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Abreu TC, Mackenbach JD, Heuvelman F, Schoonmade LJ, Beulens JW. Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis. SSM Popul Health 2024; 25:101559. [PMID: 38148999 PMCID: PMC10749911 DOI: 10.1016/j.ssmph.2023.101559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/27/2023] [Accepted: 11/11/2023] [Indexed: 12/28/2023] Open
Abstract
Aim The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD). Methods We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses. Results From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher "CVD risk scores" (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk. Conclusion Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
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Affiliation(s)
- Taymara C. Abreu
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Joreintje D. Mackenbach
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Fleur Heuvelman
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
| | - Linda J. Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, Noord-Holland, the Netherlands
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2
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Wintemute K, Noor M, Bhatt A, Bloch G, Arackal S, Kalia S, Aliarzadeh B, La Tona S, Lo J, Pinto AD, Greiver M. Implementation of targeted screening for poverty in a large primary care team in Toronto, Canada: a feasibility study. BMC FAMILY PRACTICE 2021; 22:194. [PMID: 34592935 PMCID: PMC8483428 DOI: 10.1186/s12875-021-01514-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
Background Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada. The main outcome was the proportion of targeted patients screened. Methods This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods with pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. Results 128 targeted patients with at least one visit (25%) were screened. The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up. 25 patients (20%) screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization. Conclusions We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. Screening was feasible; however, only a small number of patients were linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01514-9.
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Affiliation(s)
- Kimberly Wintemute
- Department of Family and Community Medicine, North York General Hospital, 4001 Leslie street, LE140, M2K 1E1, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Meh Noor
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.
| | - Aashka Bhatt
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada
| | - Gary Bloch
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St Michael's Hospital, 36 Queen's street East, M5B 1W8, Toronto, Ontario, Canada
| | - Suja Arackal
- North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Sumeet Kalia
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada
| | - Babak Aliarzadeh
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada
| | - Sabrina La Tona
- North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Joyce Lo
- North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St Michael's Hospital, 36 Queen's street East, M5B 1W8, Toronto, Ontario, Canada.,Upstream Lab, MAP Centre for Urban Health Solutions, St. Michael's Hospital, 36 Queen Street East, M5B 1W8, Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, North York General Hospital, 4001 Leslie street, LE140, M2K 1E1, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto Practice-Based Research Network, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada.,North York Family Health Team, 240 Duncan Mill road, M3B 3S6, Toronto, Ontario, Canada
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3
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Sousa-Uva M, Barreto M, Roquette R, Matias-Dias C, Ribeiro R, Manuel Boavida J, Nunes B. Association between area- and individual-level socio-economic factors with glycated haemoglobin-Evidence from a Portuguese population-based study. Diabet Med 2021; 38:e14542. [PMID: 33580515 DOI: 10.1111/dme.14542] [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: 11/19/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study aims to estimate the associations between area-level deprivation and individual-level socio-economic factors, as well as their interaction, with glycated haemoglobin (HbA1c ) levels. METHODS We conducted a gamma multilevel regression analysis using individual-level data from the Portuguese National Health Examination Survey and a deprivation index built through factor analysis, at municipality level, with census variables. RESULTS Living in a municipality with high material deprivation and having a low level of education were independently associated with an increase of 2.3% (95% confidence interval [CI] 0.6, 4.0) and of 1.6% (95% CI 0.6, 2.7) in the mean levels of HbA1c , respectively. The interaction between area material deprivation and individual-level education was not associated with the levels of HbA1c (0.5%, 95% CI -1.3, 2.3). CONCLUSIONS Our findings support the collective resources model that argues that people in less deprived areas have better health because there are more collective resources. The results suggest that to reduce socio-economic inequalities associated with the levels of HbA1c and, consequently, with diabetes, will require attention to the area material deprivation and individual-level education. Upstream social determinants of health are thus highlighted.
