ. Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.04.24302242. [PMID: 38370703 PMCID: PMC10871446 DOI: 10.1101/2024.02.04.24302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
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Affiliation(s)
- Chenyu Li
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Danielle L. Mowery
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Xiaomeng Ma
- University of Toronto, Institute of Health Policy Management and Evaluations
| | - Rui Yang
- Duke-NUS Medical School, Centre for Quantitative Medicine
| | - Ugurcan Vurgun
- University of Pennsylvania, Institute for Biomedical Informatics
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics
| | | | - Harsh Bandhey
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Zohaib Akhtar
- Northwestern University, Kellogg School of Management
| | - Yalini Senathirajah
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Eugene Mathew Sadhu
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Emily Getzen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Qi Long
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Michael J. Becich
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
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Beyer L, Keen R, Ertel KA, Okuzono SS, Pintro K, Delaney S, Slopen N. Comparing two measures of neighborhood quality and internalizing and externalizing behaviors in the adolescent brain cognitive development study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02614-4. [PMID: 38305870 DOI: 10.1007/s00127-024-02614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE There is widespread recognition of the importance and complexity of measuring neighborhood contexts within research on child psychopathology. In this study, we assessed the cross-sectional associations between two measures of neighborhood quality and internalizing and externalizing behaviors in preadolescence. METHODS Drawing on baseline data from the Adolescent Brain Cognitive Development Study (n = 10,577 preadolescents), we examined two multi-component assessments of neighborhood quality in relation to children's internalizing and externalizing symptoms: the Area Deprivation Index (ADI), which measures socioeconomic adversity, and the Child Opportunity Index 2.0 (COI), which measures economic, educational, and environmental opportunity. Both measures were categorized into quintiles. We then used mixed-effects linear regression models to examine bivariate and adjusted associations. RESULTS The bivariate associations displayed strong inverse associations between the COI and ADI and externalizing symptoms, with a graded pattern of fewer externalizing behaviors with increasing neighborhood quality. Only the ADI was associated with externalizing behaviors in models adjusted for child and family characteristics. We did not observe a clear association between either measure of neighborhood quality and internalizing behaviors in bivariate or adjusted models. CONCLUSIONS Neighborhood quality, as measured by the COI and ADI, was associated with externalizing behaviors in preadolescent children. The association using the ADI persisted after adjustment for family-level characteristics, including financial strain. Our results indicate that different assessments of neighborhood quality display distinct associations with preadolescent behavioral health. Future research is needed to assess the association between neighborhood quality and behavior trajectories and to identify place-based intervention strategies.
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Affiliation(s)
- Logan Beyer
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA.
- Harvard Medical School, Boston, USA.
| | - Ryan Keen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Karen A Ertel
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Sakurako S Okuzono
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Kedie Pintro
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Scott Delaney
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Center On the Developing Child, Harvard University, Boston, USA
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Pavlovic N, Ndumele CE, Saylor MA, Szanton SL, Lee CS, Shah AM, Chang PP, Florido R, Matsushita K, Himmelfarb C, Leoutsakos JM. Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010115. [PMID: 38240158 PMCID: PMC10922158 DOI: 10.1161/circoutcomes.123.010115] [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: 04/11/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes. METHODS We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011-2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression. RESULTS Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue. CONCLUSIONS We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | - Kunihiro Matsushita
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeannie Marie Leoutsakos
- Johns Hopkins School of Medicine, Baltimore, MD
- Boston College Connell School of Nursing, Boston, MA
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18
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Wang E, Diaz A, Zhang D, Dimitroyannis R, Kim D, Caballero N, Pinto JM, Roxbury CR. Impact of social determinants of health on access to rhinology care and patient outcomes: A pilot study. Laryngoscope Investig Otolaryngol 2024; 9:e1192. [PMID: 38362189 PMCID: PMC10866601 DOI: 10.1002/lio2.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024] Open
Abstract
Objective This novel pilot study constructs a social deprivation index (SDI) and utilizes an area deprivation index (ADI) to evaluate the link between social determinants of health and rhinology patient experiences. Methods Adult patients undergoing outpatient care of chronic rhinitis and chronic rhinosinusitis at a tertiary academic medical center were recruited to participate in a telephone survey assessing symptoms, social/emotional consequences of disease, and barriers to care on a 5-point Likert scale. Sociodemographic characteristics were utilized to rate SDI on an 8-point scale. ADI was obtained by area code of residence. Ordered logistic regression was used to examine associations between the SDI/ADI and perceptions of rhinology care. Results Fifty patients were included. Individuals with higher SDI scores (i.e., more socially deprived) experienced more severe nasal congestion (p = .007). Furthermore, higher national ADI correlated with increased severity of smell changes (p = .050) and facial pressure (p = .067). No association was seen between either deprivation index and global/psychiatric symptoms. While no correlations were found between higher SDI and difficulties with the costs of prescriptions, rhinologist's visits, or saline, higher SDI was correlated with decreased difficulty with surgery costs (p = .029), and individuals with higher national ADI percentile had increased difficulties obtaining nasal saline (p = .029). Conclusion Worse social deprivation is associated with difficulties obtaining saline rinses and increased severity of nasal/sinus symptoms in an urban, underserved, majority-Black population. These findings suggest social factors affect access to and quality of rhinology care in a complex and nuanced way and highlight the need for a specific SDI to further study social determinants of health in rhinology. Level of Evidence 2c.
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Affiliation(s)
- Esther Wang
- Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Ashley Diaz
- Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Douglas Zhang
- Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | | | - Daniel Kim
- Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Nadieska Caballero
- Department of Surgery, Section of OtolaryngologyUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Jayant M. Pinto
- Department of Surgery, Section of OtolaryngologyUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Christopher R. Roxbury
- Department of Surgery, Section of OtolaryngologyUniversity of Chicago MedicineChicagoIllinoisUSA
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Patel UJ, Shaikh HJF, Brodell JD, Coon M, Ketz JP, Soin SP. Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries. J Bone Joint Surg Am 2023; 105:1972-1979. [PMID: 37725686 DOI: 10.2106/jbjs.23.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The purpose of this study was to understand the role of social determinants of health assessed by the Area Deprivation Index (ADI) on hospital length of stay and discharge destination following surgical fixation of pelvic ring fractures. METHODS A retrospective chart analysis was performed for all patients who presented to our level-I trauma center with pelvic ring injuries that were treated with surgical fixation. Social determinants of health were determined via use of the ADI, a comprehensive metric of socioeconomic status, education, income, employment, and housing quality. ADI values range from 0 to 100 and are normalized to a U.S. mean of 50, with higher scores representing greater social deprivation. We stratified our cohort into 4 ADI quartiles. Statistical analysis was performed on the bottom (25th percentile and below, least deprived) and top (75th percentile and above, most deprived) ADI quartiles. Significance was set at p < 0.05. RESULTS There were 134 patients who met the inclusion criteria. Patients in the most deprived group were significantly more likely to have a history of smoking, to self-identify as Black, and to have a lower mean household income (p = 0.001). The most deprived ADI quartile had a significantly longer mean length of stay (and standard deviation) (19.2 ± 19 days) compared with the least deprived ADI quartile (14.7 ± 11 days) (p = 0.04). The least deprived quartile had a significantly higher percentage of patients who were discharged to a resource-intensive skilled nursing facility or inpatient rehabilitation facility compared with those in the most deprived quartile (p = 0.04). Race, insurance, and income were not significant predictors of discharge destination or hospital length of stay. CONCLUSIONS Patients facing greater social determinants of health had longer hospital stays and were less likely to be discharged to resource-intensive facilities when compared with patients of lesser social deprivation. This may be due to socioeconomic barriers that limit access to such facilities. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Urvi J Patel
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York
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20
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Joseph JJ, Williams A, Azap RA, Zhao S, Brock G, Kline D, Odei JB, Foraker R, Sims M, Brewer LC, Gray DM, Nolan TS. Role of Sex in the Association of Socioeconomic Status With Cardiovascular Health in Black Americans: The Jackson Heart Study. J Am Heart Assoc 2023; 12:e030695. [PMID: 38038179 PMCID: PMC10727326 DOI: 10.1161/jaha.123.030695] [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: 04/20/2023] [Accepted: 08/25/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is associated with cardiovascular health (CVH). Potential differences by sex in this association remain incompletely understood in Black Americans, where SES disparities are posited to be partially responsible for cardiovascular inequities. The association of SES measures (income, education, occupation, and insurance) with CVH scores was examined in the Jackson Heart Study. METHODS AND RESULTS American Heart Association CVH components (non-high-density-lipoprotein cholesterol, blood pressure, diet, tobacco use, physical activity, sleep, glycemia, and body mass index) were scored cross-sectionally at baseline (scale: 0-100). Differences in CVH and 95% CIs (Estimate, 95% CI) were calculated using linear regression, adjusting for age, sex, and discrimination. Heterogeneity by sex was assessed. Participants had a mean age of 54.8 years (SD 12.6 years), and 65% were women. Lower income, education, occupation (non-management/professional versus management/professional occupations), and insurance status (uninsured, Medicaid, Veterans Affairs, or Medicare versus private insurance) were associated with lower CVH scores (all P<0.01). There was heterogeneity by sex, with greater magnitude of associations of SES measures with CVH in women versus men. The lowest education level (high school) was associated with 8.8-point lower (95% CI: -10.2 to -7.3) and 5.4-point lower (95% CI: -7.2 to -3.6) CVH scores in women and men, respectively (interaction P=0.003). The lowest (<25 000) versus highest level of income (≥$75 000) was associated with a greater reduction in CVH scores in women than men (interaction P=0.1142). CONCLUSIONS Among Black Americans, measures of SES were associated with CVH, with a greater magnitude in women compared with men for education and income. Interventions aimed to address CVH through SES should consider the role of sex.
