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Truong NM, Stroud SG, Zhuang T, Fernandez A, Kamal RN, Shapiro LM. The Association Between Social Determinants of Health and Distal Radius Fracture Outcomes. J Hand Surg Am 2024:S0363-5023(24)00201-6. [PMID: 38934997 DOI: 10.1016/j.jhsa.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of distal radius fractures and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with postoperative complications. METHODS Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and environmental factors. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates. RESULTS After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07-3.29]), infection (OR: 2.37 [95% CI: 2.12-2.66]), wound dehiscence (OR: 2.06 [95% CI: 1.72-2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15-1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08-1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07-1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications. CONCLUSIONS Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the perioperative period. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis II.
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Affiliation(s)
- Nicole M Truong
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Sarah G Stroud
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Thompson Zhuang
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alicia Fernandez
- Department of Internal Medicine, University of California, San Francisco, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California, San Francisco, CA.
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Raikes A, Sayre R, Davis D. Mini-Review on Capacity-Building for Data-Driven Early Childhood Systems: The Consortium for Pre-primary Data and Measurement in Sub-Saharan Africa. Front Public Health 2021; 8:595821. [PMID: 33718313 PMCID: PMC7946824 DOI: 10.3389/fpubh.2020.595821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
Low- and middle-income countries (LMIC) are increasing investments in early childhood development programs, including early childhood education. As programs reach scale, there is increasing demand for evidence on impacts of investments. Little work to date has examined capacity required to effectively use data at scale in LMIC, including opportunities and barriers to integrating data into ongoing program implementation and tracking child development and quality of services at scale. Below, we outline the rationale and approach of the Consortium for Pre-primary Data and Measurement in Sub-Saharan Africa, focused on building capacity for data-driven decision-making in early childhood systems. Themes from the first phase include the importance of building diverse groups of stakeholders to define priorities for data and measurement, the need for coordinated and strategic investments in data and measurement, and the value of long-term investments in government/civil society/university partnerships to generate locally relevant data on early childhood education.
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Affiliation(s)
- Abbie Raikes
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Rebecca Sayre
- ECD Measure, University of Nebraska Lincoln, Lincoln, NE, United States
| | - Dawn Davis
- University of Nebraska Lincoln, Lincoln, NE, United States
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Montoya-Williams D, Peña MM, Fuentes-Afflick E. In Pursuit of Health Equity in Pediatrics. THE JOURNAL OF PEDIATRICS: X 2020; 5. [PMID: 33733084 PMCID: PMC7963264 DOI: 10.1016/j.ympdx.2020.100045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Diana Montoya-Williams
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | | | - Elena Fuentes-Afflick
- Zuckerberg San Francisco General Hospital, University of California, San Francisco, California
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Hong YR, Mainous AG. Development and Validation of a County-Level Social Determinants of Health Risk Assessment Tool for Cardiovascular Disease. Ann Fam Med 2020; 18:318-325. [PMID: 32661032 PMCID: PMC7358032 DOI: 10.1370/afm.2534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Social determinants of health (SDoH) have been linked to a variety of health conditions, but there are no multivariate measures of these determinants to estimate the risk of morbidity or mortality in a community. We developed a score derived from multivariate measures of SDoH that predicts county-level cardiovascular disease (CVD) mortality. METHODS Using county-level data from 3,026 US counties, we developed a score considering variables of neighborhood socioeconomic status, food/lifestyle environment, and health care resource availability and accessibility to predict the 3-year average (2015-2017) age-adjusted county-level mortality rate for all CVD. We used one 50% random sample to develop the score and the other to validate the score. A Poisson regression model was developed to estimate parameters of variables while accounting