1
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Hendi AS. Where Does the Black-White Life Expectancy Gap Come From? The Deadly Consequences of Residential Segregation. POPULATION AND DEVELOPMENT REVIEW 2024; 50:403-436. [PMID: 39035023 PMCID: PMC11258794 DOI: 10.1111/padr.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
The disparity in life expectancy between white and black Americans exceeds five years for men and three years for women. While prior research has investigated the roles of healthcare, health behaviors, biological risk, socioeconomic status, and life course effects on black mortality, the literature on the geographic origins of the gap is more limited. This study examines how the black-white life expectancy gap varies across counties and how much of the national gap is attributable to within-county racial inequality versus differences between counties. The estimates suggest that over 90% of the national gap can be attributed to within-county factors. Using a quasi-experimental research design, I find that black-white residential segregation increases the gap by approximately 16 years for men and five years for women. The segregation effect loads heavily on causes of death associated with access to and quality of healthcare; safety and violence; and public health measures. Residential segregation does not appear to operate through health behaviors or individual-level factors, but instead acts primarily through institutional mechanisms. Efforts to address racial disparities in mortality should focus on reducing racial residential segregation or reducing inequalities in the mechanisms through which residential segregation acts: public services, employment opportunities, and community resources.
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Affiliation(s)
- Arun S Hendi
- Office of Population Research and Department of Sociology, Princeton School of Public and International Affairs, Princeton University
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2
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Jindal M, Barnert E, Chomilo N, Gilpin Clark S, Cohen A, Crookes DM, Kershaw KN, Kozhimannil KB, Mistry KB, Shlafer RJ, Slopen N, Suglia SF, Nguemeni Tiako MJ, Heard-Garris N. Policy solutions to eliminate racial and ethnic child health disparities in the USA. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:159-174. [PMID: 38242598 PMCID: PMC11163982 DOI: 10.1016/s2352-4642(23)00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 01/21/2024]
Abstract
Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.
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Affiliation(s)
- Monique Jindal
- Department of Medicine, University of Illinois Chicago School of Medicine, Chicago, IL, USA.
| | - Elizabeth Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Nathan Chomilo
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Shawnese Gilpin Clark
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alyssa Cohen
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danielle M Crookes
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA; Department of Sociology and Anthropology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, USA
| | - Rebecca J Shlafer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nia Heard-Garris
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Institute for Policy Research, Northwestern University, Chicago, IL, USA
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3
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Loftin MC, Zynda AJ, Pollard-McGrandy A, Eke R, Covassin T, Wallace J. Racial differences in concussion diagnosis and mechanism of injury among adults presenting to emergency departments across the United States. Brain Inj 2023; 37:1326-1333. [PMID: 37607067 DOI: 10.1080/02699052.2023.2248581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the association between race and concussion diagnosis as well as the association between race and mechanism of injury (MOI) for concussion diagnoses in adult patients (>19 years old) visiting the emergency department (ED). METHODS A retrospective analysis of patient visits to the ED for concussion between 2010 and 2018, using the National Hospital Ambulatory Medical Care Survey, was conducted. Outcome measures included concussion diagnosis and MOI. Multivariable and multinomial logistic regression analyses were conducted to assess associations between race and outcome variables. The results were weighted to reflect population estimates with a significance set at p < 0.05. RESULTS Overall, 714 patient visits for concussions were identified, representing an estimated 4.3 million visits nationwide. Black adults had lower odds of receiving a concussion diagnosis [p < 0.05, Odds Ratio (OR), 0.54; 95% Confidence Interval (CI), 0.38-0.76] compared to White adults in the ED. There were no significant differences in MOI for a concussion diagnosis by race. CONCLUSION Racial differences were found in the ED for concussion diagnosis. Disparities in concussion diagnosis for Black or other minoritized racial groups could have significant repercussions that may prolong recovery or lead to long-term morbidity.
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Affiliation(s)
- Megan C Loftin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Aaron J Zynda
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | | | - Ransome Eke
- Department of Community Medicine, School of Medicine, Mercer University, Columbus, Georgia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama, USA
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Dean LT, Zhang Y, McCleary RR, Dawit R, Thorpe RJ, Gaskin D. Health Care Expenditures for Black and White US Adults Living Under Similar Conditions. JAMA HEALTH FORUM 2023; 4:e233798. [PMID: 37921746 PMCID: PMC10625039 DOI: 10.1001/jamahealthforum.2023.3798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Importance Evidence suggests that racial disparities in health outcomes disappear or diminish when Black and White adults in the US live under comparable living conditions; however, whether racial disparities in health care expenditures concomitantly disappear or diminish is unknown. Objective To examine whether disparities in health care expenditures are minimized when Black and White US adults live in similar areas of racial composition and economic condition. Design, Setting, and Participants This cross-sectional study used a nationally representative sample of 7062 non-Hispanic Black or White adults who live in 2238 of 2275 US census tracts with a 5% or greater Black population and who participated in the Medical Expenditure Panel Study (MEPS) in 2016. Differences in total health care expenditures and 6 specific categories of health care expenditures were assessed. Two-part regression models compared expenditures between Black and White adults living in the same Index of Concentration at the Extremes (ICE) quintile, a measure of racialized economic segregation. Estimated dollar amount differences in expenditures were calculated. All analyses were weighted to account for the complex sampling design of the MEPS. Data analysis was performed from December 1, 2019, to August 7, 2023. Exposure Self-reported non-Hispanic Black or non-Hispanic White race. Main Outcomes and Measures Presence and amount of patient out-of-pocket and insurance payments for annual total health care expenditures; office-based, outpatient, emergency department, inpatient hospital, or dental visits; and prescription medicines. ICE quintile 5 (Q5) reflected tracts that were mostly high income with mostly White individuals, whereas Q1 reflected tracts that were mostly low income with mostly Black individuals. Results A total of 7062 MEPS respondents (mean [SD] age, 49 [18] years; 33.1% Black and 66.9% White; 56.1% female and 43.9% male) who lived in census tracts with a 5% or greater Black population in 2016 were studied. In Q5, Black adults had 56% reduced odds of having any health care expenditures (odds ratio, 0.44; 95% CI, 0.27-0.71) compared with White adults, at an estimated $2145 less per year, despite similar health status. Among those in Q5 with any expenditures, Black adults spent 30% less on care (cost ratio, 0.70; 95% CI, 0.56-0.86). In Q3 (most racially and economically integrated), differences in total annual health care spending were minimal ($79 annually; 95% CI, -$1187 to $1345). Conclusions and Relevance In this cross-sectional study of Black and White adults in the US, health care expenditure disparities diminished or disappeared under conditions of both racial and economic equity and equitable health care access; in areas that were mostly high income and had mostly White residents, Black adults spent substantially less. Results underscore the continuing need to recognize place as a contributor to race-based differences in health care spending.
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Affiliation(s)
- Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
| | - Yuehan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Analysis Group Inc, New York, New York
| | - Rachael R. McCleary
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rahel Dawit
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roland J. Thorpe
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
- Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Darrell Gaskin
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kim H, Park D, Seomun G, Kim H, Woosnam KM, Kim BJ. Health justice and economic segregation in climate risks: Tracing vulnerability and readiness progress. Health Place 2023; 84:103113. [PMID: 37717535 DOI: 10.1016/j.healthplace.2023.103113] [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: 05/09/2023] [Revised: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
Climate vulnerability can make urban space unhealthy and accentuate existing health (in)justice and (economic) segregation. Drawing on the vulnerability-readiness nexus and measuring health justice (i.e., health poverty, health distribution, and health access) and economic segregation (through indices), we strive to investigate the plausible pathways of the two constructs at the heat risks. Our work, focusing on metropolitan cities in South Korea, addresses the role of heat vulnerability and readiness nexus regarding health justice and economic segregation through correlational analysis and a time-trend comparative approach between 2011 and 2015 (as five year-long effects). Our results show that potential positive links exist between health poverty as a component of health justice and economic segregation. Moreover, climate readiness, as opposed to vulnerability, plays a crucial role in reducing economic segregation in the context of health justice and heat risks.
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Affiliation(s)
- Hyun Kim
- School of Public Administration, Chungnam National University, Daejeon, South Korea.
| | - Dujin Park
- Department of Sociology, Chungnam National University, Daejeon, South Korea.
| | - Gyu Seomun
- Department of Environmental Planning, Seoul National University, Seoul, South Korea.
| | - Hyewon Kim
- School of Public Administration, Chungnam National University, Daejeon, South Korea.
| | - Kyle Maurice Woosnam
- Warnell School of Forestry & Natural Resources, University of Georgia, Athens, GA 30602, USA; School of Tourism and Hospitality Management, University of Johannesburg, Auckland Park, South Africa.
| | - Bong Jik Kim
- Department of Otorhinolaryngology, Chungnam National University Sejong Hospital, College of Medicine, Chungnam National University, Daejeon, South Korea.