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Affiliation(s)
| | | | | | - Songzhu Zhao
- The Ohio State University College of MedicineColumbusOHUSA
| | - Guy Brock
- The Ohio State University College of MedicineColumbusOHUSA
| | - David Kline
- Department of Biostatistics and Data Science, Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNCUSA
| | - James B. Odei
- The Ohio State University College of Public HealthColumbusOHUSA
| | - Randi Foraker
- Department of Internal Medicine and Institute for InformaticsWashington University in St. Louis School of MedicineSt. LouisMOUSA
| | | | - LaPrincess C. Brewer
- Department of Cardiovascular MedicineCenter for Health Equity and Community Engagement Research, Mayo ClinicRochesterMNUSA
| | - Darrell M. Gray
- Elevance Health (formerly of The Ohio State University Wexner Medical Center)IndianapolisINUSA
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McNeill E, Lindenfeld Z, Mostafa L, Zein D, Silver D, Pagán J, Weeks WB, Aerts A, Des Rosiers S, Boch J, Chang JE. Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review. J Am Heart Assoc 2023; 12:e030571. [PMID: 37929716 PMCID: PMC10727404 DOI: 10.1161/jaha.123.030571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023]
Abstract
Background Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. Methods and Results After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. Conclusions Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.
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Affiliation(s)
- Elizabeth McNeill
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Zoe Lindenfeld
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Logina Mostafa
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Dina Zein
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Diana Silver
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - José Pagán
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - William B. Weeks
- Microsoft Corporation, Precision Population Health, Microsoft ResearchRedmondWAUSA
| | - Ann Aerts
- The Novartis FoundationBaselSwitzerland
| | | | | | - Ji Eun Chang
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
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22
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Golden BP, Block L, Benson C, Cotton QD, Wieben A, Kaiksow F, Gilmore-Bykovskyi A. Experiences of in-hospital care among dementia caregivers in the context of high neighborhood-level disadvantage. J Am Geriatr Soc 2023; 71:3435-3444. [PMID: 37548026 PMCID: PMC10841110 DOI: 10.1111/jgs.18541] [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: 04/04/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Persons living with dementia (PLWD) experience high rates of hospitalization and rehospitalization, exposing them to added risk for adverse outcomes including delirium, hastened cognitive decline, and death. Hospitalizations can also increase family caregiver strain. Despite disparities in care quality surrounding hospitalizations for PLWD, and evidence suggesting that exposure to neighborhood-level disadvantage increases these inequities, experiences with hospitalization among PLWD and family caregivers exposed to greater levels of neighborhood disadvantage are poorly understood. This study examined family caregiver perspectives and experiences of hospitalizations among PLWD in the context of high neighborhood-level disadvantage. METHODS We analyzed data from the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) study, an in-depth, multisite qualitative study examining hospitalization and rehospitalization of PLWD in the context of high neighborhood disadvantage, to identify caregiver perspectives and experiences of in-hospital care. Data were analyzed using rapid identification of themes; duplicate transcript review was used to enhance rigor. RESULTS Data from N = 54 individuals (47 individual interviews, 2 focus groups with 7 individuals) were analyzed. Sixty-three percent of participants identified as Black/African American, 35% as non-Hispanic White, and 2% declined to report. Caregivers' experiences were largely characterized by PLWD receiving suboptimal care that caregivers viewed as influenced by system pressures and inadequate workforce competencies, leading to communication breakdowns and strain. Caregivers described poor collaboration between clinicians and caregivers with regard to in-hospital care delivery, including transitional care. Caregivers also highlighted the lack of person-focused care and the exclusion of the PLWD from care. CONCLUSIONS Caregiver perspectives highlight opportunities for improving hospital care for PLWD in the context of neighborhood disadvantage and recognition of broader issues in care structure that limit their capacity to be actively involved in care. Further work should examine and develop strategies to improve caregiver integration during hospitalizations across diverse contexts.
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Affiliation(s)
- Blair P Golden
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura Block
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Clark Benson
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Quinton D Cotton
- Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Ann Wieben
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Farah Kaiksow
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrea Gilmore-Bykovskyi
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
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23
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Bose S, McDermott KM, Keegan A, Black JH, Drudi LM, Lum YW, Zarkowsky DS, Hicks CW. Socioeconomic status fails to account for worse outcomes in non-Hispanic black patients undergoing carotid revascularization. J Vasc Surg 2023; 78:1248-1259.e1. [PMID: 37419427 PMCID: PMC10615195 DOI: 10.1016/j.jvs.2023.06.103] [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: 03/30/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Previous studies have reported an association of Black race with worse carotid revascularization outcomes, but rarely include socioeconomic status as a confounding covariate. We aimed to assess the association of race and ethnicity with in-hospital and long-term outcomes following carotid revascularization before and after accounting for socioeconomic status. METHODS We identified non-Hispanic Black and non-Hispanic white patients who underwent carotid endarterectomy, transfemoral carotid stenting, or transcarotid artery revascularization between 2003 and 2022 in the Vascular Quality Initiative. Primary outcomes were in-hospital stroke/death and long-term stroke/death. Multivariable logistic regression and Cox proportional hazards models were used to assess the association of race with perioperative and long-term outcomes after adjusting for baseline characteristics using a sequential model approach without and with consideration of Area Deprivation Index (ADI), a validated composite marker of socioeconomic status. RESULTS Of 201,395 patients, 5.1% (n = 10,195) were non-Hispanic Black, and 94.9% (n = 191,200) were non-Hispanic white. Mean follow-up time was 3.4±0.01 years. A disproportionately high percentage of Black patients were living in more socioeconomically deprived neighborhoods relative to their white counterparts (67.5% vs 54.2%; P < .001). After adjusting for demographic, comorbidity, and disease characteristics, Black race was associated with greater odds of in-hospital (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.10-1.40) and long-term stroke/death (adjusted hazard ratio [aHR], 1.13; 95% CI, 1.04-1.23). These associations did not substantially change after additionally adjusting for ADI; Black race was persistently associated with greater odds of in-hospital (aOR, 1.23; 95% CI, 1.09-1.39) and long-term stroke/death (aHR, 1.12; 95% CI, 1.03-1.21). Patients living in the most deprived neighborhoods were at greater risk of long-term stroke/death compared with patients living in the least deprived neighborhoods (aHR, 1.19; 95% CI, 1.05-1.35). CONCLUSIONS Non-Hispanic Black race is associated with worse in-hospital and long-term outcomes following carotid revascularization despite accounting for neighborhood socioeconomic deprivation. There appears to be unrecognized gaps in care that prevent Black patients from experiencing equitable outcomes following carotid artery revascularization.
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Affiliation(s)
- Sanuja Bose
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Alana Keegan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD
| | - James H. Black
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura M. Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Ying-Wei Lum
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Judge A, Kramer M, Downing KF, Andrews J, Oster ME, Benavides A, Nembhard WN, Farr SL. Neighborhood social deprivation and healthcare utilization, disability, and comorbidities among young adults with congenital heart defects: Congenital heart survey to recognize outcomes, needs, and well-being 2016-2019. Birth Defects Res 2023; 115:1608-1618. [PMID: 37578352 PMCID: PMC10916520 DOI: 10.1002/bdr2.2239] [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: 01/24/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Research on the association between neighborhood social deprivation and health among adults with congenital heart defects (CHD) is sparse. METHODS We evaluated the associations between neighborhood social deprivation and health care utilization, disability, and comorbidities using the population-based 2016-2019 Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) of young adults. Participants were identified from active birth defect surveillance systems in three U.S. sites and born with CHD between 1980 and 1997. We linked census tract-level 2017 American Community Survey information on median household income, percent of ≥25-year-old with greater than a high school degree, percent of ≥16-year-olds who are unemployed, and percent of families with children <18 years old living in poverty to survey data and used these variables to calculate a summary neighborhood social deprivation z-score, divided into tertiles. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) derived from a log-linear regression model with a Poisson distribution estimated the association between tertile of neighborhood social deprivation and healthcare utilization in previous year (no encounters, 1 and ≥2 emergency room [ER] visits, and hospital admission), ≥1 disability, and ≥1 comorbidities. We accounted for age, place of birth, sex at birth, presence of chromosomal anomalies, and CHD severity in all models, and, additionally educational attainment and work status in all models except disability. RESULTS Of the 1435 adults with CHD, 43.8% were 19-24 years old, 54.4% were female, 69.8% were non-Hispanic White, and 33.7% had a severe CHD. Compared to the least deprived tertile, respondents in the most deprived tertile were more likely to have no healthcare visit (aPR: 1.5 [95% CI: 1.1, 2.1]), ≥2 ER visits (1.6 [1.1, 2.3]), or hospitalization (1.6 [1.1, 2.3]) in the previous 12 months, a disability (1.2 [1.0, 1.5]), and ≥1 cardiac comorbidities (1.8 [1.2, 2.7]). CONCLUSIONS Neighborhood social deprivation may be a useful metric to identify patients needing additional resources and referrals.