for intrastate correlation. RESULTS The index score was based on 7 SDoH factors: percentage of the population of minority (nonwhite) race, poverty rate, percentage of the population without a high school diploma, grocery store ratio, fast-food restaurant ratio, after-tax soda price, and primary care physician supply. The area under the curve for the development and validation groups was similar, 0.851 (95% CI, 0.829-0.872) and 0.840 (95% CI, 0.817-0.863), respectively, indicating excellent discriminative ability. The index had better predictive performance for CVD burden than other area-level indexes: poverty only (area under the curve= 0.808, P <.001); the Centers for Disease Control and Prevention's Social Vulnerability Index (CDC-SVI) (area under the curve =0.786, P <.001); and the Agency for Healthcare Research and Quality's Socioeconomic Status (AHRQ-SES) index (area under the curve =0.835, P = .03). CONCLUSIONS Our validated multivariate SDoH index score accurately classifies counties with high CVD burden and therefore has the potential to improve CVD risk prediction for vulnerable populations and interventions for CVD at the county level.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
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Melo FCCD, Costa RFRD, Del Corso JM. Public health management: systemic analysis of social determinants of health in Brazilian municipalities. Health Policy Plan 2020; 35:123-132. [PMID: 31711144 DOI: 10.1093/heapol/czz123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2019] [Indexed: 01/21/2023] Open
Abstract
The health sector is considered extremely important by governments and multilateral international organisms, due to its implication to life, as well as material and human struggling involved. This study adopts a systematical approach in order to question if the mortality outcomes in medium Brazilian cities explain or may be explained by factors considered external to the public health service, expressed by health social determinants. Therefore, this study aims to investigate health conditions in public health management in medium Brazilian cities. The scenario adopted contains 192 cities with a population contingent between 100 000 and 500 000 inhabitants, between the years 2007 and 2011. The database produced, containing 30 indicators representing conceptual models referenced, allowed the elaboration of an operational model of health social determinants from a Bayesian network. As result, we elaborated a model of health system formed by six factors, showing associations that allow a better comprehension about relations among health social determinants and health conditions, producing contextualized information, able to subsidize the formulation of strategies by managers of Sistema Único de Saúde.
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Affiliation(s)
- Francisco Carlos Carvalho de Melo
- Departamento de Economia, Universidade do Estado do Rio Grande do Norte - UERN, BR 110 - KM 48, Rua Professor Antonio Campos, Costa e Silva, Mossoró, RN CEP: 59625-620, Brazil.,Programa de Mestrado e Doutorado em Administração - PPAD, Pontifícia Universidade Católica do Paraná - PUCPR, Rua Imaculada Conceição, 115, Prado Velho, Curitiba, PR CEP: 80215901, Brazil
| | - Rodolfo Ferreira Ribeiro da Costa
- Departamento de Economia, Universidade do Estado do Rio Grande do Norte - UERN, BR 110 - KM 48, Rua Professor Antonio Campos, Costa e Silva, Mossoró, RN CEP: 59625-620, Brazil.,Departamento de Economia, Universidade do Estado do Rio Grande do Norte - UERN, BR 110 - KM 48, Rua Professor Antonio Campos, Costa e Silva, Mossorõ, RN CEP: 59625-620, Brazil.,Programa de Pós-Graduação em Economia - CAEN, Universidade Federal do Ceará - UFC, Av. da Universidade, 2762, Prédio CAEN, 1° e 2° andares, Benfica, Fortaleza, CE CEP: 60.020-181, Brazil
| | - Jansen Maia Del Corso
- Programa de Mestrado e Doutorado em Administração - PPAD, Pontifícia Universidade Católica do Paraná - PUCPR, Rua Imaculada Conceição, 115, Prado Velho, Curitiba, PR CEP: 80215901, Brazil.,Programa de Mestrado e Doutorado em Administração - PPAD, Pontifícia Universidade Católica do Paraná - PUCPR, Rua Imaculada Conceição, 115, Prado Velho, Curitiba, PR CEP: 80215901, Brazil.,Escuela Superior de Administración y Dirección de Empresas - ESADE, Universidad Ramón Llull - URL, Barcelona, Espanha
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Prescott C, Shahram SZ, Ogilvie G, Hassam N, Franks AS, Pauly B. Applying a health equity tool to assess a public health nursing guideline for practice in sexually transmitted infection assessment in British Columbia. Canadian Journal of Public Health 2020; 111:610-616. [PMID: 32086774 DOI: 10.17269/s41997-019-00285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/10/2019] [Indexed: 11/17/2022]
Abstract