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6
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Wu XC, Yu Q, Yi Y, Maniscalco LS, Hsieh MC, Gruber D, Mendoza L, Subbiah S, Sokol T, Shrestha P, Chen VW, Mederos ET, Ochoa A. Effect of chronic disease on racial difference in COVID-19-associated hospitalization among cancer patients. J Natl Cancer Inst 2023; 115:1204-1212. [PMID: 37697664 PMCID: PMC10560601 DOI: 10.1093/jnci/djad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Research indicates that Black cancer patients have higher rates of COVID-19 hospitalization than their White counterparts. However, the extent to which chronic diseases contribute to racial disparities remains uncertain. We aimed to quantify the effect of chronic diseases on racial disparity in COVID-19-associated hospitalization among cancer patients. METHODS We linked Louisiana Tumor Registry's data with statewide COVID-19 data and hospital in-patient discharge data to identify patients diagnosed with cancer in 2015-2019 who tested positive for COVID-19 in 2020 and those with COVID-19-associated hospitalization. Multivariable logistic regression and mediation methods based on linear structural equations were employed to assess the effects of the number of chronic diseases (0, 1-2, ≥3) and individual chronic diseases. RESULTS Of 6381 cancer patients who tested positive for COVID-19, 31.6% were non-Hispanic Black cancer patients. Compared with non-Hispanic White cancer patients, non-Hispanic Black cancer patients had a higher prevalence of chronic diseases (79.5% vs 66.0%) and higher COVID-19-associated hospitalization (27.2% vs 17.2%). The odds of COVID-19-associated hospitalization were 80% higher for non-Hispanic Black cancer patients than non-Hispanic White cancer patients (odds ratio = 1.80, 95% confidence interval = 1.59 to 2.04). After adjusting for age, sex, insurance, poverty, obesity, and cancer type, number of chronic diseases explained 37.8% of the racial disparity in COVID-19-associated hospitalization, and hypertension, diabetes, and chronic renal disease were the top 3 chronic diseases explaining 9.6%, 8.9%, and 7.3% of the racial disparity, respectively. CONCLUSION Chronic diseases played a substantial role in the racial disparity in COVID-19-associated hospitalization among cancer patients, especially hypertension, diabetes, and renal disease. Understanding and addressing the root causes are crucial for targeted interventions, policies, and health-care strategies to reduce racial disparity.
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Affiliation(s)
- Xiao-Cheng Wu
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health, LSU Health, New Orleans, LA, USA
| | - Yong Yi
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Lauren S Maniscalco
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - DeAnn Gruber
- Bureau of Infectious Diseases, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Lee Mendoza
- Bureau of Health Informatics, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Suki Subbiah
- Section of Hematology-Oncology, School of Medicine, LSU Health, New Orleans, LA, USA
| | - Theresa Sokol
- Bureau of Infectious Diseases, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Pratibha Shrestha
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Vivien W Chen
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Eileen T Mederos
- LSU-LCMC Health Cancer Center, Department of Interdisciplinary Oncology, LSU Health, New Orleans, LA, USA
| | - Augusto Ochoa
- LSU-LCMC Health Cancer Center, Department of Interdisciplinary Oncology, LSU Health, New Orleans, LA, USA
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7
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Anderson KF, Wolski C. Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01766-4. [PMID: 37624536 DOI: 10.1007/s40615-023-01766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Much research has been conducted that demonstrates a link between racial/ethnic residential segregation and health care outcomes. We suggest that minority segregated neighborhoods may have diminished access to organizations and that this differential access may contribute to differences in health care outcomes across communities. We analyze this specifically using the case of pediatric health care provider choice. To examine this association, we estimate a series of multinomial logistic regression models using restricted data with ZIP code level geoidentifiers from the 2011-2012 National Survey of Children's Health (NSCH). We find that racial/ethnic residential segregation is related to a greater reliance on non-ideal forms of health care, such as clinics, and hospital outpatient departments, instead of pediatric physician's offices. This association is at least partially attenuated by the distribution of health care facilities in the local area, physician's offices, and health care practitioners in particular. Additionally, families express greater dissatisfaction with these other forms of care compared to physician's offices, demonstrating that the lack of adequate health care provision is meaningful for health care outcomes. This study expands the literature by examining how the siting of health organizations has consequences for individuals residing within these areas.
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Affiliation(s)
- Kathryn Freeman Anderson
- Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX, 77204-3012, USA.
| | - Caroline Wolski
- Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX, 77204-3012, USA
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Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:89-103. [PMID: 36735420 DOI: 10.1097/spv.0000000000001302] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Studies have sought to evaluate factors that have perpetuated disparities in health care, including urogynecologic care. However, there remains a lack of understanding of barriers to care specific to racial/ethnic minority populations. OBJECTIVES We aimed to report identified barriers to urogynecologic care (eg, care for symptoms/diagnoses of urinary incontinence [UI], accidental bowel leakage [ABL], and pelvic organ prolapse [POP]) for underrepresented racial and ethnic minority (URM) women in the United States. STUDY DESIGN We conducted a systematic search for studies through 5 electronic bibliographic databases. Inclusion criteria for eligible studies included the following: (1) studies reporting barriers to care for those with urogynecologic symptoms/diagnoses, (2) publication date year 2000 or later. Exclusion criteria included study cohorts with children, exclusively non-U.S. populations, cohorts without URM participants, and studies without qualitative research methodology. Study methodology, characteristics, as well as barriers and facilitators to urogynecologic care were captured using a thematic synthesis approach. RESULTS There were 360 studies identified. Twelve studies met criteria: 6 had study populations with UI, 3 with POP, 2 on UI and/or POP, and 1 on ABL. There were 7 focus group studies (total 44 groups, n = 330), 4 interview studies (total 160 interviews, n = 160), and 1 had both (10 interviews, 6 groups, n = 39). Most studies reported on patient-associated barriers (n = 10/12) and physician/provider-associated barriers (n = 10/12), whereas only half reported system-associated barriers (n = 6/12). CONCLUSION Identified barriers to urogynecologic care for URM populations were examined. Findings likely do not fully reflect barriers to urogynecologic care for URM populations. Comprehensive evaluation of social determinants of health and systemic racism within studies is needed to understand the unique barriers present for racially/ethnically diverse populations.
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Anderson KF, Ray-Warren D. Racial-Ethnic Residential Clustering and Early COVID-19 Vaccine Allocations in Five Urban Texas Counties. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:472-490. [PMID: 35164599 PMCID: PMC9716049 DOI: 10.1177/00221465221074915] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Previous research has indicated that racial-ethnic minority communities lack a wide variety of health-related organizations. We examine how this relates to the early COVID-19 vaccine rollout. In a series of spatial error and linear growth models, we analyze how racial-ethnic residential segregation is associated with the distribution of vaccine sites and vaccine doses across ZIP codes in the five largest urban counties in Texas. We find that Black and Latino clustered ZIP codes are less likely to have vaccine distribution sites and that this disparity is partially explained by the lack of hospitals and physicians' offices in these areas. Moreover, Black clustering is also negatively related to the number of allocated vaccine doses, and again, this is largely explained by the unequal distribution of health care resources. These results suggest that extant disparities in service provision are key to understanding racial-ethnic inequality in an acute crisis like the COVID-19 pandemic.
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10
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Chen YL. Medical use and costs for native fathers and children from transnational marriage families in Taiwan from 2004 to 2017. Front Public Health 2022; 10:870859. [PMID: 36267991 PMCID: PMC9578682 DOI: 10.3389/fpubh.2022.870859] [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: 02/07/2022] [Accepted: 09/20/2022] [Indexed: 01/21/2023] Open
Abstract
Objectives This is the first study to examine health care utilization in terms of medical use and costs in native fathers and children from transnational families. Methods Taiwan National Health Insurance Research Database was used to compare the annual medical use and inflation-adjusted medical cost for ambulatory care from 2004 to 2017 between native fathers and children from transnational and native families. Results Native fathers from transnational families had lower annual medical use (-0.23 visits) but higher total medical costs (New Taiwan dollars, NT$, 966), especially in dialysis and psychiatry, compared with those from native families. Unlike fathers from transnational families, their children were observed to consistently have lower medical use (-1.35 visits) and costs (NT$ -636), compared with those from native families. Conclusions There was different medical use and costs in transnational marriage families, possibly as a result of features in transnational marriage families. These findings provide insight for future health care policies to address the different health care utilization by exploring the unmet needs and barriers relating to children and fathers from transnational families.
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Affiliation(s)
- Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan,Department of Psychology, Asia University, Taichung, Taiwan,*Correspondence: Yi-Lung Chen
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Qiu Y, Liao K, Zou Y, Huang G. A Bibliometric Analysis on Research Regarding Residential Segregation and Health Based on CiteSpace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10069. [PMID: 36011701 PMCID: PMC9408714 DOI: 10.3390/ijerph191610069] [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] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Considerable scholarly attention has been directed to the adverse health effects caused by residential segregation. We aimed to visualize the state-of-the-art residential segregation and health research to provide a reference for follow-up studies. Employing the CiteSpace software, we uncovered popular themes, research hotspots, and frontiers based on an analysis of 1211 English-language publications, including articles and reviews retrieved from the Web of Science Core Collection database from 1998 to 2022. The results revealed: (1) The Social Science & Medicine journal has published the most studies. Roland J. Thorpe, Thomas A. LaVeist, Darrell J. Gaskin, David R. Williams, and others are the leading scholars in residential segregation and health research. The University of Michigan, Columbia University, Harvard University, the Johns Hopkins School of Public Health, and the University of North Carolina play the most important role in current research. The U.S. is the main publishing country with significant academic influence. (2) Structural racism, COVID-19, mortality, multilevel modelling, and environmental justice are the top five topic clusters. (3) The research frontier of residential segregation and health has significantly shifted from focusing on community, poverty, infant mortality, and social class to residential environmental exposure, structural racism, and health care. We recommend strengthening comparative research on the health-related effects of residential segregation on minority groups in different socio-economic and cultural contexts.