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Affiliation(s)
- Ashley Judge
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Michael Kramer
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Andrews
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona, USA
| | - Matthew E. Oster
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Argelia Benavides
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona, USA
| | - Wendy N. Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Yan C, Zhang X, Yang Y, Kang K, Were MC, Embí P, Patel MB, Malin BA, Kho AN, Chen Y. Differences in Health Professionals' Engagement With Electronic Health Records Based on Inpatient Race and Ethnicity. JAMA Netw Open 2023; 6:e2336383. [PMID: 37812421 PMCID: PMC10562942 DOI: 10.1001/jamanetworkopen.2023.36383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 10/10/2023] Open
Abstract
Importance US health professionals devote a large amount of effort to engaging with patients' electronic health records (EHRs) to deliver care. It is unknown whether patients with different racial and ethnic backgrounds receive equal EHR engagement. Objective To investigate whether there are differences in the level of health professionals' EHR engagement for hospitalized patients according to race or ethnicity during inpatient care. Design, Setting, and Participants This cross-sectional study analyzed EHR access log data from 2 major medical institutions, Vanderbilt University Medical Center (VUMC) and Northwestern Medicine (NW Medicine), over a 3-year period from January 1, 2018, to December 31, 2020. The study included all adult patients (aged ≥18 years) who were discharged alive after hospitalization for at least 24 hours. The data were analyzed between August 15, 2022, and March 15, 2023. Exposures The actions of health professionals in each patient's EHR were based on EHR access log data. Covariates included patients' demographic information, socioeconomic characteristics, and comorbidities. Main Outcomes and Measures The primary outcome was the quantity of EHR engagement, as defined by the average number of EHR actions performed by health professionals within a patient's EHR per hour during the patient's hospital stay. Proportional odds logistic regression was applied based on outcome quartiles. Results A total of 243 416 adult patients were included from VUMC (mean [SD] age, 51.7 [19.2] years; 54.9% female and 45.1% male; 14.8% Black, 4.9% Hispanic, 77.7% White, and 2.6% other races and ethnicities) and NW Medicine (mean [SD] age, 52.8 [20.6] years; 65.2% female and 34.8% male; 11.7% Black, 12.1% Hispanic, 69.2% White, and 7.0% other races and ethnicities). When combining Black, Hispanic, or other race and ethnicity patients into 1 group, these patients were significantly less likely to receive a higher amount of EHR engagement compared with White patients (adjusted odds ratios, 0.86 [95% CI, 0.83-0.88; P < .001] for VUMC and 0.90 [95% CI, 0.88-0.92; P < .001] for NW Medicine). However, a reduction in this difference was observed from 2018 to 2020. Conclusions and Relevance In this cross-sectional study of inpatient EHR engagement, the findings highlight differences in how health professionals distribute their efforts to patients' EHRs, as well as a method to measure these differences. Further investigations are needed to determine whether and how EHR engagement differences are correlated with health care outcomes.
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Affiliation(s)
- Chao Yan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xinmeng Zhang
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yuyang Yang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kaidi Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Martin C. Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter Embí
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mayur B. Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research and Education Clinical Center, Veterans Affairs, Tennessee Valley Healthcare System, Nashville
- Division of Acute Care Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley A. Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Abel N. Kho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
- Department of Medicine-General Internal Medicine, Northwestern University, Chicago, Illinois
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
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Frank DA, Johnson AE, Hausmann LRM, Gellad WF, Roberts ET, Vajravelu RK. Disparities in Guideline-Recommended Statin Use for Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and Gender : A Nationally Representative Cross-Sectional Analysis of Adults in the United States. Ann Intern Med 2023; 176:1057-1066. [PMID: 37487210 PMCID: PMC10804313 DOI: 10.7326/m23-0720] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Although statins are a class I recommendation for prevention of atherosclerotic cardiovascular disease and its complications, their use is suboptimal. Differential underuse may mediate disparities in cardiovascular health for systematically marginalized persons. OBJECTIVE To estimate disparities in statin use by race-ethnicity-gender and to determine whether these potential disparities are explained by medical appropriateness of therapy and structural factors. DESIGN Cross-sectional analysis. SETTING National Health and Nutrition Examination Survey from 2015 to 2020. PARTICIPANTS Persons eligible for statin therapy based on 2013 and 2018 American College of Cardiology/American Heart Association blood cholesterol guidelines. MEASUREMENTS The independent variable was race-ethnicity-gender. The outcome of interest was use of a statin. Using the Institute of Medicine framework for examining unequal treatment, we calculated adjusted prevalence ratios (aPRs) to estimate disparities in statin use adjusted for age, disease severity, access to health care, and socioeconomic status relative to non-Hispanic White men. RESULTS For primary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors among non-Hispanic Black men (aPR, 0.73 [95% CI, 0.59 to 0.88]) and non-Mexican Hispanic women (aPR, 0.74 [CI, 0.53 to 0.95]). For secondary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors for non-Hispanic Black men (aPR, 0.81 [CI, 0.64 to 0.97]), other/multiracial men (aPR, 0.58 [CI, 0.20 to 0.97]), Mexican American women (aPR, 0.36 [CI, 0.10 to 0.61]), non-Mexican Hispanic women (aPR, 0.57 [CI, 0.33 to 0.82), non-Hispanic White women (aPR, 0.69 [CI, 0.56 to 0.83]), and non-Hispanic Black women (aPR, 0.75 [CI, 0.57 to 0.92]). LIMITATION Cross-sectional data; lack of geographic, language, or statin-dose data. CONCLUSION Statin use disparities for several race-ethnicity-gender groups are not explained by measurable differences in medical appropriateness of therapy, access to health care, and socioeconomic status. These residual disparities may be partially mediated by unobserved processes that contribute to health inequity, including bias, stereotyping, and mistrust. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- David A. Frank
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Department of Epidemiology, University of Pittsburgh School of Public Health
| | - Amber E. Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine
| | - Leslie R. M. Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Walid F. Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Eric T. Roberts
- Department of Health Policy and Management, University of Pittsburgh School of Public Health
| | - Ravy K. Vajravelu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine
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Wong CG, Miller JB, Zhang F, Rissman RA, Raman R, Hall JR, Petersen M, Yaffe K, Kind AJ, O’Bryant SE. Evaluation of Neighborhood-Level Disadvantage and Cognition in Mexican American and Non-Hispanic White Adults 50 Years and Older in the US. JAMA Netw Open 2023; 6:e2325325. [PMID: 37647071 PMCID: PMC10469291 DOI: 10.1001/jamanetworkopen.2023.25325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Understanding how socioeconomic factors are associated with cognitive aging is important for addressing health disparities in Alzheimer disease. Objective To examine the association of neighborhood disadvantage with cognition among a multiethnic cohort of older adults. Design, Setting, and Participants In this cross-sectional study, data were collected between September 1, 2017, and May 31, 2022. Participants were from the Health and Aging Brain Study-Health Disparities, which is a community-based single-center study in the Dallas/Fort Worth area of Texas. A total of 1614 Mexican American and non-Hispanic White adults 50 years and older were included. Exposure Neighborhood disadvantage for participants' current residence was measured by the validated Area Deprivation Index (ADI); ADI Texas state deciles were converted to quintiles, with quintile 1 representing the least disadvantaged area and quintile 5 the most disadvantaged area. Covariates included age, sex, and educational level. Main Outcomes and Measures Performance on cognitive tests assessing memory, language, attention, processing speed, and executive functioning; measures included the Spanish-English Verbal Learning Test (SEVLT) Learning and Delayed Recall subscales; Wechsler Memory Scale, third edition (WMS-III) Digit Span Forward, Digit Span Backward, and Logical Memory 1 and 2 subscales; Trail Making Test (TMT) parts A and B; Digit Symbol Substitution Test (DSST); Letter Fluency; and Animal Naming. Raw scores were used for analyses. Associations between neighborhood disadvantage and neuropsychological performance were examined via demographically adjusted linear regression models stratified by ethnic group. Results Among 1614 older adults (mean [SD] age, 66.3 [8.7] years; 980 women [60.7%]), 853 were Mexican American (mean [SD] age, 63.9 [7.9] years; 566 women [66.4%]), and 761 were non-Hispanic White (mean [SD] age, 69.1 [8.7] years; 414 women [54.4%]). Older Mexican American adults were more likely to reside in the most disadvantaged areas (ADI quintiles 3-5), with 280 individuals (32.8%) living in ADI quintile 5, whereas a large proportion of older non-Hispanic White adults resided in ADI quintile 1 (296 individuals [38.9%]). Mexican American individuals living in more disadvantaged areas had worse performance than those living in ADI quintile 1 on 7 of 11 cognitive tests, including SEVLT Learning (ADI quintile 5: β = -2.50; 95% CI, -4.46 to -0.54), SEVLT Delayed Recall (eg, ADI quintile 3: β = -1.11; 95% CI, -1.97 to -0.24), WMS-III Digit Span Forward (eg, ADI quintile 4: β = -1.14; 95% CI, -1.60 to -0.67), TMT part A (ADI quintile 5: β = 7.85; 95% CI, 1.28-14.42), TMT part B (eg, ADI quintile 5: β = 31.5; 95% CI, 12.16-51.35), Letter Fluency (ADI quintile 4: β = -2.91; 95% CI, -5.39 to -0.43), and DSST (eg, ADI quintile 5: β = -4.45; 95% CI, -6.77 to -2.14). In contrast, only non-Hispanic White individuals living in ADI quintile 4 had worse performance than those living in ADI quintile 1 on 4 of 11 cognitive tests, including SEVLT Learning (β = -2.35; 95% CI, -4.40 to -0.30), SEVLT Delayed Recall (β = -0.95; 95% CI, -1.73 to -0.17), TMT part B (β = 15.95; 95% CI, 2.47-29.44), and DSST (β = -3.96; 95% CI, -6.49 to -1.43). Conclusions and Relevance In this cross-sectional study, aging in a disadvantaged area was associated with worse cognitive functioning, particularly for older Mexican American adults. Future studies examining the implications of exposure to neighborhood disadvantage across the life span will be important for improving cognitive outcomes in diverse populations.