SETTING There is a multitude of health equity tools but little guidance on how to effectively use these tools in public health nursing practice. In BC, public health nurses who are certified in sexually transmitted infection care utilize guidelines authorized by the nursing regulatory body. INTERVENTION As part of the Equity Lens in Public Health (ELPH) research project, an assessment of the nursing guideline, Sexually Transmitted Infection (STI) Assessment Decision Support Tool, was undertaken using the Assessing Equity in Clinical Practice Guidelines health equity assessment tool. The chosen tool is intended for use by health care providers, is broadly applicable to clinical practice guidelines, can be used retrospectively, and falls within the category of equity checklists and audits. OUTCOMES Overall, the tool was useful in assessing the inclusion and omission of an equity focus in the guideline. However, there were several challenges: the identification of an appropriate health equity tool; the absence of an evaluation of the chosen tool; the tool's focus on chronic disease versus communicable disease; and the difficulty of obtaining client perspectives. IMPLICATIONS For an improved equity lens in the STI Assessment Decision Support Tool, future revisions should be equity focused and include perspectives from affected populations, an emphasis on the determinants of health that perpetuate inequities for populations who experience a disproportionate burden of STI, information on provincially available resources, and service delivery models that improve timely and equitable access to treatment and care.
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Affiliation(s)
- Cheryl Prescott
- Sexual Health and Blood Borne Infections, Population Public Health, Fraser Health Authority, 400 - 13450 - 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - Sana Z Shahram
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada.
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, British Columbia Centre for Disease Control, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Noorjean Hassam
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - Bernie Pauly
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
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Adams JM. Appointment of Editor in Chief of Public Health Reports: Charting the Journal’s New Course and Sustaining Momentum. Public Health Rep 2020. [DOI: 10.1177/0033354920904086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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De Jesus M, Williams DR. The Care and Prevention in the United States Demonstration Project: A Call for More Focus on the Social Determinants of HIV/AIDS. Public Health Rep 2019; 133:28S-33S. [PMID: 30457952 DOI: 10.1177/0033354918801353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Maria De Jesus
- 1 School of International Service and Center on Health, Risk, and Society, American University, Washington, DC, USA
| | - David R Williams
- 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,3 Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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Ahuja M, Aseltine R, Warren N, Reisine S, Williams PH, Cislo A. Challenges faced with the implementation of Web-Based Data Query Systems for population health: development of a questionnaire based on expert consensus. Pilot Feasibility Stud 2018; 4:113. [PMID: 29942641 PMCID: PMC6003067 DOI: 10.1186/s40814-018-0307-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 06/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND State health agencies (SHA) and local health agencies (LHA) face several challenges with the dissemination of local health data using Web-Based Data Query Systems (WDQS). To help guide future research, this study aimed to utilize expert consensus to identify the most relevant items that contribute to these challenges. METHODS A total of 17 researchers and public health professionals agreed to participate in a three-round Delphi process. In round 1, four topics were represented on a 42-item questionnaire using a 5-point Likert scale, along with free-text responses. Free-text responses were analyzed leading to a series of items for a second Delphi round. Participants were given an opportunity to revise results in round 3 for items that did not meet consensus in round 1 or round 2. Consensus on expert opinions was defined at interquartile range (IQR) ≤ 1. RESULTS The experts reached consensus on a total of 21 (50%) of the 42 items presented in the initial questionnaire. Eleven of the 15 (73%) of the items extracted from the free-text responses met consensus. Items in consensus from this pilot study were used to develop an instrument for a broader survey across Behavioral Risk Factor Surveillance System (BRFSS) coordinators across all 50 US states. CONCLUSION Experts confirmed that software development costs, inadequate human resources, data sharing gaps, a lack of political support, and poor data quality contribute significantly to challenges in their data implementation. The findings from this pilot study inform us of items of public health significance that will help guide future research.