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Affiliation(s)
- Yanrong Qiu
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Kaihuai Liao
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Yanting Zou
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Gengzhi Huang
- School of Geography and Planning, Sun Yat-sen University, Guangzhou 510275, China
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12
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Wallace J, Lollo A, Duchowny KA, Lavallee M, Ndumele CD. Disparities in Health Care Spending and Utilization Among Black and White Medicaid Enrollees. JAMA HEALTH FORUM 2022; 3:e221398. [PMID: 35977238 PMCID: PMC9187949 DOI: 10.1001/jamahealthforum.2022.1398] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/15/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Administrative records indicate that more than half of the 80 million Medicaid enrollees identify as belonging to a racial and ethnic minority group. Despite this, disparities within the Medicaid program remain understudied. For example, we know of no studies examining racial differences in Medicaid spending, a potential measure of how equitably state resources are allocated. Objectives To examine whether and to what extent there are differences in health care spending and utilization between Black and White enrollees in Medicaid. Design Setting and Participants This cross-sectional study used calendar year 2016 administrative data from 3 state Medicaid programs and included 1 966 689 Black and White Medicaid enrollees. Analyses were performed between January 28, 2021, and October 18, 2021. Exposures Self-reported race. Main Outcomes and Measures Rates and racial differences in health care spending and utilization (including Healthcare Effectiveness Data and Information Set [HEDIS] access measures). Results Of 1 966 689 Medicaid adults and children (mean [SD] age, 20.3 [17.1] years; 1 119 136 [56.9%] female), 867 183 (44.1%) self-identified as non-Hispanic Black and 1 099 506 (55.9%) self-identified as non-Hispanic White. Results were adjusted for age, sex, Medicaid eligibility category, zip code, health status, and usual source of care. On average, annual spending on Black adult (19 years or older) Medicaid enrollees was $317 (95% CI, $259-$375) lower than White enrollees, a 6% difference. Among children (18 years or younger), annual spending on Black enrollees was $256 (14%) lower (95% CI, $222-$290). Adult Black enrollees also had 19.3 (95% CI, 16.78-21.84), or 4%, fewer primary care encounters per 100 enrollees per year compared with White enrollees. Among children, the differences in primary care utilization were larger: Black enrollees had 90.1 (95% CI, 88.2-91.8) fewer primary care encounters per 100 enrollees per year compared with White enrollees, a 23% difference. Black enrollees had lower utilization of most other services, including high-value prescription drugs, but higher emergency department use and rates of HEDIS preventive screenings. Conclusions and Relevance In this cross-sectional study of US Medicaid enrollees in 3 states, Black enrollees generated lower spending and used fewer services, including primary care and recommended care for acute and chronic conditions, but had substantially higher emergency department use. While Black enrollees had higher rates of HEDIS preventive screenings, ensuring equitable access to all services in Medicaid must remain a national priority.
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Affiliation(s)
- Jacob Wallace
- Yale School of Public Health, New Haven, Connecticut
| | - Anthony Lollo
- Yale School of Public Health, New Haven, Connecticut
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Mabeza RM, Chervu N, Sanaiha Y, Hadaya J, Tran Z, de Virgilio C, Benharash P. Demystifying the outcome disparities in carotid revascularization: Utilization of experienced centers. Surgery 2022; 172:766-771. [DOI: 10.1016/j.surg.2022.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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Sung B. A spatial analysis of the effect of neighborhood contexts on cumulative number of confirmed cases of COVID-19 in U.S. Counties through October 20 2020. Prev Med 2021; 147:106457. [PMID: 33607122 PMCID: PMC7886632 DOI: 10.1016/j.ypmed.2021.106457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/05/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
COVID-19 has become a nationwide public health crisis in the United States and the number of COVID-19 cases is different by U.S. counties. Also, previous studies have reported that neighborhood contexts have an influence on health outcomes. Therefore, the objective of this study was to examine the association between neighborhood contexts and cumulative number of confirmed COVID-19 cases (per 100,000) in U.S. counties. Cumulative number of COVID-19 cases gained from USA FACTS and variables related to neighborhood contexts gained from the 2018 5-Year American Community Survey at the county level. Data were analyzed using spatial autoregressive models. According to the present results, firstly, larger population, high poverty rate, higher % of bachelor's degree, higher % of no health insurance, higher employment rate, higher % of manufacturing jobs, higher % of primary industry jobs, higher % of commute by drove alone, higher % of foreign born, higher % of Hispanic, and higher % of Black are positively associated with higher cumulative number of COVID-19 cases. Secondly, higher income, higher % of cash assistance recipient, higher % of SNAP recipient, higher unemployment rate, higher % of commute by walked, higher % of Asian, and higher % of senior citizen are negatively associated with higher cumulative number of COVID-19 cases. In conclusion, there exist geographical differences in cumulative number of COVID-19 cases in U.S. counties, which is influenced by various neighborhood contexts. Hence, these findings emphasize the need to take various neighborhood contexts into account when planning COVID-19 prevention.
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Affiliation(s)
- Baksun Sung
- Department of Sociology, Social Work, and Anthropology, Utah State University, United States of America.
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Progovac AM, Cortés DE, Chambers V, Delman J, Delman D, McCormick D, Lee E, De Castro S, Sánchez Román MJ, Kaushal NA, Creedon TB, Sonik RA, Quinerly CR, Rodgers CRR, Adams LB, Nakash O, Moradi A, Abolaban H, Flomenhoft T, Nabisere R, Mann Z, Hou SSY, Shaikh FN, Flores M, Jordan D, Carson NJ, Carle AC, Lu F, Tran NM, Moyer M, Cook BL. Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences. QUALITATIVE HEALTH RESEARCH 2020; 30:1833-1850. [PMID: 32713258 PMCID: PMC10797602 DOI: 10.1177/1049732320937663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.
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Affiliation(s)
- Ana M. Progovac
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dharma E. Cortés
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan Delman
- University of Massachusetts Medical School, Worcester, USA
- Massachusetts Mental Health Center, Boston, USA
| | | | - Danny McCormick
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Esther Lee
- Cambridge Health Alliance, Massachusetts, USA
- Columbia Mailman School of Public Health, New York City, New York, USA
| | | | - María José Sánchez Román
- Cambridge Health Alliance, Massachusetts, USA
- George Washington University, District of Columbia, USA
| | | | | | - Rajan A. Sonik
- Cambridge Health Alliance, Massachusetts, USA
- AltaMed Institute for Health Equity, Los Angeles, California, USA
| | - Catherine Rodriguez Quinerly
- The Transformation Center, Roxbury, Massachusetts, USA
- Dr. Solomon Carter Fuller Mental Health Center, Boston, Massachusetts, USA
| | | | - Leslie B. Adams
- Cambridge Health Alliance, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Ora Nakash
- Smith College School for Social Work, Northampton, Massachusetts, USA
| | - Afsaneh Moradi
- Cambridge Health Alliance, Massachusetts, USA
- Blair Athol Medical Center, South Australia, Australia
| | - Heba Abolaban
- Cambridge Health Alliance, Massachusetts, USA
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Tali Flomenhoft
- Cambridge Health Alliance, Massachusetts, USA
- Brandeis University, Waltham, Massachusetts, USA
| | | | - Ziva Mann
- Cambridge Health Alliance, Massachusetts, USA
- Ascent Leadership Networks, New York City, New York, USA
| | - Sherry Shu-Yeu Hou
- Cambridge Health Alliance, Massachusetts, USA
- McGill University, Montreal, Quebec, Canada
| | | | | | | | - Nicholas J. Carson
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adam C. Carle
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA
| | - Frederick Lu
- Cambridge Health Alliance, Massachusetts, USA
- Boston University School of Medicine, Massachusetts, USA
| | | | - Margo Moyer
- Cambridge Health Alliance, Massachusetts, USA
| | - Benjamin L. Cook
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Alidu L, Grunfeld EA. 'What a dog will see and kill, a cat will see and ignore it': An exploration of health-related help-seeking among older Ghanaian men residing in Ghana and the United Kingdom. Br J Health Psychol 2020; 25:1102-1117. [PMID: 32656938 DOI: 10.1111/bjhp.12454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 06/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health care utilization rates are lower among men; however, little is known about how men's health care utilization is affected by migration. The aim of this study was to explore health-related help-seeking decisions among older Ghanaian men residing in the United Kingdom and in Ghana. METHODS Twenty-six men aged 50 years or over were recruited from community locations within two large cities in the UK and Ghana. Face-to-face semi-structured interviews were undertaken to explore the illness and help-seeking experiences of older men. RESULTS Help-seeking experiences differed among the Ghanaian men living in the UK and in Ghana. Three themes were identified that impacted on help-seeking decisions: (1) pluralistic approaches to managing health and illness and (2) perceptions of formal health services in Ghana and UK and (3) financial constraints and masculinity norms as barriers to help-seeking. CONCLUSION This is the first study to look at help-seeking decisions among older men residing in the UK and Ghana. Findings highlight how older migrant men's explanatory models of their health encompass enduring faith-based beliefs around causation of illness and approaches to management, as well as the use of pluralistic approaches to managing health. This study supports the call for culturally sensitive community-based interventions to increase engagement and facilitate improved health outcomes for migrant populations, particularly older men.