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Affiliation(s)
- Christina G. Wong
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada
| | - Justin B. Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada
| | - Fan Zhang
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth
| | - Robert A. Rissman
- Department of Neurosciences, University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego
| | - James R. Hall
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
| | - Melissa Petersen
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
| | - Amy J. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sid E. O’Bryant
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
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28
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Batley MG, Lenart J, Sankar WN. Socioeconomic Deprivation and its Associations With Follow-up Compliance After In Situ Pinning of Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2023; 43:e421-e426. [PMID: 37072922 DOI: 10.1097/bpo.0000000000002416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is a common cause of hip pain in adolescents and is most often treated by in situ screw fixation. Orthopaedic follow-up is critical after treatment for SCFE due to risks of complications and subsequent contralateral slip. Recent studies have shown that socioeconomic deprivation is associated with decreased fracture care compliance, but no studies have explored this relationship with SCFEs. The study aims to determine the relationship between socioeconomic deprivation and SCFE follow-up care compliance. METHODS This study included pediatric patients treated with in situ pinning of SCFE between 2011 and 2019 at a single tertiary-care urban children's hospital. Demographic and clinical information were obtained from electronic medical records. The Area Deprivation Index (ADI) was used to quantify the socioeconomic deprivation of each. Outcome variables included patient age and status of physeal closure at the most recent appointment, in addition to the length of follow-up (mo). Statistical relationships were evaluated using nonparametric bivariate analysis and correlation. RESULTS We identified 247 evaluable patients; 57.1% were male, and the median age was 12.4 years. Most slips were stable (95.1%) and treated with isolated unilateral pinning (55.9%). Median length of follow-up was 11.9 months (interquartile range, 4.95 to 23.1) with median patient age at final visit of 13.6 years (interquartile range, 12.4 to 15.1). Only 37.2% of patients were followed until physeal closure. The mean ADI spread in this sample was similar to the national distribution. However, patients in the most deprived quartile were lost to follow-up significantly earlier (median, 6.5 mo) than those in the least deprived quartile (median, 12.5 mo; P <0.001). Throughout the entire cohort, there was a significant, inverse relationship between deprivation and follow-up length ( rs (238) = -0.3; P <0.001), with this relationship most pronounced in the most deprived quartile. CONCLUSIONS In this sample, ADI spread was representative of national trends, and the incidence of SCFE was distributed evenly across deprivation quartiles. However, follow-up length does not mirror this relationship; increased socioeconomic deprivation is associated with an earlier loss to follow-up (often well before physeal closure). LEVEL OF EVIDENCE Level II-retrospective prognostic study.
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Affiliation(s)
- Morgan G Batley
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Gilmore-Bykovskyi A, Zuelsdorff M, Block L, Golden B, Kaiksow F, Sheehy AM, Bartels CM, Kind AJ, Powell WR. Disparities in 30-day readmission rates among Medicare enrollees with dementia. J Am Geriatr Soc 2023; 71:2194-2207. [PMID: 36896859 PMCID: PMC10363234 DOI: 10.1111/jgs.18311] [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: 08/13/2022] [Revised: 01/14/2023] [Accepted: 02/14/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Readmissions contribute to excessive care costs and burden for people living with dementia. Assessments of racial disparities in readmissions among dementia populations are lacking, and the role of social and geographic risk factors such as individual-level exposure to greater neighborhood disadvantage is poorly understood. We examined the association between race and 30-day readmissions in a nationally representative sample of Black and non-Hispanic White individuals with dementia diagnoses. METHODS This retrospective cohort study used 100% Medicare fee-for-service claims from all 2014 hospitalizations nationwide among Medicare enrollees with dementia diagnosis linked to patient, stay, and hospital factors. The sample consisted of 1,523,142 hospital stays among 945,481 beneficiaries. The relationship between all cause 30-day readmissions and the explanatory variable of self-reported race (Black, non-Hispanic White) was examined via generalized estimating equations approach adjusting for patient, stay, and hospital-level characteristics to model 30-day readmission odds. RESULTS Black Medicare beneficiaries had 37% higher readmission odds compared to White beneficiaries (unadjusted OR 1.37, CI 1.35-1.39). This heightened readmission risk persisted after adjusting for geographic factors (OR 1.33, CI 1.31-1.34), social factors (OR 1.25, CI 1.23-1.27), hospital characteristics (OR 1.24, CI 1.23-1.26), stay-level factors (OR 1.22, CI 1.21-1.24), demographics (OR 1.21, CI 1.19-1.23), and comorbidities (OR 1.16, CI 1.14-1.17), suggesting racially-patterned disparities in care account for a portion of observed differences. Associations varied by individual-level exposure to neighborhood disadvantage such that the protective effect of living in a less disadvantaged neighborhood was associated with reduced readmissions for White but not Black beneficiaries. Conversely, among White beneficiaries, exposure to the most disadvantaged neighborhoods associated with greater readmission rates compared to White beneficiaries residing in less disadvantaged contexts. CONCLUSIONS There are significant racial and geographic disparities in 30-day readmission rates among Medicare beneficiaries with dementia diagnoses. Findings suggest distinct mechanisms underlying observed disparities differentially influence various subpopulations.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Megan Zuelsdorff
- School of Nursing, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Laura Block
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
- School of Nursing, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Blair Golden
- Division of Hospital Medicine, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Farah Kaiksow
- Division of Hospital Medicine, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Ann M. Sheehy
- Division of Hospital Medicine, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Christie M. Bartels
- Division of Rheumatology, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Amy J.H. Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - W. Ryan Powell
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
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Lans A, Bales JR, Tobert DG, Rossi LP, Verlaan JJ, Schwab JH. Prevalence of and factors associated with limited health literacy in spine patients. Spine J 2023; 23:440-447. [PMID: 36372351 DOI: 10.1016/j.spinee.2022.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Limited health literacy exacerbates health inequity and has serious implications for patient care. It hinders successful communication and comprehension of relevant health information, which can lead to suboptimal care. Despite the evidence regarding the significance of health literacy, the topic has received little consideration in orthopedic spine patients. PURPOSE To investigate the prevalence of and factors associated with limited health literacy among outpatients presenting to a tertiary urban academic hospital-based orthopedic spine center. STUDY DESIGN Cross-sectionals. PATIENT SAMPLE Patients 18 years of age or older seen at a tertiary urban academic hospital-based multi-surgeon outpatient spine center. OUTCOME MEASURES The Newest Vital Sign (NVS) health literacy assessment. METHODS Between December 2021 and March 2022, 447 consecutive English-speaking patients over the age of 18 years and new to the outpatient spine clinic were approached for participation in a cross-sectional survey study, of which 405 agreed to participate. Patients completed the Newest Vital Sign (NVS) health literacy assessment tool, the Rapid Estimation of Adult Literacy in Medicine Short Form (REALM-SF), and a sociodemographic survey (including race/ethnicity, level of education, employment status, income, and marital status). The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy. REALM-SF scores were classified into reading levels below ninth grade (0-6) or at least ninth grade (7). Additional demographic data was extracted from patient records. Online mapping tools were used to collect the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI) for each patient. Subsequently, multivariable regression modeling was performed to identify independent factors associated with limited health literacy. RESULTS The prevalence of limited health literacy in patients presenting to an urban academic outpatient spine center was 33% (135/405). Unadjusted analysis found that patients who were socioeconomically disadvantaged (eg, unemployed, lower household income, publicly insured and higher SVI) and had more unfavorable social determinant of health features (eg, housing concerns, higher ADI, less years of education, below ninth grade reading level, unmarried) had high rates of limited health literacy. Adjusted regression analysis demonstrated that limited health literacy was independently associated with higher ADI state decile, living less than 10 years at current address, having housing concerns, not being employed, non-native English speaking, having less years of education and below ninth grade reading level. CONCLUSIONS This study found that a substantial portion of the patients presenting to an outpatient spine center have limited health literacy, more so if they are socially disadvantaged. Future efforts should investigate the impact of limited health literacy on access to care, treatment outcomes and health care utilization in orthopedic patients. Neighborhood social vulnerability measures may be a feasible way to identify patients at risk of limited health literacy in clinical practice and offer opportunities for tailored patient care. This may contribute to prioritizing the mitigation of disparities and aid in the development of meaningful interventions to improve health equity in orthopedics.