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Affiliation(s)
- Manik Ahuja
- Brown School of Social Work, Washington University, St. Louis, MO 63110 USA
| | - Robert Aseltine
- Center for Population Health, University of Connecticut Health Center, Farmington, CT 06032 USA
| | - Nicholas Warren
- Division of Occupational and Environmental Medicine, University of Connecticut Health Center, Farmington, CT 06032 USA
| | - Susan Reisine
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT 06032 USA
| | - Pam Holtzclaw Williams
- Department of Nursing, University of Arkansas Medical Sciences (UAMS), Little Rock, AR 72205 USA
| | - Andy Cislo
- Center for Population Health, University of Connecticut Health Center, Farmington, CT 06032 USA
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Patterson MT, Grossman RL. Detecting Spatial Patterns of Disease in Large Collections of Electronic Medical Records Using Neighbor-Based Bootstrapping. BIG DATA 2017; 5:213-224. [PMID: 28933946 PMCID: PMC5647508 DOI: 10.1089/big.2017.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We introduce a method called neighbor-based bootstrapping (NB2) that can be used to quantify the geospatial variation of a variable. We applied this method to an analysis of the incidence rates of disease from electronic medical record data (International Classification of Diseases, Ninth Revision codes) for ∼100 million individuals in the United States over a period of 8 years. We considered the incidence rate of disease in each county and its geospatially contiguous neighbors and rank ordered diseases in terms of their degree of geospatial variation as quantified by the NB2 method. We show that this method yields results in good agreement with established methods for detecting spatial autocorrelation (Moran's I method and kriging). Moreover, the NB2 method can be tuned to identify both large area and small area geospatial variations. This method also applies more generally in any parameter space that can be partitioned to consist of regions and their neighbors.
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Affiliation(s)
- Maria T. Patterson
- Center for Data Intensive Science, University of Chicago, Chicago, Illinois
| | - Robert L. Grossman
- Center for Data Intensive Science, University of Chicago, Chicago, Illinois
- Computation Institute, University of Chicago, Chicago, Illinois
- Section of Computational Biomedicine and Biomedical Data Science, Department of Medicine, University of Chicago, Chicago, Illinois
- Institute for Genomics and Systems Biology, University of Chicago, Chicago, Illinois
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Caracciolo C, Parker D, Marshall E, Brown J. Excess Readmission vs Excess Penalties: Maximum Readmission Penalties as a Function of Socioeconomics and Geography. J Hosp Med 2017; 12:610-617. [PMID: 28786426 PMCID: PMC6091554 DOI: 10.12788/jhm.2781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with "excess" readmissions up to 3% of Medicare reimbursement. Approximately 75% of eligible hospitals received penalties, worth an estimated $428 million, in fiscal year 2015. OBJECTIVE To identify demographic and socioeconomic disparities between matched and localized maximum-penalty and no-penalty hospitals. DESIGN A case-control study in which cases included were hospitals to receive the maximum 3% penalty under the HRRP during the 2015 fiscal year. Controls were drawn from no-penalty hospitals and matched to cases by hospital characteristics (primary analysis) or geographic proximity (secondary analysis). SETTING A selectiion of 3383 US hospitals eligible for HRRP. PARTICIPANTS Thirty-nine case and 39 control hospitals from the HRRP cohort. MEASUREMENTS Socioeconomic status variables were collected by the American Community Survey. Hospital and health system characteristics were drawn from Centers for Medicare and Medicaid Services, American Hospital Association, and Dartmouth Atlas of Health Care. The statistical analysis was conducted using Student t tests. RESULTS Thirty-nine hospitals received a maximum penalty. Relative to controls, maximum-penalty hospitals in counties with lower SES profiles are defined by increased poverty rates (19.1% vs 15.5%, 𝑃 = 0.015) and lower rates of high school graduation (82.2% vs 87.5%, 𝑃 = 0.001). County level age, sex, and ethnicity distributions were similar between cohorts. CONCLUSIONS Cases were more likely than controls to be in counties with low socioeconomic status; highlighting potential unintended consequences of national benchmarks for phenomena underpinned by environmental factors; specifically, whether maximum penalties under the HRRP are a consequence of underperforming hospitals or a manifestation of underserved communities.