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Affiliation(s)
- Lailah Alidu
- Population Evidence and Technology, University of Warwick Medical School, Coventry, UK
| | - Elizabeth A Grunfeld
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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Chan KS, Parikh MA, Thorpe RJ, Gaskin DJ. Health Care Disparities in Race-Ethnic Minority Communities and Populations: Does the Availability of Health Care Providers Play a Role? J Racial Ethn Health Disparities 2020; 7:539-549. [PMID: 31845286 PMCID: PMC7231628 DOI: 10.1007/s40615-019-00682-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine disparities in use and access to different health care providers by community and individual race-ethnicity and to test provider supply as a potential mediator. DATA SOURCES National secondary data from 2014 Medical Expenditure Panel Survey, 5-year estimates (2010-2014) from American Community Survey, and 2014 InfoUSA. STUDY DESIGN Multiple logistic regression models examined the association of community and individual race-ethnicity with reported health care visits and access. Mediation analyses tested the role of provider supply. DATA EXTRACTION METHODS Individual-level survey data were linked to race-ethnic composition and health business counts of the respondent's primary care service area (PCSA). PRINCIPAL FINDINGS Minority PCSAs are significantly and independently associated with lower odds of having a visit to a physician assistant/nurse practitioner, dentist, or other health professionals and having a usual care provider (all p < 0.05). Few significant associations were observed for integrated PCSAs or for health provider supply. A modest mediation effect for provider supply was observed for travel time to usual care provider and visit to other health professionals. CONCLUSIONS Use of a range of health services is lower in minority communities and individuals. However, provider supply was not an important explanatory factor of these disparities.
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Affiliation(s)
- Kitty S Chan
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Medstar Health Research Institute, 3800 Reservoir Rd., NW, Gorman 3056, Washington, DC, 20007, USA.
| | - Megha A Parikh
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Darrell J Gaskin
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Sonik RA, Creedon TB, Progovac AM, Carson N, Delman J, Delman D, Lê Cook B. Depression treatment preferences by race/ethnicity and gender and associations between past healthcare discrimination experiences and present preferences in a nationally representative sample. Soc Sci Med 2020; 253:112939. [PMID: 32276182 DOI: 10.1016/j.socscimed.2020.112939] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Depression treatment disparities are well documented. Differing treatment preferences across social groups have been suggested as a cause of these disparities. However, existing studies of treatment preferences have been limited to individuals currently receiving clinical care, and existing measures of depression treatment preferences have not accounted for factors that may be disproportionately relevant to the preferences of disparities populations. This study therefore aimed to assess depression treatment preferences by race/ethnicity and gender in a representative community sample, while accounting for access to healthcare, provider characteristics, and past experiences of discrimination in healthcare settings. METHODS We conducted a nationally representative study of individuals with depression in and out of clinical care. Treatment preferences (medication versus talk therapy) were elicited through a discrete choice experiment that accounted for tradeoffs with factors related to access and provider characteristics deemed relevant by community stakeholders. Past discrimination was assessed through questions about unfair treatment from medical providers and front desk staff due to personal characteristics (e.g., race, gender). We used conditional logit models to assess treatment preferences by race/ethnicity and gender and examined whether preferences were associated with past experiences of healthcare discrimination. RESULTS Non-Hispanic white respondents (OR-here, the odds of a talk therapy preference over the odds of a medication preference: 0.80, 95% CI: 0.64, 0.99) and men (OR 0.76, 95% CI: 0.60, 0.96) preferred medication over talk therapy, while non-Hispanic black respondents, Hispanic respondents, and women did not prefer one over the other. Past discrimination in healthcare settings was associated with lower preferences for talk therapy and greater preferences for medication, particularly among non-Hispanic black respondents and women respondents. CONCLUSIONS Addressing previous methodological limitations yielded estimates for depression treatment preferences by race/ethnicity and gender that differed from past studies. Also, past discrimination in healthcare settings was associated with current treatment preferences.
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Affiliation(s)
| | - Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
| | - Ana Maria Progovac
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
| | - Nicholas Carson
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
| | | | | | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
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Ceasar JN, Ayers C, Andrews MR, Claudel SE, Tamura K, Das S, de Lemos J, Neeland IJ, Powell-Wiley TM. Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study. PLoS One 2020; 15:e0230041. [PMID: 32163470 PMCID: PMC7067436 DOI: 10.1371/journal.pone.0230041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Neighborhood environment perception (NEP) has been associated with health outcomes. However, little is known about how NEP relates to routine healthcare utilization. This study investigated the relationship between NEP and independent subfactors with healthcare utilization behavior, as measured by self-reported (1) usual source of healthcare and (2) time since last routine healthcare check-up. We used cross-sectional data from the Dallas Heart Study, which features a diverse, probability-based sample of Dallas County residents ages 18 to 65. We used logistic regression modeling to examine the association of self-reported NEP and routine healthcare utilization. NEP was assessed via a questionnaire exploring residents' neighborhood perceptions, including violence, the physical environment, and social cohesion. Routine healthcare utilization was assessed via self-reported responses regarding usual source of care and time since last routine healthcare check-up. The analytic sample (N = 1706) was 58% black, 27% white, 15% Hispanic, 42% male, and had a mean age of 51 (SD = 10.3). Analysis of NEP by tertile demonstrated that younger age, lower income, and lower education were associated with unfavorable overall NEP (p trend <0.05 for each). After adjustment for potential confounders, including neighborhood deprivation, health insurance, disease burden and psychosocial factors, we found that individuals with more unfavorable perception of their physical environment were more likely to report lack of a usual source of care (p = 0.013). Individuals with more unfavorable perception of the neighborhood physical environment or greater neighborhood violence reported longer time periods since last routine visit (p = 0.001, p = 0.034 respectively). There was no relationship between perceived social cohesion and healthcare utilization. Using a multi-ethnic cohort, we found that NEP significantly associates with report of a usual source of care and time since last routine check-up. Our findings suggest that public health professionals should prioritize improving NEP since it may act as barrier to routine preventive healthcare and ideal health outcomes.
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Affiliation(s)
- Joniqua N. Ceasar
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Colby Ayers
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Marcus R. Andrews
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sophie E. Claudel
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kosuke Tamura
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sandeep Das
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - James de Lemos
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Ian J. Neeland
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Tiffany M. Powell-Wiley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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McDaniel JT. Emergency room visits for chronic obstructive pulmonary disease in Illinois counties: An epidemiological study based on the Social Ecological Model. Chronic Illn 2020; 16:69-82. [PMID: 29788786 DOI: 10.1177/1742395318778102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives This study aimed to determine the predictive capability of the Social Ecological Model for emergency room visits for acute exacerbation of chronic obstructive pulmonary disease. Methods County-level secondary data ( n = 102) on emergency room visits for chronic obstructive pulmonary disease were retrieved from the Illinois Department of Public Health for 2016. Data for variables operationalized from the intrapersonal, interpersonal, institutional, community, and public policy levels of the Social Ecological Model were retrieved from several sources. Geographic information system software was used to examine the spatial distribution of emergency room visits for chronic obstructive pulmonary disease in Illinois. Robust linear regression analysis was used to examine significant predictors of emergency room visits for chronic obstructive pulmonary disease. Results A regression model with all five levels of the Social Ecological Model accounted for 50% of the variability in emergency room visits for chronic obstructive pulmonary disease, F(24,77) = 4.62, p < 0.001. Statistically significant predictors of emergency room visits for chronic obstructive pulmonary disease were observed within the interpersonal, institutional, and community levels of the Social Ecological Model. Discussion Community health practitioners working to develop programs aimed at controlling chronic obstructive pulmonary disease exacerbations in Illinois should consider multiple levels of influence.
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Affiliation(s)
- Justin T McDaniel
- Department of Public Health and Recreation Professions, Southern Illinois University, Carbondale, USA
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21
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Reed C, Rabito FA, Werthmann D, Smith S, Carlson JC. Factors associated with using alternative sources of primary care: a cross-sectional study. BMC Health Serv Res 2019; 19:933. [PMID: 31801526 PMCID: PMC6894211 DOI: 10.1186/s12913-019-4743-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 11/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. However, providing access does not guarantee utilization. This study explored the utilization of these alternative sources of health care and assessed factors associated with residential segregation that may influence their utilization. METHODS A cross-sectional study design assessed the associations between travel distance, perceived quality of care, satisfaction-adjusted distance (SAD) and patient utilization of alternative health care clinics. Adults (n = 165), child caregivers (n = 124), and adult caregivers (n = 7) residing in New Orleans, Louisiana between 2014 and 2015 were conveniently sampled. Data were obtained via face-to face interviews using standardized questionnaires and geospatial data geocoded using GIS mapping tools. Multivariate regression models were used to predict alternative care utilization. RESULTS Overall 49.4% of respondents reported ever using a MCH, CHC, or SBHC. Travel distance was not significantly associated with using either MCH, CHC, or SBHC (OR = 0.91, 0.74-1.11 p > .05). Controlling for covariates, higher perceived quality of care (OR = 1.02, 1.01-1.04 p < .01) and lower SAD (OR = 0.81, 0.73-0.91 p < .01) were significantly associated with utilization. CONCLUSIONS Provision of primary care via alternative health clinics may overcome some barriers to care but have yet to be fully integrated as regular sources of care. Perceived quality and mixed-methods measures are useful indicators of access to care. Future health delivery research is needed to understand the multiple mechanisms by which residential segregation influences health-seeking behavior.