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Affiliation(s)
- Amanda Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.
| | - John R Bales
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Laura P Rossi
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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McDermott A, Kim N, Hausmann LRM, Magnani JW, Good CB, Litam TMA, Mor MK, Omole TD, Gellad WF, Fine MJ, Essien UR. Association of Neighborhood Disadvantage and Anticoagulation for Patients with Atrial Fibrillation in the Veterans Health Administration: the REACH-AF Study. J Gen Intern Med 2023; 38:848-856. [PMID: 36151447 PMCID: PMC10039185 DOI: 10.1007/s11606-022-07810-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia, the management of which includes anticoagulation for stroke prevention. Although disparities in anticoagulant prescribing have been well documented for individual socioeconomic factors, less is known about the association of neighborhood-level disadvantage and anticoagulation for AF. OBJECTIVE To assess the association between neighborhood disadvantage and anticoagulant initiation for patients with incident AF. DESIGN Retrospective cohort study. PARTICIPANTS A cohort of patients enrolled in the Veterans Health Administration (VA) with incident AF from January 2014 through December 2020 from the Race, Ethnicity, and Anticoagulant CHoice in Atrial Fibrillation (REACH-AF) Study. MAIN MEASURES The primary exposure was neighborhood disadvantage quantified using area deprivation index (ADI), classified by quintiles (Q). The outcomes were initiation of any anticoagulant therapy (warfarin or direct oral anticoagulant, DOAC) within 90 days of AF diagnosis and DOAC use among initiators. We used mixed effects logistic regression to assess the association between ADI and anticoagulant therapy, incorporating a fixed effect for treatment site and baseline patient, provider, and facility covariates. KEY RESULTS Among 161,089 patients, 105,489 (65.5%) initiated any anticoagulant therapy, and 78,903 (74.8%) used DOACs. Any anticoagulant therapy increased 3.2 percentage points (63.0% to 66.2%; p<.001) from Q1 to Q5, whereas DOAC use decreased 8.2 percentage points (79.4% to 71.2%; p<.0001) across quintiles. The adjusted odd ratios of any anticoagulant therapy were non-significantly different for Q2-Q5 than Q1. The adjusted odds of DOAC use decreased progressively from 0.89 (95% CI, 0.84-0.94) in Q2 to 0.77 (95% CI, 0.73-0.83) in Q5 compared to Q1 (p<.0001). CONCLUSIONS Among Veterans with incident AF, we observed similar initiation of any anticoagulant, though neighborhood deprivation was associated with decreased DOAC use among anticoagulant initiators. Future interventions to improve pharmacoequity in anticoagulant prescribing for AF should consider the role of neighborhood-level determinants of health inequities.
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Affiliation(s)
- Annie McDermott
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nadejda Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Centers for Value-Based Pharmacy Initiatives and High-Value Health Care, UPMC Health Plan, Pittsburgh, PA, USA
| | - Terrence M A Litam
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Toluwa D Omole
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Utibe R Essien
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1372] [Impact Index Per Article: 1372.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Impact of neighborhood social disadvantage on carotid artery disease presentation, management, and discharge outcomes. J Vasc Surg 2023; 77:1700-1709.e2. [PMID: 36787807 DOI: 10.1016/j.jvs.2023.01.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Recent studies have highlighted that race and socioeconomic status serve as important determinants of disease presentation and perioperative outcomes in carotid artery disease. However, these investigations only focus on individual factors of social disadvantage, and fail to account for community factors that may drive disparities. Area Deprivation Index (ADI) is a validated measure of neighborhood adversity that offers a more comprehensive assessment of social disadvantage. We examined the impact of ADI ranking on carotid artery disease severity, management, and postoperative outcomes. METHODS We identified patients who underwent carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), and transcarotid artery revascularization (TCAR) in the Vascular Quality Initiative registry between 2016 and 2020. Patients were assigned ADI scores of 1 to 100 based on zip codes and grouped into quintiles, with higher quintiles reflecting increasing adversity. Outcomes assessed included disease presentation, intervention type, and discharge patterns. Logistic regression was used to evaluate independent associations between ADI quintiles and these outcomes. RESULTS Among 91,904 patients undergoing carotid revascularization, 9811 (10.7%) were in the lowest ADI quintile (Q1), 18,905 (20.6%) in Q2, 25,442 (27.7%) in Q3, 26,099 (28.4%) in Q4, and 11,647 (12.7%) in Q5. With increasing ADI quintiles, patients were more likely to present with symptomatic disease (Q5, 52.1% vs Q1, 46.6%; P < .001), and stroke vs transient ischemic attack (Q5, 63.1% vs Q1, 53.5%; P < .001); they also more frequently underwent CAS vs CEA (Q5, 46.4% vs Q1, 33.9%; P < .001), and specifically tfCAS vs TCAR (Q5, 54.2% vs Q1, 33.9%; P < .001). In adjusted analyses, higher ADI quintiles remained as independent risk factors for presenting with symptomatic disease and stroke and undergoing CAS and tfCAS. Across ADI quintiles, patients were more likely to experience death (Q5, 0.8% vs Q1, 0.4%; P < .001), stroke/death (Q5, 2.1% vs Q1, 1.6%; P = .001), failure to discharge home (Q5, 11.5% vs Q1, 8.0%; P < .001) and length of stay >2 days (Q5, 33.3% vs Q1, 26.3%; P < .001) following revascularization. CONCLUSIONS Among carotid revascularization patients, those with greater neighborhood social disadvantage had greater disease severity and more frequently underwent tfCAS. These patients also had higher rates of death and stroke/death, were less frequently discharged home, and had prolonged hospital stays. Greater efforts are needed to ensure that patients in higher ADI quintiles undergo better carotid surveillance and are treated appropriately for their carotid artery disease.