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Affiliation(s)
- Chris Caracciolo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Netter School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Devin Parker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Emily Marshall
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jeremiah Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Medicine and of Community and Family Medicine, Geisel School of Medicine, Lebanon, New Hampshire
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Zhou Y, Bemanian A, Beyer KM. Housing Discrimination, Residential Racial Segregation, and Colorectal Cancer Survival in Southeastern Wisconsin. Cancer Epidemiol Biomarkers Prev 2017; 26:561-568. [DOI: 10.1158/1055-9965.epi-16-0929] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 02/10/2017] [Indexed: 11/16/2022] Open
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Valentine NB, Koller TS, Hosseinpoor AR. Monitoring health determinants with an equity focus: a key role in addressing social determinants, universal health coverage, and advancing the 2030 sustainable development agenda. Glob Health Action 2016; 9:34247. [PMID: 27989275 PMCID: PMC5165053 DOI: 10.3402/gha.v9.34247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Nicole B Valentine
- Department of Public Health, Environmental and Social Determinants of Health, WHO, Geneva;
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14
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[Monitoring social determinants of health]. GACETA SANITARIA 2016; 30 Suppl 1:38-44. [PMID: 27837795 DOI: 10.1016/j.gaceta.2016.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 01/11/2023]
Abstract
Public health surveillance is the systematic and continuous collection, analysis, dissemination and interpretation of health-related data for planning, implementation and evaluation of public health initiatives. Apart from the health system, social determinants of health include the circumstances in which people are born, grow up, live, work and age, and they go a long way to explaining health inequalities. A surveillance system of the social determinants of health requires a comprehensive and social overview of health. This paper analyses the importance of monitoring social determinants of health and health inequalities, and describes some relevant aspects concerning the implementation of surveillance during the data collection, compilation and analysis phases, as well as dissemination of information and evaluation of the surveillance system. It is important to have indicators from sources designed for this purpose, such as continuous records or periodic surveys, explicitly describing its limitations and strengths. The results should be published periodically in a communicative format that both enhances the public's ability to understand the problems that affect them, whilst at the same time empowering the population, with the ultimate goal of guiding health-related initiatives at different levels of intervention.
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Koch U, Stout S, Landon BE, Phillips RS. From healthcare to health: A proposed pathway to population health. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 4:291-297. [PMID: 27693259 DOI: 10.1016/j.hjdsi.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/26/2016] [Accepted: 06/29/2016] [Indexed: 10/20/2022]
Abstract
Innovations in payment are encouraging clinical-community partnerships that address health determinants. However, little is known about how healthcare systems transform and partner to improve population health. We synthesized views of population health experts from nine organizations and illustrated the resulting model using examples from four health systems. The transformation requires a foundation of primary care, connectors and integrators that span the boundaries, sharing of goals among participants, aligned funding and incentives, and a supporting infrastructure, all leading to a virtuous cycle of collaboration. Policies are needed that will provide funding and incentives to encourage spread beyond early adopter organizations.