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Affiliation(s)
- Charlie Reed
- Tulane School Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.
| | - Felicia A Rabito
- Tulane School Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - Derek Werthmann
- Tulane School Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - Shannon Smith
- Tulane School Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - John C Carlson
- Tulane School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
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Sung B, Etemadifar A. Multilevel Analysis of Socio-Demographic Disparities in Adulthood Obesity Across the United States Geographic Regions. Osong Public Health Res Perspect 2019; 10:137-144. [PMID: 31263662 PMCID: PMC6590879 DOI: 10.24171/j.phrp.2019.10.3.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives The objective of this study was to examine the socio-demographic disparities in obesity among US adults across 130 metropolitan and micropolitan statistical areas. Methods This study used data from the 2015 Behavioral Risk Factor Surveillance System and Selected Metropolitan/Micropolitan Area Risk Trend of 159,827 US adults aged 18 years and older. Data were analyzed using the multilevel linear regression models. Results According to individual level analyses, socio-demographic disparities in obesity exist in the United States. Individuals with low socioeconomic status were associated with a higher body mass index. The participants from the Midwest United States tend to have higher body mass index than those who from the South. According to metropolitan and micropolitan statistical area level analyses, secondly, there were significant differences in obesity status between different areas and the relation of obesity with 5 socio-demographic factors varied across different areas. According to geospatial mapping analyses, even though obesity status by metropolitan and micropolitan statistical area level has improved overtime, differences in body mass index between United States regions are increasing from 2007 to 2015. Conclusion Socio-demographic and regional disparities in obesity status persist among US adults. Hence, these findings underscore the need to take socio-environmental factors into account when planning obesity prevention on vulnerable populations and areas.
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Affiliation(s)
- Baksun Sung
- Department of Sociology, Social Work, and Anthropology, Utah State University, United States
| | - Amin Etemadifar
- Department of Sociology, Social Work, and Anthropology, Utah State University, United States
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Who Gets Held Back? An Analysis of Grade Retention Using Stratified Frailty Models. POPULATION RESEARCH AND POLICY REVIEW 2019. [DOI: 10.1007/s11113-019-09524-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Racial/Ethnic Residential Segregation, the Distribution of Physician’s Offices and Access to Health Care: The Case of Houston, Texas. SOCIAL SCIENCES-BASEL 2018. [DOI: 10.3390/socsci7080119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Previous research has demonstrated the impacts of racial/ethnic residential segregation on access to health care, but little work has been conducted to tease out the mechanisms at play. I posit that the distribution of health care facilities may contribute to poor access to health care. In a study of the Houston area, I examine the association between residential segregation, the distribution of physician’s offices, and two health care access outcomes of having a personal physician, as well as the travel time to their office location. Using the 2010 Health of Houston Survey combined with several census products, I test these relationships in a series of spatial and multilevel models. I find that Black segregation is related to a lower density of physician’s offices. However, I find that this distribution is not related to having a personal physician, but is related to travel times, with a greater number of facilities leading to shorter travel times to the doctor. I also find that Black segregation is positively associated with travel times, and that the distribution of physician’s offices partially mediates this relationship. In sum, these findings suggest that a more equitable provision of health care resources across urban neighborhoods would mitigate some of the negative effects of segregation.
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Gibbons J, Yang TC. Searching for Silver Linings: Is Perceived Medical Discrimination Weaker in Segregated Areas? APPLIED SPATIAL ANALYSIS AND POLICY 2018; 11:37-58. [PMID: 29449905 PMCID: PMC5809004 DOI: 10.1007/s12061-016-9211-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An ongoing obstacle in dealing with minority health disparities is discriminatory behavior from healthcare practitioners, also known as medical discrimination. It is not clear, however, if the effects of medical discriminations onto health are constant across space. For example, there is evidence to suspect minorities in racially segregated neighborhoods suffer less from discrimination compared to those living elsewhere. To determine the presence of spatial heterogeneity underlying medical discrimination, we implement logistic geographically weighted regression (GWR) using individual data in the city of Philadelphia from the 2006 and 2008 Public Health Management Corporation's Southeastern Pennsylvania Household Health Surveys. Evaluating the potential role residential segregation has in offsetting medical discrimination, we compare the GWR results to tract data from the 2005-2009 American Community Survey. Through this comparison, we find that the effects of medical discrimination on self-rated health are weaker in magnitude in areas that are mostly minority. However, evidence of direct health benefits for minorities in segregated communities is inconclusive. Thus, while we cannot say living in segregated neighborhoods leads to better minority health, the sting of medical discrimination can be weaker in these places. These results emphasize the importance of local variation, even within a city like Philadelphia, challenging the aspatial one-model-fits-all approach normally found in population studies.
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Affiliation(s)
- Joseph Gibbons
- Department of Sociology, 5500 Campanile Drive, San Diego State University
| | - Tse-Chuan Yang
- Department of Sociology, 1400 Washington Ave, University at Albany
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The use of psychiatric services by young adults who came to Sweden as teenage refugees: a national cohort study. Epidemiol Psychiatr Sci 2017; 26:526-534. [PMID: 27353562 PMCID: PMC6999002 DOI: 10.1017/s2045796016000445] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS To investigate the patterns of use of different forms of psychiatric care in refugees who settled in Sweden as teenagers. METHOD Cox proportional hazards models were used to estimate the use of different forms of psychiatric care from 2009 to 2012 in a population of 35 457 refugees, aged from 20 to 36, who had settled in Sweden as teenagers between 1989 and 2004. These findings were compared with 1.26 million peers from the same birth cohorts in the general Swedish population. RESULTS Unaccompanied and accompanied refugees were more likely to experience compulsory admission to a psychiatric hospital compared with the native Swedish population, with hazard ratios (HRs) of 2.76 (1.86-4.10) and 1.89 (1.53-2.34), respectively, as well as psychiatric inpatient care, with HRs of 1.62 (1.34-1.94) and 1.37 (1.25-1.50). Outpatient care visits by the young refugees were similar to the native Swedish population. The longer the refugees had residency in Sweden, the more they used outpatient psychiatric care. Refugees born in the Horn of Africa and Iran were most likely to undergo compulsory admission, with HRs of 3.98 (2.12-7.46) and 3.07 (1.52-6.19), respectively. They were also the groups who were most likely to receive inpatient care, with HRs of 1.55 (1.17-2.06) and 1.84 (1.37-2.47), respectively. Our results also indicated that the use of psychiatric care services increased with the level of education in the refugee population, while the opposite was true for the native Swedish population. In fact, the risks of compulsory admissions were particularly higher among refugees who had received a secondary education, compared with native Swedish residents, with HRs of 4.72 (3.06-7.29) for unaccompanied refugees and 2.04 (1.51-2.73) for accompanied refugees. CONCLUSIONS Young refugees received more psychiatric inpatient care than the native Swedish population, with the highest rates seen in refugees who were not accompanied by their parents. The discrepancy between the use of inpatient and outpatient care by young refugees suggests that there are barriers to outpatient care, but we did note that living in Sweden longer increased the use of outpatient services. Further research is needed to clarify the role that education levels among Sweden's refugee populations have on their mental health and health-seeking behaviour.
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Abstract
Hypertension is a major independent risk factor for cardiovascular disease for all ethnic and racial groups. Compared with other lifestyle and metabolic risk factors, hypertension is the leading cause of death in women. Women with preeclampsia are three times more likely to develop chronic hypertension and have an elevated risk of future cardiovascular disease. The objective of this article is to provide a review of the factors related to racial and ethnic disparities in blood pressure control. This is followed by a summary of contemporary clinical practice guidelines for the prevention, through lifestyle behavioral modification, and treatment of hypertension with pharmacotherapy.
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Affiliation(s)
- Theresa M Beckie
- College of Nursing and Division of Cardiovascular Sciences, College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612.
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Socioeconomic, Geospatial, and Geopolitical Disparities in Access to Health Care in the US 2011-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060573. [PMID: 28555045 PMCID: PMC5486259 DOI: 10.3390/ijerph14060573] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/13/2017] [Accepted: 05/23/2017] [Indexed: 11/17/2022]
Abstract
Individuals forgoing needed medical care due to barriers associated with cost are at risk of missing needed care that may be necessary for the prevention or maintenance of a chronic condition among other things. Thus, continued monitoring of factors associated with forgone medical care, especially among vulnerable populations, is critical. National survey data (2011–2015) for non-institutionalized adults residing in the USA were utilized to assess forgone medical care, defined as not seeking medical care when the individual thought it was necessary because of cost in the past 12 months. Logistic regression was used to predict forgone medical care vs. sought medical care. Racial/ethnic minority working-age adults, those with lower incomes, those with lower educations, those residing in the South, and those residing in states that failed to participate in Medicaid Expansion in 2014 were more likely (p < 0.01) to forgo medical care due to cost in the past year. Policy makers seeking to reduce barriers to forgone medical care can use this information to tailor their efforts (e.g., mechanisms targeted to bridge gaps in access to care) to those most at-risk and to consider state-level policy decisions that may impact access to care.