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Okafor CM, Zhu C, Raparelli V, Murphy TE, Arakaki A, D’Onofrio G, Tsang SW, Smith MN, Lichtman JH, Spertus JA, Pilote L, Dreyer RP. Association of Sociodemographic Characteristics With 1-Year Hospital Readmission Among Adults Aged 18 to 55 Years With Acute Myocardial Infarction. JAMA Netw Open 2023; 6:e2255843. [PMID: 36787140 PMCID: PMC9929697 DOI: 10.1001/jamanetworkopen.2022.55843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/27/2022] [Indexed: 02/15/2023] Open
Abstract
Importance Among younger adults, the association between Black race and postdischarge readmission after hospitalization for acute myocardial infarction (AMI) is insufficiently described. Objectives To examine whether racial differences exist in all-cause 1-year hospital readmission among younger adults hospitalized for AMI and whether that difference retains significance after adjustment for cardiac factors and social determinants of health (SDOHs). Design, Setting, and Participants The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study was an observational cohort study of younger adults (aged 18-55 years) hospitalized for AMI with a 2:1 female-to-male ratio across 103 US hospitals from January 1, 2008, to December 31, 2012. Data analysis was performed from August 1 to December 31, 2021. Main Outcomes and Measures The primary outcome was all-cause readmission, defined as any hospital or observation stay greater than 24 hours within 1 year of discharge, identified through medical record abstraction and clinician adjudication. Logistic regression with sequential adjustment evaluated racial differences and potential moderation by sex and SDOHs. The Blinder-Oaxaca decomposition quantified how much of any racial difference was explained and not explained by covariates. Results This study included 2822 participants (median [IQR] age, 48 [44-52] years; 1910 [67.7%] female; 2289 [81.1%] White and 533 [18.9%] Black; 868 [30.8%] readmitted). Black individuals had a higher rate of readmission than White individuals (210 [39.4%] vs 658 [28.8%], P < .001), particularly Black women (179 of 425 [42.1%]). After adjustment for sociodemographic characteristics, cardiac factors, and SDOHs, the odds of readmission were 34% higher among Black individuals (odds ratio [OR], 1.34; 95% CI, 1.06-1.68). The association between Black race and 1-year readmission was positively moderated by unemployment (OR, 1.68; 95% CI, 1.09- 2.59; P for interaction = .02) and fewer number of working hours per week (OR, 1.01; 95% CI, 1.00-1.02; P for interaction = .01) but not by sex. Decomposition indicates that 79% of the racial difference in risk of readmission went unexplained by the included covariates. Conclusions and Relevance In this multicenter study of younger adults hospitalized for AMI, Black individuals were more often readmitted in the year following discharge than White individuals. Although interventions to address SDOHs and employment may help decrease racial differences in 1-year readmission, more study is needed on the 79% of the racial difference not explained by the included covariates.
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Affiliation(s)
- Chinenye M. Okafor
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Terrence E. Murphy
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Andrew Arakaki
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sui W. Tsang
- Program on Aging, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut
| | - Judith H. Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - John A. Spertus
- School of Medicine, University of Missouri, Kansas City
- Department of Cardiovascular Research, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Louise Pilote
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Rachel P. Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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Nwana N, Taha MB, Javed Z, Gullapelli R, Nicolas JC, Jones SL, Acquah I, Khan S, Satish P, Mahajan S, Cainzos-Achirica M, Nasir K. Neighborhood deprivation and morbid obesity: Insights from the Houston Methodist Cardiovascular Disease Health System Learning Registry. Prev Med Rep 2022; 31:102100. [PMID: 36820380 PMCID: PMC9938328 DOI: 10.1016/j.pmedr.2022.102100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
This study examined the relationship between a validated measure of socioeconomic deprivation, such as the Area Deprivation Index (ADI), and morbid obesity. We used cross-sectional data on adult patients (≥18 years) in the Houston Methodist Cardiovascular Disease Health System Learning Registry (located in Houston, Texas, USA) between June 2016 and July 2021. Each patient was grouped by quintiles of ADI, with higher quintiles signaling greater deprivation. BMI was calculated using measured height and weight with morbid obesity defined as ≥ 40 kg/m2. Multivariable logistic regression models were used to examine the association between ADI and morbid obesity adjusting for demographic (age, sex, and race/ethnicity) factors. Out of the 751,174 adults with an ADI ranking included in the analysis, 6.9 % had morbid obesity (n = 51,609). Patients in the highest ADI quintile had a higher age-adjusted prevalence (10.9 % vs 3.3 %), and about 4-fold odds (aOR, 3.8; 95 % CI = 3.6, 3.9) of morbid obesity compared to the lowest ADI quintile. We tested for and found interaction effects between ADI and each demographic factor, with stronger ADI-morbid obesity association observed for patients that were female, Hispanic, non-Hispanic White and 40-65 years old. The highest ADI quintile also had a high prevalence (44 %) of any obesity (aOR, 2.2; 95 % CI = 2.1, 2.2). In geospatial mapping, areas with higher ADI were more likely to have higher proportion of patients with morbid obesity. Census-based measures, like the ADI, may be informative for area-level obesity reduction strategies as it can help identify neighborhoods at high odds of having patients with morbid obesity.
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Key Words
- ADI, Area Deprivation Index
- BMI, Body Mass Index
- CA, Catchment Area
- CI, Confidence Interval
- CVD, Cardiovascular Diseases
- Data-driven
- ED, Emergency Department
- FIPS, Federal Information Processing Standards
- HM, Houston Methodist
- Health equity
- IRB, Internal Review Board
- Morbid obesity
- Neighborhood deprivation
- OR, Odds Ratio
- SD, Standard Deviation
- SDOH, Social Determinants of Health
- SES, Socio-Economic Status
- US, United States
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Affiliation(s)
- Nwabunie Nwana
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamad B. Taha
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Zulqarnain Javed
- Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Rakesh Gullapelli
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Juan C. Nicolas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Stephen L. Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Safi Khan
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Priyanka Satish
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shivani Mahajan
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA,Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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Van Iterson EH, Laffin LJ, Cho L. National, regional, and urban-rural patterns in fixed-terrestrial broadband internet access and cardiac rehabilitation utilization in the United States. Am J Prev Cardiol 2022; 13:100454. [PMID: 36636124 PMCID: PMC9830103 DOI: 10.1016/j.ajpc.2022.100454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
Objective Sparse patterns in fixed-terrestrial broadband internet access are predominantly observed among older adults and low income areas, which are interrelated factors also associated with low center-based cardiac rehabilitation (CR) utilization in the United States (US). Telehealth CR is proposed to increase CR utilization under an assumption that fixed-terrestrial broadband internet access is readily available nationwide and parallels CR utilization demand. We aimed to characterize national, geographical, and urban-rural patterns in fixed-terrestrial broadband internet access, CR eligibility rates, and center-based utilization throughout the US. Methods Centers for Disease Control data were used to estimate CR eligibility rates and center-based utilization for 2017-2018 among Medicare fee-for-service beneficiaries aged ≥65 years. Census Bureau data for 2018 were used to estimate fixed-terrestrial broadband internet access among households of adults aged ≥65 years. Results Southern states exhibited the highest percentage of households without broadband internet [median (IQR): 32% (24-39)] coupled with the highest CR eligibility rates [per 1,000 beneficiaries, median (IQR): 18 (15-21)] and lowest participation rates [percentage completing ≥1 session, median (IQR): 25% (17-33)]. Compared with urban areas, rural areas demonstrated significantly higher eligibility rates [15.5 (13.2-18.4) vs. 17.4 (14.5-21.0)], participation rates [30.6% (22.0-39.4) vs. 34.6% (22.6-48.3)], and percentage of households without broadband internet [23.8% (18.1-29.2) vs. 31.6% (26.5-37.6)], respectively. Conclusion Overlapping patterns in fixed-terrestrial broadband internet access and CR eligibility rates and center-based utilization suggest telehealth CR policies need to account for the possibility that lack of broadband-quality internet access could be a barrier to accessing telehealth CR delivery models.
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Harmon DM, Adedinsewo D, Van't Hof JR, Johnson M, Hayes SN, Lopez-Jimenez F, Jones C, Attia ZI, Friedman PA, Patten CA, Cooper LA, Brewer LC. Community-based participatory research application of an artificial intelligence-enhanced electrocardiogram for cardiovascular disease screening: A FAITH! Trial ancillary study. Am J Prev Cardiol 2022; 12:100431. [PMID: 36419480 PMCID: PMC9677088 DOI: 10.1016/j.ajpc.2022.100431] [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: 09/20/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022] Open
Abstract
Objective With the emergence of artificial intelligence (AI)-based health interventions, systemic racism remains a concern as these advancements are frequently developed without race-specific data analysis or validation. To evaluate the potential utility of an AI-based cardiovascular diseases (CVD) screening tool in an under-resourced African-American cohort, we reviewed the AI-enhanced electrocardiogram (ECG) data of participants enrolled in a community-based clinical trial as a proof-of-concept ancillary study for community-based screening. Methods Enrollees completed cardiovascular testing including standard 12-lead ECG and a limited echocardiogram (TTE). All ECGs were analyzed using previously published institution-based AI algorithms. AI-ECG predictions were generated for age, sex, and decreased left ventricular ejection fraction (LVEF). Diagnostic accuracy of the AI-ECG for decreased LVEF and sex was quantified using area under the receiver operating characteristic curve (AUC). Correlation between actual age and AI-ECG predicted age was assessed using Pearson correlation coefficients. Results Fifty-four participants completed both an ECG and TTE (mean age 55 years [range 31-87 years]; 66.7% female). All participants were in sinus rhythm, and the median LVEF of the cohort was 60-65%. The AI-ECG for decreased LVEF demonstrated excellent performance with an AUC of 0.892 (95% confidence interval [CI] 0.708-1); sensitivity=50% (95% CI 9.5-90.5%; n=1/2) and specificity=96% (95% CI 86.8-98.9%; n=49/51). The AI-ECG for participant sex demonstrated similar performance with AUC of 0.944 (95% CI 0.891-0.998); sensitivity=100% (95% CI 82.4-100.0%; n=18/18) and specificity=77.8% (95% CI 61.9-88.3%; n=28/36). The AI-ECG predicted mean age was 55 years (range 26.9-72.6 years) with a strong correlation to actual age (R=0.769; p<0.001). Conclusion Our analyses of previously developed AI-ECG algorithms for prediction of age, sex, and decreased LVEF demonstrated reliable performance in this community-based, African-American cohort. This novel, community-centric delivery of AI could provide valuable screening resources and appropriate referrals for early detection of highly-morbid CVD for under-resourced patient populations.