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Affiliation(s)
- Ursula Koch
- Department of National Prevention Programs at the Federal Office of Public Health, Schwarztorstrasse 96, Bern, 3003 Switzerland; University of Zürich, Institute for Primary Care, Pestalozzistrasse 24, Zürich, 8091 Switzerland.
| | - Somava Stout
- Center for Primary Care, Harvard Medical School, Boston, MA, USA; Institute for Healthcare Improvement, Cambridge, MA, 02139 USA; Cambridge Health Alliance, USA.
| | - Bruce E Landon
- Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Health Care Policy and Department of Medicine at Harvard Medical School, USA.
| | - Russell S Phillips
- Center for Primary Care, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA.
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16
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Beyer KMM, Zhou Y, Matthews K, Bemanian A, Laud PW, Nattinger AB. New spatially continuous indices of redlining and racial bias in mortgage lending: links to survival after breast cancer diagnosis and implications for health disparities research. Health Place 2016; 40:34-43. [PMID: 27173381 DOI: 10.1016/j.healthplace.2016.04.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 04/20/2016] [Accepted: 04/29/2016] [Indexed: 11/18/2022]
Abstract
Racial health disparities continue to be a serious problem in the United States and have been linked to contextual factors, including racial segregation. In some cases, including breast cancer survival, racial disparities appear to be worsening. Using the Home Mortgage Disclosure Act (HMDA) database, we extend current spatial analysis methodology to derive new, spatially continuous indices of (1) racial bias in mortgage lending and (2) redlining. We then examine spatial patterns of these indices and the association between these new measures and breast cancer survival among Black/African American women in the Milwaukee, Wisconsin metropolitan area. These new measures can be used to examine relationships between mortgage discrimination and patterns of disease throughout the United States.
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Affiliation(s)
- Kirsten M M Beyer
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, WI 53226-0509, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA.
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, WI 53226-0509, USA
| | - Kevin Matthews
- Department of Geographical and Sustainability Sciences, University of Iowa, 316 Jessup Hall, Iowa City, IA 52242, USA
| | - Amin Bemanian
- Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA
| | - Purushottam W Laud
- Division of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA
| | - Ann B Nattinger
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA
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Penman-Aguilar A, Talih M, Huang D, Moonesinghe R, Bouye K, Beckles G. Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22 Suppl 1:S33-42. [PMID: 26599027 PMCID: PMC5845853 DOI: 10.1097/phh.0000000000000373] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Reduction of health disparities and advancement of health equity in the United States require high-quality data indicative of where the nation stands vis-à-vis health equity, as well as proper analytic tools to facilitate accurate interpretation of these data. This article opens with an overview of health equity and social determinants of health. It then proposes a set of recommended practices in measurement of health disparities, health inequities, and social determinants of health at the national level to support the advancement of health equity, highlighting that (1) differences in health and its determinants that are associated with social position are important to assess; (2) social and structural determinants of health should be assessed and multiple levels of measurement should be considered; (3) the rationale for methodological choices made and measures chosen should be made explicit; (4) groups to be compared should be simultaneously classified by multiple social statuses; and (5) stakeholders and their communication needs can often be considered in the selection of analytic methods. Although much is understood about the role of social determinants of health in shaping the health of populations, researchers should continue to advance understanding of the pathways through which they operate on particular health outcomes. There is still much to learn and implement about how to measure health disparities, health inequities, and social determinants of health at the national level, and the challenges of health equity persist. We anticipate that the present discussion will contribute to the laying of a foundation for standard practice in the monitoring of national progress toward achievement of health equity.