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Sohn EK, Porch T, Hill S, Thorpe RJ. Geography, Race/Ethnicity, and Physical Activity Among Men in the United States. Am J Mens Health 2017; 11:1019-1027. [PMID: 28147893 PMCID: PMC5675347 DOI: 10.1177/1557988316689498] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Engaging in regular physical activity reduces one’s risk of chronic disease, stroke, cardiovascular disease, and some forms of cancer. These preventive benefits associated with physical activity are of particular importance for men, who have shorter life expectancy and experience higher rates of chronic diseases as compared to women. Studies at the community and national levels have found that social and environmental factors are important determinants of men’s physical activity, but little is known about how regional influences affect physical activity behaviors among men. The objective of this study is to examine the association between geographic region and physical activity among men in the United States, and to determine if there are racial/ethnic differences in physical activity within these geographic regions. Cross-sectional data from men who participated the 2000 to 2010 National Health Interview Survey (N = 327,556) was used. The primary outcome in this study was whether or not men had engaged in sufficient physical activity to receive health benefits, defined as meeting the 2008 Physical Activity Guidelines for Americans. Race/ethnicity and geographic region were the primary independent variables. Within every region, Hispanic and Asian men had lower odds of engaging in sufficient physical activity compared to white men. Within the Northeast, South, and West, black men had lower odds of engaging in sufficient physical activity compared to white men. The key findings indicate that the odds of engaging in sufficient physical activity among men differ significantly between geographic regions and within regions by race/ethnicity.
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Affiliation(s)
- Elizabeth Kelley Sohn
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tichelle Porch
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Hill
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Charron-Chénier R, Fink JJ, Keister LA. Race and Consumption: Black and White Disparities in Household Spending. SOCIOLOGY OF RACE AND ETHNICITY (THOUSAND OAKS, CALIF.) 2017; 3:50-67. [PMID: 31328134 PMCID: PMC6641572 DOI: 10.1177/2332649216647748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Differences in consumption patterns are usually treated as a matter of preferences. In this article, the authors examine consumption from a structural perspective and argue that black households face unique constraints restricting their ability to acquire important goods and services. Using data from the Consumer Expenditure Surveys, the authors examine racial differences in total spending and in spending on major categories of goods and services (food, transportation, utilities, housing, health care, and entertainment). The authors also capture heterogeneous effects of racial stratification across class by modeling racial consumption gaps across household income levels. The results show that black households tend to have lower levels of total spending than their white counterparts and that these disparities tend to persist across income levels. Overall, these analyses indicate that racial disparities in consumption exist independently of other economic disparities and may be a key unexamined factor in the reproduction of racial inequality.
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Thorpe RJ, Gamaldo AA, Salas RE, Gamaldo CE, Whitfield KE. Relationship between Physical Function and Sleep Quality in African Americans. J Clin Sleep Med 2016; 12:1323-1329. [PMID: 27448426 DOI: 10.5664/jcsm.6180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 06/20/2016] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVES There is a growing body of research examining the relationship between sleep and functional outcomes. However, little is known about sleep and physical functioning in older African Americans. METHODS Data for this project included 450 community-dwelling older African Americans (71.4 ± 9.2 years of age) who participated in the Baltimore Study of Black Aging. Overall sleep pattern and quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Physical functioning was measured by the number of activities of daily living that each participant reported difficulty (ADL; e.g. eating, dressing, and bathing). Negative binomial regression models were conducted to estimate the association between sleep quality and physical functioning. RESULTS Seventy-two percent of the participants reported poor sleep quality. African Americans who reported poor sleep quality had a greater likelihood of an increase in the number of difficulties in ADLs that they reported even after accounting for demographic characteristics and health conditions. The relationship between sleep quality and physical functioning did not vary by gender. CONCLUSIONS Sleep may be an important factor to consider when seeking to improve physical functioning among community-dwelling older African Americans.
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Affiliation(s)
- Roland J Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Rachel E Salas
- Johns Hopkins University, School of Medicine, Baltimore, MD
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Norton JM, Moxey-Mims MM, Eggers PW, Narva AS, Star RA, Kimmel PL, Rodgers GP. Social Determinants of Racial Disparities in CKD. J Am Soc Nephrol 2016; 27:2576-95. [PMID: 27178804 PMCID: PMC5004663 DOI: 10.1681/asn.2016010027] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Significant disparities in CKD rates and outcomes exist between black and white Americans. Health disparities are defined as health differences that adversely affect disadvantaged populations, on the basis of one or more health outcomes. CKD is the complex result of genetic and environmental factors, reflecting the balance of nature and nurture. Social determinants of health have an important role as environmental components, especially for black populations, who are disproportionately disadvantaged. Understanding the social determinants of health and appreciating the underlying differences associated with meaningful clinical outcomes may help nephrologists treat all their patients with CKD in an optimal manner. Altering the social determinants of health, although difficult, may embody important policy and research efforts, with the ultimate goal of improving outcomes for patients with kidney diseases, and minimizing the disparities between groups.
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Affiliation(s)
- Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marva M Moxey-Mims
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul W Eggers
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrew S Narva
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Robert A Star
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Griffin P Rodgers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland Office of the Director and
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Race, Medical Mistrust, and Segregation in Primary Care as Usual Source of Care: Findings from the Exploring Health Disparities in Integrated Communities Study. J Urban Health 2016; 93:456-67. [PMID: 27193595 PMCID: PMC4899337 DOI: 10.1007/s11524-016-0054-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Compared to White Americans, African-Americans are less likely to use primary care (PC) as their usual source of care. This is generally attributed to race differences in socioeconomic status and in access to primary care services. Little is known about the relationship between race differences in medical mistrust and the usual source of care disparity. Using data from the Exploring Health Disparities in Integrated Communities (EHDIC) study, we examined the role of medical mistrust in choosing usual source of care in 1408 black and white adults who were exposed to the same healthcare facilities and low-income racially integrated community. Multinomial logistic regression models were estimated to examine the relationship between race, medical mistrust, and usual source of care. After adjusting for demographic and health-related factors, African-Americans were more likely than whites to use the emergency department (ED) (relative risk ratio [RRR] = 1.43 (95 % confidence interval (CI) [1.06-1.94])) and hospital outpatient department (RRR1.50 (95 %CI [1.10-2.05])) versus primary care as a usual source of care. When medical mistrust was added to the model, the gap between African-Americans' and whites' risk of using the ED versus primary care as a usual source of care closed (RRR = 1.29; 95 % CI [0.91-1.83]). However, race differences in the use of the hospital outpatient department remained even after accounting for medical mistrust (RRR = 1.67; 95 % CI [1.16-2.40]). Accounting for medical mistrust eliminated the ED-as-usual-source of care disparity. This study highlights the importance of medical mistrust as an intervention point for decreasing ED use as a usual source of care by low-income, urban African-Americans.
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Howard JT, Sparks PJ. Does allostatic load calculation method matter? Evaluation of different methods and individual biomarkers functioning by race/ethnicity and educational level. Am J Hum Biol 2016; 28:627-35. [DOI: 10.1002/ajhb.22843] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/22/2015] [Accepted: 01/09/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Jeffrey T. Howard
- US Army Institute of Surgical Research; San Antonio Texas
- Epidemiology and Biostatistics Department; US Army Institute of Surgical Research, JBSA San Antonio; Texas
| | - P. Johnelle Sparks
- Department of Demography; University of Texas at San Antonio; San Antonio Texas
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Howard JT, Sparks PJ. The Effects of Allostatic Load on Racial/Ethnic Mortality Differences in the United States. POPULATION RESEARCH AND POLICY REVIEW 2016. [DOI: 10.1007/s11113-016-9382-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kinlock BL, Thorpe RJ, Howard DL, Bowie JV, Ross LE, Fakunle DO, LaVeist TA. Racial Disparity in Time Between First Diagnosis and Initial Treatment of Prostate Cancer. Cancer Control 2016; 23:47-51. [PMID: 27009456 PMCID: PMC6448564 DOI: 10.1177/107327481602300108] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Disparities among patients with prostate cancer exist across the continuum of care. The interval of time that lapses between first diagnosis and treatment is another disparity that may exist but has not been fully explored. METHODS Our study looked at the data of 749 men (353 black and 396 white) who were 40 to 81 years of age when they entered the North Carolina Central Cancer Registry during the years 2007 and 2008. Our dependent variable was the amount of months that had passed between first diagnosis and treatment. Our main independent variable was self-reported race. Covariates included age, income, level of education, insurance status, treatment received, Gleason score, and level of medical mistrust. We used negative binomial regression analysis to determine the association between the amount of time that lapsed between a diagnosis of prostate cancer and treatment by race. RESULTS Compared with white men, black men were more likely to experience a longer wait time between diagnosis and treatment of prostate cancer (incidence rate ratio [IRR] 1.19; 95% confidence interval [CI], 1.04-1.36). Controls for demographical, clinical, and psychosocial variables (IRR 1.24; 95% CI, 1.04-1.43) did not explain this difference between the races. CONCLUSIONS These results suggest that the amount of time that lapses between first diagnosis and treatment of prostate cancer is longer for black men compared with white men. Our findings have identified an underreported racial disparity in the disease continuum of prostate cancer.