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Key Words
- ADI, Area Deprivation Index
- AHA, American Heart Association
- Artificial intelligence
- CBPR, community-based participatory research
- CVD, cardiovascular disease
- CVH, cardiovascular health
- Disparities
- Electrocardiogram
- FAITH!, Fostering African-American Improvement in Total Health!
- LS7, Life's Simple 7
- LVEF, left ventricular ejection fraction
- Race
- SDOH, Social determinants of health
- TTE, transthoracic echocardiogram
- mHealth, mobile health
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Affiliation(s)
- David M. Harmon
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Jeremy R. Van't Hof
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN
| | - Matthew Johnson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sharonne N. Hayes
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | - Zachi I. Attia
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Paul A. Friedman
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - LaPrincess C. Brewer
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
- Corresponding author at: Department of Cardiovascular Disease, 200 1st Street SW, Rochester, MN 55905.
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Tipre M, Bolaji B, Blanchard C, Harrelson A, Szychowski J, Sinkey R, Julian Z, Tita A, Baskin ML. Relationship Between Neighborhood Socioeconomic Disadvantage and Severe Maternal Morbidity and Maternal Mortality. Ethn Dis 2022; 32:293-304. [PMID: 36388861 PMCID: PMC9590600 DOI: 10.18865/ed.32.4.293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Rates of severe maternal morbidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health. Purpose Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM. Methods Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indicated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrelation and ORs were computed to evaluate the relationship between ADI and SMM/MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence. Results Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood transfusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increasing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM. Conclusion Our results suggest that residence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene.
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Affiliation(s)
- Meghan Tipre
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL
| | - Bolanle Bolaji
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL
| | - Christina Blanchard
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
| | - Alex Harrelson
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Jeff Szychowski
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL
| | - Rachel Sinkey
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Zoe Julian
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
| | - Alan Tita
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Monica L. Baskin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL
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Grits D, Emara AK, Klika AK, Murray TG, McLaughlin JP, Piuzzi NS. Neighborhood Socioeconomic Disadvantage Associated With Increased Healthcare Utilization After Total Hip Arthroplasty. J Arthroplasty 2022; 37:1980-1986.e2. [PMID: 35526755 DOI: 10.1016/j.arth.2022.04.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The multifaceted effects of socioeconomic status on healthcare outcomes can be difficult to quantify. The Area Deprivation Index (ADI) quantifies a socioeconomic disadvantage with higher scores indicating more disadvantaged groups. The present study aimed to describe the ADI distribution for primary total hip arthroplasty (THA) patients stratified by patient demographics and to characterize the association of ADI with healthcare utilization (discharge disposition and length of stay [LOS]), 90-day emergency department (ED) visits, and 90-day all cause readmissions. METHODS Two thousand three hundred and ninety one patients who underwent primary elective THA over a 13-month period were included. A multivariable binary logistic regression analysis with outcomes of nonhome discharge, prolonged LOS (>3 days), 90-day ED visits, and 90-day readmission were performed using predictors of ADI, gender, race, smoking status, body mass index, insurance status, and Charlson comorbidity index. Plots of restricted cubic splines were used to graph associations between ADI as a continuous variable and the outcomes of interest using odds ratios. RESULTS In the multivariable regression model, there were statistically significant higher odds of nonhome discharge (OR, 1.82; 95% CI, 1.19-2.77, P = .005) for individuals in the 61-80 ADI quintile as compared to the reference group of 21-40. Individuals in the highest ADI quintile, 81-100, had the greatest odds of nonhome discharge (OR, 2.20; 95% CI, 1.39-3.49, P < .001) and prolonged LOS (OR, 1.91, 95% CI, 1.28-2.84, P = .001). CONCLUSIONS Higher ADI is associated with an increased healthcare utilization within 90 days of THA.
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Affiliation(s)
- Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John P McLaughlin
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Distelhorst KS, Hansen DM. Neighborhood matters for transitional care and heart failure hospital readmission in older adults. Geriatr Nurs 2022; 47:183-190. [PMID: 35940036 DOI: 10.1016/j.gerinurse.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022]
Abstract
A retrospective correlational design with existing data was utilized to examine the relationship between early provider follow-up, nursing care coordination intensity, and 30-day hospital readmission in older adults with heart failure and determine if an interaction exists with neighborhood disadvantage. Forward logistic regression was conducted to determine which variables predicted early provider follow-up and readmission. Ordinary least squares regression, logistic regression, and bootstrap confidence intervals were used to test for mediation and moderation. A direct relationship between early provider follow-up and decreased readmission was identified, but no indirect relationship through care coordination intensity. Neighborhood disadvantage did not moderate the effect of provider follow-up on readmission. Early provider follow-up and care coordination intensity were related and moderated by neighborhood disadvantage, but not for those living in highly disadvantaged neighborhoods. Neighborhood disadvantage is a key factor that may negatively influence participation in transitional care interventions in the elderly heart failure population.
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Affiliation(s)
- Karen S Distelhorst
- Cleveland Clinic, Office of Nursing Research & Innovation, 9500 Euclid Avenue, T4-48, Cleveland, OH 44195, United States.
| | - Dana M Hansen
- Kent State University, College of Nursing, Henderson Hall, P.O. Box 5190, Kent, OH 44242, United States
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Essien UR, Johnson AE. Whose Streets? Neighborhood-Level Determinants of Atrial Fibrillation Care. Circulation 2022; 146:172-174. [PMID: 35861772 DOI: 10.1161/circulationaha.122.060640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Utibe R Essien
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., A.E.J.).,Division of General Internal Medicine (U.R.E.), University of Pittsburgh School of Medicine, PA
| | - Amber E Johnson
- Division of General Internal Medicine (U.R.E.), University of Pittsburgh School of Medicine, PA.,Division of Cardiology (A.E.J.), University of Pittsburgh School of Medicine, PA
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Shiff HM, Arias F, Dufour AB, Carr D, Chen F, Gou Y, Jones R, Schmitt E, Travison TG, Kunicki ZJ, Okereke OI, Inouye SK. Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures. Innov Aging 2022; 6:igac050. [PMID: 36128514 PMCID: PMC9478553 DOI: 10.1093/geroni/igac050] [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: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later-life delirium. In this study, we explored the association between paternal occupation and delirium risk.
Research Design and Methods
A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM-Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay.
Results
Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR (95% confidence interval [CI]) = 1.6 (1.1, 2.3). All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index. Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared with white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 (95% CI = 0.4, 1.4) additional severity units.
Discussion and Implications
Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life-course framework to evaluate the risk of later-life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.
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Affiliation(s)
- Haley M Shiff
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
| | - Alyssa B Dufour
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Deborah Carr
- Department of Sociology, Boston University , Boston, Massachusetts , USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Yun Gou
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Richard Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Eva Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Thomas G Travison
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Olivia I Okereke
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts , USA
| | - Sharon K Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
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Bonner SN, Kunnath N, Dimick JB, Ibrahim AM. Neighborhood deprivation and Medicare expenditures for common surgical procedures. Am J Surg 2022; 224:1274-1279. [PMID: 35750504 DOI: 10.1016/j.amjsurg.2022.06.004] [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: 04/25/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The Center of Medicare and Medicaid Services valued based payments for inpatient surgical hospitalizations are adjusted for clinical but not social risk factors. While research has shown that social risk is associated with worse surgical patient outcomes, it is unknown if inpatient surgical episode Medicare payments are affected by social risk factors. METHODS Retrospective review of Medicare beneficiaries, age 65-99, undergoing appendectomy, colectomy, hernia repair, or cholecystectomy between 2014 and 2018. Neighborhood deprivation measured by Area Deprivation Index for beneficiary census tract. We evaluated Medicare payments for a total episode of surgical care comprised of index hospitalization, physician fees, post-acute care, and readmission by beneficiary neighborhood deprivation. RESULTS A total of 809,059 patients (Women, 56.0%) and mean (SD) age of 75.7 (7.4 years were included. A total of 145,351 beneficiaries lived in the least deprived neighborhoods and 134,188 who lived in the most deprived neighborhoods. Total surgical episode spending was $2654 higher among beneficiaries from the most deprived neighborhoods compared to those from the least after risk adjustment for clinical and hospital factors. These differences were driven in part by higher rates of readmissions (12.9% vs 10.8%, P < 0.001) and post-acute care (67.8% vs. 61.2%, P < 0.001) among beneficiaries living in the most deprived neighborhoods. CONCLUSION These findings suggest that value-based payment models with inclusion of social risk adjustment may be needed for surgical cohorts. Moreover, efforts focused on investing in deprived communities may be aligned with surgical quality improvement.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA.