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Affiliation(s)
- Ana Penman-Aguilar
- Office of Minority Health and Health Equity (Drs Penman-Aguilar, Moonesinghe, and Bouye) and National Center for Chronic Disease and Health Promotion (Dr Beckles), Centers for Disease Control and Prevention, Atlanta, Georgia; and National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland (Drs Talih and Huang)
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18
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Blum AB, Egorova NN, Sosunov EA, Gelijns AC, DuPree E, Moskowitz AJ, Federman AD, Ascheim DD, Keyhani S. Impact of socioeconomic status measures on hospital profiling in New York City. Circ Cardiovasc Qual Outcomes 2014; 7:391-7. [PMID: 24823956 PMCID: PMC4072036 DOI: 10.1161/circoutcomes.113.000520] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current 30-day readmission models used by the Center for Medicare and Medicaid Services for the purpose of hospital-level comparisons lack measures of socioeconomic status (SES). We examined whether the inclusion of an SES measure in 30-day congestive heart failure readmission models changed hospital risk-standardized readmission rates in New York City (NYC) hospitals. METHODS AND RESULTS Using a Centers for Medicare & Medicaid Services (CMS)-like model, we estimated 30-day hospital-level risk-standardized readmission rates by adjusting for age, sex, and comorbid conditions. Next, we examined how hospital risk-standardized readmission rates changed relative to the NYC mean with inclusion of the Agency for Healthcare Research and Quality (AHRQ)-validated SES index score. In a secondary analysis, we examined whether inclusion of the AHRQ SES index score in 30-day readmission models disproportionately impacted the risk-standardized readmission rates of minority-serving hospitals. Higher AHRQ SES scores, indicators of higher SES, were associated with lower odds (0.99) of 30-day readmission (P<0.019). The addition of the AHRQ SES index did not change the model's C statistic (0.63). After adjustment for the AHRQ SES index, 1 hospital changed status from worse than the NYC average to no different than the NYC average. After adjustment for the AHRQ SES index, 1 NYC minority-serving hospital was reclassified from worse to no different than average. CONCLUSIONS Although patients with higher SES were less likely to be admitted, the impact of SES on readmission was small. In NYC, inclusion of the AHRQ SES score in a CMS-based model did not impact hospital-level profiling based on 30-day readmission.
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Affiliation(s)
- Alexander B Blum
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
| | - Natalia N Egorova
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
| | - Eugene A Sosunov
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
| | - Annetine C Gelijns
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
| | - Erin DuPree
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
| | - Alan J Moskowitz
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
| | - Alex D Federman
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
| | - Deborah D Ascheim
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
| | - Salomeh Keyhani
- From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.)
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Dean HD, Fenton KA. Integrating a social determinants of health approach into public health practice: a five-year perspective of actions implemented by CDC's national center for HIV/AIDS, viral hepatitis, STD, and TB prevention. Public Health Rep 2014; 128 Suppl 3:5-11. [PMID: 24179273 DOI: 10.1177/00333549131286s302] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hazel D Dean
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA
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20
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Penman-Aguilar A, Harrison KM, Dean HD. Identifying the root causes of health inequities: reflections on the 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention health equity symposium. Public Health Rep 2014; 128 Suppl 3:29-32. [PMID: 24179276 DOI: 10.1177/00333549131286s305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ana Penman-Aguilar
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA ; Current affiliation: Centers for Disease Control and Prevention, Office of the Director, Office of Minority Health and Health Equity, Atlanta, GA
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Moonesinghe R, Fleming E, Truman BI, Dean HD. Linear and non-linear associations of gonorrhea diagnosis rates with social determinants of health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012. [PMID: 23202676 PMCID: PMC3499859 DOI: 10.3390/ijerph9093149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Identifying how social determinants of health (SDH) influence the burden of disease in communities and populations is critically important to determine how to target public health interventions and move toward health equity. A holistic approach to disease prevention involves understanding the combined effects of individual, social, health system, and environmental determinants on geographic area-based disease burden. Using 2006–2008 gonorrhea surveillance data from the National Notifiable Sexually Transmitted Disease Surveillance and SDH variables from the American Community Survey, we calculated the diagnosis rate for each geographic area and analyzed the associations between those rates and the SDH and demographic variables. The estimated product moment correlation (PMC) between gonorrhea rate and SDH variables ranged from 0.11 to 0.83. Proportions of the population that were black, of minority race/ethnicity, and unmarried, were each strongly correlated with gonorrhea diagnosis rates. The population density, female proportion, and proportion below the poverty level were moderately correlated with gonorrhea diagnosis rate. To better understand relationships among SDH, demographic variables, and gonorrhea diagnosis rates, more geographic area-based estimates of additional variables are required. With the availability of more SDH variables and methods that distinguish linear from non-linear associations, geographic area-based analysis of disease incidence and SDH can add value to public health prevention and control programs.