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Affiliation(s)
- Mafalda Sousa-Uva
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Marta Barreto
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Rita Roquette
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Carlos Matias-Dias
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Rogério Ribeiro
- APDP Diabetes Portugal, Education and Research Center (APDP-ERC), Lisbon, Portugal
- iBiMED, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - José Manuel Boavida
- APDP Diabetes Portugal, Education and Research Center (APDP-ERC), Lisbon, Portugal
- iBiMED, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Baltazar Nunes
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol 2018; 28:493-502. [PMID: 29628285 DOI: 10.1016/j.annepidem.2018.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research. METHODS We abstracted information on the environmental and health outcome variables and the methods and data sources used. RESULTS The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas. CONCLUSIONS Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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Gonzalez-Zacarias AA, Mavarez-Martinez A, Arias-Morales CE, Stoicea N, Rogers B. Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus. Front Public Health 2016; 4:195. [PMID: 27672634 PMCID: PMC5018496 DOI: 10.3389/fpubh.2016.00195] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 01/27/2023] Open
Abstract
Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications.
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Affiliation(s)
| | - Ana Mavarez-Martinez
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Carlos E Arias-Morales
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Barbara Rogers
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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Biro S, Williamson T, Leggett JA, Barber D, Morkem R, Moore K, Belanger P, Mosley B, Janssen I. Utility of linking primary care electronic medical records with Canadian census data to study the determinants of chronic disease: an example based on socioeconomic status and obesity. BMC Med Inform Decis Mak 2016; 16:32. [PMID: 26969124 PMCID: PMC4788841 DOI: 10.1186/s12911-016-0272-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Electronic medical records (EMRs) used in primary care contain a breadth of data that can be used in public health research. Patient data from EMRs could be linked with other data sources, such as a postal code linkage with Census data, to obtain additional information on environmental determinants of health. While promising, successful linkages between primary care EMRs with geographic measures is limited due to ethics review board concerns. This study tested the feasibility of extracting full postal code from primary care EMRs and linking this with area-level measures of the environment to demonstrate how such a linkage could be used to examine the determinants of disease. The association between obesity and area-level deprivation was used as an example to illustrate inequalities of obesity in adults. Methods The analysis included EMRs of 7153 patients aged 20 years and older who visited a single, primary care site in 2011. Extracted patient information included demographics (date of birth, sex, postal code) and weight status (height, weight). Information extraction and management procedures were designed to mitigate the risk of individual re-identification when extracting full postal code from source EMRs. Based on patients’ postal codes, area-based deprivation indexes were created using the smallest area unit used in Canadian censuses. Descriptive statistics and socioeconomic disparity summary measures of linked census and adult patients were calculated. Results The data extraction of full postal code met technological requirements for rendering health information extracted from local EMRs into anonymized data. The prevalence of obesity was 31.6 %. There was variation of obesity between deprivation quintiles; adults in the most deprived areas were 35 % more likely to be obese compared with adults in the least deprived areas (Chi-Square = 20.24(1), p < 0.0001). Maps depicting spatial representation of regional deprivation and obesity were created to highlight high risk areas. Conclusions An area based socio-economic measure was linked with EMR-derived objective measures of height and weight to show a positive association between area-level deprivation and obesity. The linked dataset demonstrates a promising model for assessing health disparities and ecological factors associated with the development of chronic diseases with far reaching implications for informing public health and primary health care interventions and services.
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Affiliation(s)
- Suzanne Biro
- Kingston, Frontenac, and Lennox & Addington Public Health, 221 Portsmouth Avenue, Kingston, ON, K7M 1V5, Canada.
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - David Barber
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Rachael Morkem
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kieran Moore
- Kingston, Frontenac, and Lennox & Addington Public Health, 221 Portsmouth Avenue, Kingston, ON, K7M 1V5, Canada.,Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Paul Belanger
- Kingston, Frontenac, and Lennox & Addington Public Health, 221 Portsmouth Avenue, Kingston, ON, K7M 1V5, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Geography, Queen's University, Kingston, ON, Canada
| | - Brian Mosley
- Kingston, Frontenac, and Lennox & Addington Public Health, 221 Portsmouth Avenue, Kingston, ON, K7M 1V5, Canada
| | - Ian Janssen
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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