| | - Nicholas Kunnath
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Andrew M Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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Omole TD, Zhu J, Garrard W, Thoma FW, Mulukutla S, McDermott A, Herbert BM, Essien UR, Magnani JW. American Journal of Preventive Cardiology: Area Deprivation Index and Oral Anticoagulation in New Onset Atrial Fibrillation. Am J Prev Cardiol 2022; 10:100346. [PMID: 35517873 PMCID: PMC9066349 DOI: 10.1016/j.ajpc.2022.100346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 12/29/2022] Open
Abstract
Objective Oral anticoagulation is a standard of care for thromboembolic stroke prevention in individuals with atrial fibrillation (AF). Social determinants of health have had limited investigation in AF and particularly in access to anticoagulation. We examined the relation between area deprivation index (ADI) and anticoagulation in individuals at risk of stroke due to AF. Methods We conducted a retrospective analysis of patients with incident, non-valvular AF from 2015-2020 receiving care at a large, regional health center. We extracted demographics, medications, and problem lists and used administrative coding to identify comorbid conditions and relevant covariates, and individual-level residential address to ascertain ADI. We examined the relation between ADI and receipt of prescribed oral anticoagulation (warfarin or direct-acting oral anticoagulant, or DOAC) at 90 days following AF diagnosis in multivariable-adjusted models. Results Following exclusions, the dataset included 20,210 individuals (age 74.5±10.9 years; 51% women; 94% white race). In multivariable-adjusted analyses, individuals in the highest quartile of ADI had a 16% lower likelihood of receiving anticoagulation prescription than those in the lowest ADI quartile (Odds Ratio [OR] 0.84; 95% Confidence Interval [CI], 0.75-0.95) at 90 days following AF diagnosis. In those receiving anticoagulation, individuals in the highest ADI quartile had a 24% lower likelihood of receiving a DOAC prescription as opposed to warfarin prescription than those in the lowest quartile (OR 0.76; 95% CI, 0.60-0.96) at 90 days following AF diagnosis. Conclusions We demonstrate the association of higher neighborhood deprivation as determined by ADI with decreased likelihood of (1) anticoagulation prescribing for stroke prevention in AF and (2) prescription of a DOAC when any oral anticoagulation is prescribed. Our results suggest neighborhood-based health inequities in the receipt of anticoagulation prescription for stroke prevention in AF in a large, regional health care system.
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Affiliation(s)
| | - Jianuhi Zhu
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh, PA
| | | | - Floyd W. Thoma
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh, PA
| | - Suresh Mulukutla
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh, PA
| | | | - Brandon M. Herbert
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Utibe R. Essien
- Univeristy of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Jared W. Magnani
- Univeristy of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh, PA
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Corresponding author at: Dr. Jared W Magnani, Department of Medicine, Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, United States, Phone: 412-692-4942, Fax: 412-692-4944
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Yao X, Noseworthy PA. Bringing context and nuance to risk prediction by incorporating social determinants of health. Eur J Prev Cardiol 2022; 29:1463-1464. [PMID: 35580587 DOI: 10.1093/eurjpc/zwac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Xiaoxi Yao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Morris MC, Bruehl S, Stone AL, Garber J, Smith C, Palermo TM, Walker LS. Place and Pain: Association Between Neighborhood SES and Quantitative Sensory Testing Responses in Youth With Functional Abdominal Pain. J Pediatr Psychol 2022; 47:446-455. [PMID: 34757421 PMCID: PMC9308448 DOI: 10.1093/jpepsy/jsab113] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Neighborhood socioeconomic status (SES) is linked to self-reported pain severity and disability but its association with evoked pain responsiveness in individuals with chronic pain remains unclear. The present study examined relations between neighborhood SES, assessed through the area deprivation index (ADI), and static and dynamic pain response indices. It was hypothesized that youth with functional abdominal pain (FAP) living in lower SES neighborhoods would exhibit lower pain threshold, lower pain tolerance, and reduced conditioned pain modulation (CPM) compared to youth living in higher SES neighborhoods. METHODS Participants were 183 youth with FAP and their parents. Youth completed a quantitative sensory testing protocol. Family addresses were used to compute ADI scores. Thermal stimuli for pain threshold and tolerance were delivered to participants' forearms using thermodes. CPM, an index of descending pain inhibition, was determined using a thermode as test stimulus and a hot water bath as conditioning stimulus. RESULTS As hypothesized, youth with FAP living in lower SES neighborhoods exhibited weaker CPM. Contrary to hypotheses, lower neighborhood SES was associated with neither pain thresholds nor with pain tolerance. CONCLUSIONS These findings demonstrated the independent contribution of place of residence-an often neglected component of the biopsychosocial model-to efficiency of descending pain inhibition. Understanding the mechanisms that account for such associations between place and pain could guide the development of public health and policy initiatives designed to mitigate chronic pain risk in underserved and economically marginalized communities.
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Affiliation(s)
- Matthew C Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Craig Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
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47
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Amiya E. Social Inequalities in Non-ischemic Cardiomyopathies. Front Cardiovasc Med 2022; 9:831918. [PMID: 35321101 PMCID: PMC8934878 DOI: 10.3389/fcvm.2022.831918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) has various characteristics, such as etiology, clinical course, and clinical characteristics. Several studies reported the clinical findings of the characteristics of non-ischemic cardiomyopathy. There have been issues with genetic, biochemical, or pathophysiological problems. Some studies have been conducted on non-ischemic cardiomyopathy and social factors, for instance, racial disparities in peripartum cardiomyopathy (PPCM) or the social setting of hypertrophic cardiomyopathy. However, there have been insufficient materials to consider the relationship between social factors and clinical course in non-ischemic cardiomyopathies. There were various methodologies in therapeutic interventions, such as pharmacological, surgical, or rehabilitational, and educational issues. However, interventions that could be closely associated with social inequality have not been sufficiently elucidated. We will summarize the effects of social equality, which could have a large impact on the development and progression of HF in non-ischemic cardiomyopathies.
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Affiliation(s)
- Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, University of Tokyo, Tokyo, Japan
- *Correspondence: Eisuke Amiya
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48
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Johnson AE, Zhu J, Garrard W, Thoma FW, Mulukutla S, Kershaw KN, Magnani JW. Area Deprivation Index and Cardiac Readmissions: Evaluating Risk-Prediction in an Electronic Health Record. J Am Heart Assoc 2021; 10:e020466. [PMID: 34212757 PMCID: PMC8403312 DOI: 10.1161/jaha.120.020466] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Assessment of the social determinants of post-hospital cardiac care is needed. We examined the association and predictive ability of neighborhood-level determinants (area deprivation index, ADI), readmission risk, and mortality for heart failure, myocardial ischemia, and atrial fibrillation. Methods and Results Using a retrospective (January 1, 2011-December 31, 2018) analysis of a large healthcare system, we assess the predictive ability of ADI on 30-day and 1-year readmission and mortality following hospitalization. Cox proportional hazards models analyzed time-to-event. Log rank analyses determined survival. C-statistic and net reclassification index determined the model's discriminative power. Covariates included age, sex, race, comorbidity, number of medications, length of stay, and insurance. The cohort (n=27 694) had a median follow-up of 46.5 months. There were 14 469 (52.2%) men and 25 219 White (91.1%) patients. Patients in the highest ADI quintile (versus lowest) were more likely to be admitted within 1 year of index heart failure admission (hazard ratio [HR], 1.25; 95% CI, 1.03‒1.51). Patients with myocardial ischemia in the highest ADI quintile were twice as likely to be readmitted at 1 year (HR, 2.04; 95% CI, 1.44‒2.91]). Patients with atrial fibrillation living in areas with highest ADI were less likely to be admitted within 1 year (HR, 0.79; 95% CI, 0.65‒0.95). As ADI increased, risk of readmission increased, and risk reclassification was improved with ADI in the models. Patients in the highest ADI quintile were 25% more likely to die within a year (HR, 1.25 1.08‒1.44). Conclusions Residence in socioeconomically disadvantaged communities predicts rehospitalization and mortality. Measuring neighborhood deprivation can identify individuals at risk following cardiac hospitalization.
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Affiliation(s)
- Amber E Johnson
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | - Jianhui Zhu
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | | | - Floyd W Thoma
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | - Suresh Mulukutla
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | - Kiarri N Kershaw
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Jared W Magnani
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
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