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Affiliation(s)
- Ramal Moonesinghe
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
- Author to whom correspondence should be addressed; ; Tel.: +1-770-488-8203; Fax: +1-770-488-8336
| | - Eleanor Fleming
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
- Centers for Disease Control and Prevention, Division of Applied Sciences, Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Atlanta, GA 30333, USA
| | - Benedict I. Truman
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
| | - Hazel D. Dean
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
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Depadilla L, Elifson KW, Sterk CE. Beyond Sexual Partnerships: The Lack of Condom Use during Vaginal Sex with Steady Partners. INTERNATIONAL PUBLIC HEALTH JOURNAL 2012; 4:435-446. [PMID: 24634708 PMCID: PMC3949990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this paper is to identify independent correlates of the lack of condom use when engaging in vaginal sex with steady partners among HIV-negative African American adults. The conceptual model includes proximal as well as more distal domains. METHODS Cross-sectional data were collected between May 2009 and August 2011. Recruitment involved active and passive recruitment strategies. Computer-assisted, individual interviews were conducted with 1,050 African American adults. Multivariate logistic regression was used to identify independent predictors of a lack of condom use with steady partners in the past 30 days. RESULTS In multivariate analysis, being older than 35, being partnered, perceiving having a steady partner as important, and ever having been homeless were associated positively with the odds of a lack of condom use during vaginal sex with steady partners in the past 30 days. On the other hand, reporting more than one steady partner in the past 30 days, having health insurance during the past 12 months, and perceived neighborhood social cohesion were negatively associated. CONCLUSIONS These findings highlight the need for HIV risk-reduction prevention and intervention efforts that consider distal as well as proximal domains. Such a perspective allows for a broader sociological inquiry into health disparities that moves beyond epidemiological factors that commonly guide public health research.
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Affiliation(s)
- Lara Depadilla
- Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road, Atlanta, GA 30322
| | - Kirk W Elifson
- Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road, Atlanta, GA 30322
| | - Claire E Sterk
- Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road, Atlanta, GA 30322
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Rivera-Diaz M, Varas-Diaz N, Reyes-Estrada M, Suro B, Coriano D. [SOCIO STRUCTURAL FACTORS AND HIV/AIDS STIGMA: EXPERIENCES FROM PUERTO RICANS LIVING WITH HIV/AIDS ACCESING HEALTH SERVICES.]. SALUD Y SOCIEDAD 2012; 3:180-192. [PMID: 24639599 PMCID: PMC3955388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
HIV/AIDS stigma continues affecting the provision of health services to people living with HIV/AIDS, as well as their physical and mental well-being. Scientific literature has highlighted the importance of understanding stigma manifestations that surpass one-on-one social interactions. For that reason, social research in Puerto Rico and elsewhere has highlighted the importance of understanding the Socio-Structural Factors (SSF) that foster HIV/AIDS stigma. With the objective of exploring the SSF that influence stigma manifestations related to HIV/AIDS, we conducted 9 focus groups composed by women and men on HIV/AIDS treatment that had experienced social stigma related to the disease. Participants identified SSF that they understood were related to stigma such as a) development of housing projects for people with HIV/AIDS, b) decentralization of health related services, and c) health services administrative protocols that fostered exclusion. Results evidence the importance of addressing SSF when developing stigma related interventions for this population.
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