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Thorpe RJ, Kelley E, Bowie JV, Griffith DM, Bruce M, LaVeist T. Explaining Racial Disparities in Obesity Among Men: Does Place Matter? Am J Mens Health 2015; 9:464-72. [PMID: 25249452 PMCID: PMC4864070 DOI: 10.1177/1557988314551197] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
National data indicate that Black men have higher rates of obesity than White men. Black men also experience earlier onset of many chronic conditions and premature mortality linked to obesity. Explanations for these disparities have been underexplored, and existing national-level studies may be limited in their ability to explicate these long-standing patterns. National data generally do not account for race differences in risk exposures resulting from racial segregation or the confounding between race and socioeconomic status. Therefore, these differences in obesity may be a function of social environment rather than race. This study examined disparities in obesity among Black and White men living in the same social and environmental conditions, who have similar education levels and incomes using data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study. The findings were compared with the 2003 National Health Interview Survey (NHIS). Logistic regression was used to examine the association between race and obesity adjusting for demographics, socioeconomic status, and health conditions. In the NHIS, Black men had a higher odds of obesity (odds ratio=1.29, 95% confidence interval=1.12-1.49) than White men. However in the EHDIC-SWB, which accounts for social and environmental conditions of where these men live, Black men had similar odds of obesity (odds ratio=1.06, 95% confidence interval=0.70-1.62) compared with White men. These data highlight the importance of the role that setting plays in understanding race disparities in obesity among men. Social environment may be a key determinant of health when seeking to understand race disparities in obesity among Black and White men.
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Affiliation(s)
- Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Kelley
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janice V Bowie
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Derek M Griffith
- Institute for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Marino Bruce
- Center for Health of Minority Males, University of Mississippi Medical Center, Jackson, MS, USA Jackson State University, Jackson, MS, USA
| | - Thomas LaVeist
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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González G, Wilson-Frederick Wilson SM, Thorpe RJ. Examining Place As a Social Determinant of Health: Association Between Diabetes and US Geographic Region Among Non-Hispanic Whites and a Diverse Group of Hispanic/Latino Men. FAMILY & COMMUNITY HEALTH 2015; 38:319-331. [PMID: 26291192 DOI: 10.1097/fch.0000000000000081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Place (geographic location), birthplace, the number of years in the United States, and gender are important social determinants of health essential to our understanding of health disparities. In this study, we examined the association between place and diabetes in white and Hispanic/Latino men and found that place and the number of years in the United States are important social determinants of health. Our findings provide implications for a nuanced perspective by highlighting the importance of examining social determinants of health to identify tailored interventions to address disparities in diabetes for diverse groups of Hispanic/Latino men.
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Affiliation(s)
- Gloria González
- Hopkins Center for Health Disparities Solutions (Dr González), Department of Epidemiology (Dr Wilson-Frederick Wilson), and Program for Men's Health Research, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gaskin DJ, Zare H, Haider AH, LaVeist TA. The Quality of Surgical and Pneumonia Care in Minority-Serving and Racially Integrated Hospitals. Health Serv Res 2015; 51:910-36. [PMID: 26418717 DOI: 10.1111/1475-6773.12394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore the association between quality of care for surgical and pneumonia patients and the racial/ethnic composition of hospitals' patients. DATA SOURCE Our primary data were surgical and pneumonia processes of care indicators from the 2012 Medicare Hospital Compare Data. We merged this data with information from the 2011 American Hospital Association Annual Survey of Hospitals. We computed the racial and ethnic composition of hospital patients using 2008 data from the Healthcare Costs and Utilization Project. STUDY DESIGN The sample included 1,198 acute care general hospitals from 11 states: AZ, CA, FL, IA, MA, MD, NC, NJ, NY, WA, and WI. We compared quality across minority-serving, racially integrated, and majority-white hospitals using unconditional quantile regression models controlling for hospital and market characteristics. PRINCIPAL FINDINGS We found quality differences between the lowest performing minority-serving, racially integrated, and majority-white hospitals. As we moved from 10th to 90th quantile, the quality differences between hospitals by patients' racial composition disappeared. In other words, the best minority-serving and racially integrated hospitals performed as well as the best majority hospitals. CONCLUSIONS Efforts to improve quality of care for patients in minority-serving and racially integrated hospitals should focus on the lowest performers.
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Affiliation(s)
- Darrell J Gaskin
- Department of Health Policy and Management, Hopkins Center of Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hossein Zare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Faculty Appointments & Services, University of Maryland University College (UMUC), Adelphi, MD
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospitals, Boston, MA
| | - Thomas A LaVeist
- Department of Health Policy and Management, Hopkins Center of Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Santoro MS, Van Liew C, Holloway B, McKinnon S, Little T, Cronan TA. Honor Thy Parents: An Ethnic Multigroup Analysis of Filial Responsibility, Health Perceptions, and Caregiving Decisions. Res Aging 2015; 38:665-88. [PMID: 26282571 DOI: 10.1177/0164027515598349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The present study explores patterns of parity and disparity in the effect of filial responsibility on health-related evaluations and caregiving decisions. Participants who identified as White, Black, Hispanic, or Asian/Pacific Islander read a vignette about an older man needing medical care. They were asked to imagine that they were the man's son and answer questions regarding their likelihood of hiring a health care advocate (HCA) for services related to the father's care. A multigroup (ethnicity) path analysis was performed, and an intercept invariant multigroup model fits the data best. Direct and indirect effect estimation showed that filial responsibility mediated the relationship between both the perceived severity of the father's medical condition and the perceived need for medical assistance and the likelihood of hiring an HCA only for White and Hispanic participants, albeit differently. The findings demonstrate that culture and ethnicity affect health evaluations and caregiving decision making.
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Affiliation(s)
- Maya S Santoro
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Charles Van Liew
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Breanna Holloway
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Symone McKinnon
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Timothy Little
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Terry A Cronan
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA Department of Psychology, San Diego State University, San Diego, CA, USA
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Eisen CH, Bowie JV, Gaskin DJ, LaVeist TA, Thorpe RJ. The contribution of social and environmental factors to race differences in dental services use. J Urban Health 2015; 92:415-21. [PMID: 25680951 PMCID: PMC4456482 DOI: 10.1007/s11524-015-9938-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dental services use is a public health issue that varies by race. African Americans are less likely than whites to make use of these services. While several explanations exist, little is known about the role of segregation in understanding this race difference. Most research does not account for the confounding of race, socioeconomic status, and segregation. Using cross-sectional data from the Exploring Health Disparities in Integrated Communities Study, we examined the relationship between race and dental services use. Our primary outcome of interest was dental services use within 2 years. Our main independent variable was self-identified race. Of the 1408 study participants, 59.3% were African American. More African Americans used dental services within 2 years than whites. After adjusting for age, gender, marital status, income, education, insurance, self-rated health, and number of comorbidities, African Americans had greater odds of having used services (odds ratio = 1.48, 95% confidence interval 1.16, 1.89) within 2 years. Within this low-income racially integrated sample, African Americans participated in dental services more than whites. Place of living is an important factor to consider when seeking to understand race differences in dental service use.
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Affiliation(s)
- Colby H Eisen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ste 441, Baltimore, MD, 21205, USA
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Thorpe RJ, McCleary R, Smolen JR, Whitfield KE, Simonsick EM, LaVeist T. Racial disparities in disability among older adults: finding from the exploring health disparities in integrated communities study. J Aging Health 2015; 26:1261-79. [PMID: 25502241 DOI: 10.1177/0898264314534892] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Persistent and consistently observed racial disparities in physical functioning likely stem from racial differences in social resources and environmental conditions. METHOD We examined the association between race and reported difficulty performing instrumental activities of daily living (IADL) in 347 African American (45.5%) and Whites aged 50 or above in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore, Maryland Study (EHDIC-SWB). RESULTS Contrary to previous studies, African Americans had lower rates of disability (women: 25.6% vs. 44.6%, p = .006; men: 15.7% vs. 32.9%; p = .017) than Whites. After adjusting for sociodemographics, health behaviors, and comorbidities, African American women (odds ratio [OR] = 0.32, 95% confidence interval [CI] = [0.14, 0.70]) and African American men (OR = 0.34, 95% CI = [0.13, 0.90]) retained their functional advantage compared with White women and men, respectively. CONCLUSION These findings within an integrated, low-income urban sample support efforts to ameliorate health disparities by focusing on the social context in which people live.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Rachael McCleary
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jenny R Smolen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith E Whitfield
- Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Eleanor M Simonsick
- Johns Hopkins School of Medicine, Baltimore, MD, USA National Institute on Aging, Baltimore, MD, USA
| | - Thomas LaVeist
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Racial Residential Segregation and Access to Health-Care Coverage: A Multilevel Analysis. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0275-4959(2012)0000030009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Kelley EA, Bowie JV, Griffith DM, Bruce M, Hill S, Thorpe RJ. Geography, Race/Ethnicity, and Obesity Among Men in the United States. Am J Mens Health 2015; 10:228-36. [PMID: 25567236 DOI: 10.1177/1557988314565811] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prevalence of obesity in the United States has increased significantly and is a particular concern for minority men. Studies focused at the community and national levels have reported that geography can play a substantial role in contributing to obesity, but little is known about how regional influences contribute to obesity among men. The objective of this study is to examine the association between geographic region and obesity among men in the United States and to determine if there are racial/ethnic differences in obesity within these geographic regions. Data from men, aged 18 years and older, from the National Health Interview Survey were combined for the years 2000 to 2010. Obesity was defined as body mass index (BMI) ≥30 kg/m(2) Logistic regression models were specified to calculate the odds ratio (OR) and 95% confidence interval (CI) for the association between geographic region and obesity and for race and obesity within geographic regions. Compared to men living in the Northeast, men living in the Midwest had significantly greater odds of being obese (OR = 1.09, 95% CI [1.02, 1.17]), and men living in the West had lower odds of being obese (OR = 0.82, 95% CI [0.76, 0.89]). Racial/ethnic differences were also observed within geographic region. Black men have greater odds of obesity than White men in the South, West, and Midwest. In the South and West, Hispanic men also have greater odds of obesity than White men. In all regions, Asian men have lower odds of obesity than White men.
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Affiliation(s)
- Elizabeth A Kelley
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janice V Bowie
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Derek M Griffith
- Institute for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Marino Bruce
- Center for Health of Minority Males, University of Mississippi Medical Center, Jackson, MS, USA Jackson State University, Jackson, MS, USA
| | - Sarah Hill
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Johns Hopkins University, Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ferris RE, Glicksman A, Kleban MH. Environmental Predictors of Unmet Home-and Community-Based Service Needs of Older Adults. J Appl Gerontol 2014; 35:179-208. [DOI: 10.1177/0733464814525504] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 02/02/2014] [Indexed: 01/01/2023] Open
Abstract
Home- and community-based services (HCBS) for many older adults are an essential component of aging-in-place. Andersen developed the contemporary model used to predict service use. Researchers have modified the model to examine need. Studies that attempt to predict unmet needs have explained only 10% to 15% of the variance. This study is based on the supposition that lack of accounting for environmental factors has resulted in such small explanatory power. Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs. Findings reveal that lack of access to healthy foods and poor housing quality have a significant relationship to unmet HCBS needs. This model predicted 54% of the variance. Results reveal environmental questions to ask, a way to identify older adults with unmet HCBS needs and environmental barriers that if addressed may reduce older adults’ eventual need for health services and HCBS.
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Whitaker SM, Bowie JV, McCleary R, Gaskin DJ, LaVeist TA, Thorpe RJ. The Association Between Educational Attainment and Diabetes Among Men in the United States. Am J Mens Health 2014; 8:349-56. [PMID: 24429135 DOI: 10.1177/1557988313520034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Few studies have examined the relationship between education and diabetes among men in the United States and whether this relationship differs by race/ethnicity. This study examined whether racial disparities in diabetes existed by educational attainment in 336,746 non-Hispanic White, non-Hispanic Black, and Hispanic men 18 years of age and older in the United States. Logistic regression models were specified to examine the odds of reporting diabetes by educational attainment. Within race/ethnicity, both White and Hispanic men who had less than a high school education (odds ratio [OR] = 1.42, 95% confidence interval [CI] = [1.19, 1.69], and OR = 1.64, 95% CI = [1.22, 2.21], respectively) had consistently higher odds of diabetes than men with a bachelor's degree or higher level of educational attainment. Educational attainment did not appear to be associated with reporting a diagnosis of diabetes in non-Hispanic Black men. Identifying why educational attainment is associated with diabetes outcomes in some racial/ethnic groups but not others is essential for diabetes treatment and management.
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Affiliation(s)
- Shanta M Whitaker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janice V Bowie
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rachael McCleary
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Darrell J Gaskin
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas A LaVeist
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Thorpe RJ, Bowie JV, Smolen JR, Bell CN, Jenkins ML, Jackson J, LaVeist TA. Racial disparities in hypertension awareness and management: are there differences among African Americans and Whites living under similar social conditions? Ethn Dis 2014; 24:269-275. [PMID: 25065066 PMCID: PMC4350680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To examine the nature of disparities in hypertension awareness, treatment, and control within a sample of Whites and African Americans living in the same social context and with access to the same health care environment. DESIGN Cross-sectional study SETTING Southwest Baltimore, Maryland PARTICIPANTS 949 hypertensive African American and White adults in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) Study. MAIN OUTCOME MEASURES Hypertensive participants who reported having been diagnosed by a doctor were considered to be aware of their hypertension. Among hypertensive adults aware of their condition, those who reported taking antihypertensive medications were classified as being in treatment. Among the treated hypertensive adults who had diabetes, those with systolic BP < 130 mm Hg and diastolic BP < 80 mm Hg were considered to be controlled. Among the treated hypertensive participants who did not have diabetes, those with systolic BP < 140 mmHg and diastolic BP < 90 mm Hg were also considered to be controlled. RESULTS After adjusting for age, sex, marital status, education, income, health insurance, weight status, smoking status, drinking status, physical activity, cardiovascular disease, stroke, and diabetes, African Americans had greater odds of being aware of their hypertension than Whites (odds ratio = 1.44; 95% confidence interval 1.04, 2.01). However, African Americans and Whites had similar odds of being treated for hypertension, and having their hypertension under control. CONCLUSION Within this racially integrated sample of hypertensive adults who share similar health care markets, race differences in treatment and control of hypertension were eliminated. Accounting for the social context should be considered in public health interventions to increase hypertension awareness and management.
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Ko M, Needleman J, Derose KP, Laugesen MJ, Ponce NA. Residential segregation and the survival of U.S. urban public hospitals. Med Care Res Rev 2013; 71:243-60. [PMID: 24362646 DOI: 10.1177/1077558713515079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Residential segregation is associated geographic disparities in access to care, but its impact on local health care policy, including public hospitals, is unknown. We examined the effects of racial residential segregation on U.S. urban public hospital closures from 1987 to 2007, controlling for hospital, market, and policy characteristics. We found that a high level of residential segregation moderated the protective effects of Black population composition, such that a high level of residential segregation, in combination with a high percentage of poor residents, conferred a higher likelihood of hospital closure. More segregated and poorer communities face disadvantages in access to care that may be compounded as a result of instability in the health care safety net. Policy makers should consider the influence of social factors such as residential segregation on the allocation of the safety net resources.
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Affiliation(s)
- Michelle Ko
- 1University of California, San Francisco, CA, USA
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Viruell-Fuentes EA, Ponce NA, Alegría M. Neighborhood context and hypertension outcomes among Latinos in Chicago. J Immigr Minor Health 2013; 14:959-67. [PMID: 22527740 DOI: 10.1007/s10903-012-9608-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Although a health advantage in hypertension has been documented among Latinos, this advantage appears to be eroding. Of particular concern is the observation that Latinos are less likely to be screened and treated for hypertension and to having it controlled. Scholars have suggested that, above and beyond individual-level factors, neighborhood characteristics may be important predictors of health and health care. We analyzed 2001-2003 data from the Chicago Community Adult Health Study to examine (a) the relationship between the Latino and immigrant composition of neighborhoods in Chicago and several outcomes among Latinos: having hypertension, utilizing hypertension-related health care, and being treated for hypertension; and (b) whether there was a differential effect of neighborhood Latino/immigrant concentration by language of interview and nativity status. We controlled for additional neighborhood characteristics relevant to hypertension and to the availability and accessibility of health care resources. Neighborhoods with higher concentrations of immigrants and Latinos were associated with Latinos having lower odds of hypertension (OR = 0.60, p = 0.03). However, among those with hypertension, our results point to deleterious effects on hypertension care (OR = 0.55, p = 0.06) and treatment (OR = 0.54, p = 0.04) associated with living in neighborhoods with higher concentrations of immigrants and Latinos. We detected no significant interaction effects between immigrant/Latino neighborhood composition and language of interview or being an immigrant in this sample. These results suggest that improving access to care for Latinos with hypertension requires enhanced placement of community clinics and other safety-net health centers in neighborhoods with higher proportions of immigrants and Latinos.
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Rossen LM. Neighbourhood economic deprivation explains racial/ethnic disparities in overweight and obesity among children and adolescents in the U.S.A. J Epidemiol Community Health 2013; 68:123-9. [PMID: 24072744 DOI: 10.1136/jech-2012-202245] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Low-income and some racial and ethnic subpopulations are more likely to suffer from obesity. Inequities in the physical and social environment may contribute to disparities in paediatric obesity, but there is little empirical evidence to date. This study explored whether neighbourhood-level socioeconomic factors attenuate racial and ethnic disparities in obesity among youth in the U.S.A. and whether individual-level socioeconomic status (SES) interacts with neighbourhood deprivation. METHODS This analysis used data from 17,100 youth ages 2-18 years participating in the 2001-2010 National Health and Nutrition Examination Survey linked to census tract-level socioeconomic characteristics. Multilevel logistic regression models were used to examine neighbourhood deprivation in association with odds of obesity (age-specific and sex-specific body mass index percentile ≥95). RESULTS The unadjusted prevalence of obesity was 15% among non-Hispanic white children and 21% among non-Hispanic black and Mexican-American children. Adjustment for individual-level SES neighbourhood deprivation and the interaction between these two factors resulted in a 74% attenuation of the disparity in obesity between non-Hispanic black and non-Hispanic white children and a 49% attenuation of the disparity between Mexican-American and non-Hispanic white children. There was a significant interaction between individual-level SES and neighbourhood deprivation where higher individual-level income was protective for children living in low-deprivation neighbourhoods, but not for children who lived in high-deprivation areas. Conversely, area deprivation was associated with higher odds of obesity, but only among children who were above the poverty threshold. CONCLUSIONS Future research on disparities in obesity and other health outcomes should examine broader contextual factors and social determinants of inequities.
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Affiliation(s)
- Lauren M Rossen
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, , Hyattsville, Maryland, USA
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