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Zolotor A, Huang RW, Bhavsar NA, Cholera R. Comparing Social Disadvantage Indices in Pediatric Populations. Pediatrics 2024; 154:e2023064463. [PMID: 39143925 PMCID: PMC11350100 DOI: 10.1542/peds.2023-064463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Place-based social disadvantage indices are increasingly used to promote health equity, but vary in design. We compared associations between 3 commonly used indices (Social Vulnerability Index [SVI], Area Deprivation Index [ADI], and Child Opportunity Index [COI]) and infant well-child check (WCC) attendance and adolescent obesity. We hypothesized that the COI would have the strongest association with child health outcomes. METHODS We conducted a cross-sectional analysis of 2014-2019 Duke University Health System electronic health record data. Eligible participants were ≤18 years old, had outpatient encounters during the study period, and resided in Durham County, North Carolina. We aggregated indices into deciles; higher deciles represented greater disadvantage. Multivariable logistic regression models quantified the association between each index and infant WCC attendance (ages 0-15 months) and adolescent obesity (11-17 years). RESULTS There were 10 175 and 14 961 children in the WCC and obesity cohorts, respectively. All 3 indices were similarly associated with WCCs (SVI odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08-1.12; ADI OR 1.10, 95% CI 1.08-1.12; COI OR 1.12, 95% CI 1.10-1.14) and obesity (SVI OR 1.06, 95% CI 1.04-1.07; ADI OR 1.08, 95% CI 1.06-1.10; COI OR 1.07, 95% CI 1.05-1.08). ORs indicate the increase in the outcome odds for every 1-decile index score increase. CONCLUSIONS Higher disadvantage as defined by all 3 indices was similarly associated with adolescent obesity and decreased infant WCC attendance. The SVI, ADI, and COI may be equally suitable for pediatric research, but population and outcome characteristics should be considered when selecting an index.
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Affiliation(s)
- Anna Zolotor
- Duke-Margolis Institute for Health Policy, Washington, District of Columbia
| | - Ro W. Huang
- Duke-Margolis Institute for Health Policy, Washington, District of Columbia
- Trinity College of Arts & Sciences, Duke University, Durham, North Carolina
| | | | - Rushina Cholera
- Duke-Margolis Institute for Health Policy, Washington, District of Columbia
- Population Health Sciences
- Pediatrics, Duke University School of Medicine, Durham, North Carolina
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D’Angelo Campos A, Ng SW. Nutritional quality of food purchases during the COVID-19 public health crisis: An analysis of geographic disparities in North Carolina. Prev Med Rep 2024; 44:102812. [PMID: 39091570 PMCID: PMC11292539 DOI: 10.1016/j.pmedr.2024.102812] [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: 02/21/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 08/04/2024] Open
Abstract
Objective To examine geographic disparities in the nutritional quality of food purchases during the COVID-19 public health crisis in North Carolina (NC). Methods Using shopper-level longitudinal transaction records between October 2019- and December 2020 from NC's largest grocery retailer, we fit mixed-effect models to examine disparities in the nutritional quality of food purchases among shoppers in counties with different levels of socioeconomic development and how such disparities changed after March 2020, accounting for other observed and contextual factors. Results Shoppers in counties with lower development levels purchased a larger share of calories from least healthy foods and a smaller share from healthier foods compared to shoppers in counties with higher development levels. These disparities were slightly attenuated for the least healthy foods and did not change for healthier foods after the onset of the COVID crisis. Conclusion Despite existing nutritional disparities among shoppers in counties with different levels of socioeconomic development, we did not observe a large-scale accentuation of inequities in dietary quality during the COVID-19 crisis. This pattern may have resulted from programmatic responses to mitigate the adverse effects of the COVID crisis on vulnerable populations. Future work should further explore the role of such responses.
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Affiliation(s)
- Aline D’Angelo Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Smith LL, Falvey J, Grace B, Vaeth E, Rubin J, Perlmutter R, Blythe D, Hawkins D, Mbuthia M, Roghmann MC, Rock C, Leekha S. C. auris and neighborhood socioeconomic vulnerability in the state of Maryland from 2019 to 2022. Infect Control Hosp Epidemiol 2024:1-7. [PMID: 39075017 DOI: 10.1017/ice.2024.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Candida auris is an emerging fungal pathogen increasingly recognized as a cause of healthcare-associated infections including outbreaks. METHODS We performed a mixed-methods study to characterize the emergence of C. auris in the state of Maryland from 2019 to 2022, with a focus on socioeconomic vulnerability and infection prevention opportunities. We describe all case-patients of C. auris among Maryland residents from June 2019 to December 2021 detected by Maryland Department of Health. We compared neighborhood socioeconomic characteristics of skilled nursing facilities (SNFs) with and without C. auris transmission outbreaks using both the social vulnerability index (SVI) and the area deprivation index (ADI). The SVI and the ADI were obtained at the state level, with an SVI ≥ 75th percentile or an ADI ≥ 80th percentile considered severely disadvantaged. We summarized infection control assessments at SNFs with outbreaks using a qualitative analysis. RESULTS A total of 140 individuals tested positive for C. auris in the study period in Maryland; 46 (33%) had a positive clinical culture. Sixty (43%) were associated with a SNF, 37 (26%) were ventilated, and 87 (62%) had a documented wound. Separate facility-level neighborhood analysis showed SNFs with likely C. auris transmission were disproportionately located in neighborhoods in the top quartile of deprivation by the SVI, characterized by low socioeconomic status and high proportion of racial/ethnic minorities. Multiple infection control deficiencies were noted at these SNFs. CONCLUSION Neighborhood socioeconomic vulnerability may contribute to the emergence and transmission of C. auris in a community.
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Affiliation(s)
- L Leigh Smith
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Falvey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Jamie Rubin
- Maryland Department of Health; Baltimore, MD, USA
| | | | - David Blythe
- Maryland Department of Health; Baltimore, MD, USA
| | | | | | - Mary-Claire Roghmann
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Clare Rock
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Johnson C, Wolff C, Xu J. Health Equity and Access to COVID-19 Treatments Available through Emergency Use Authorizations. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02094-x. [PMID: 39039261 DOI: 10.1007/s40615-024-02094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
Understanding and evaluating equity in access to care is a critical component to ensuring health equity for all individuals. During the COVID-19 pandemic, the U.S. Food and Drug Administration made unprecedented use of its regulatory authority by authorizing the use of unapproved products through Emergency Use Authorizations (EUAs). We use data from the U.S. National COVID Cohort Collaborative (N3C) to understand how access to therapeutic products authorized under EUAs has varied across COVID-19 patients and over time. We find that Black patients were more likely to receive early EUA drugs while White patients were more likely to receive monoclonal antibodies. Male patients were more likely to receive any EUA drug than Female patients. Patients in Metropolitan areas were more likely to receive EUA drugs than patients in other regions. Additionally, differences in the rates of exposure to EUA drugs by gender, rural-urban classification, and length of stay decreased over time while differences by race and ethnicity have generally persisted. Our project identifies inequities in the rate of access to EUA drugs across patient groups that can inform policy makers in future planning and decision making.
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Affiliation(s)
- Candon Johnson
- Food and Drug Administration, Office of the Commissioner, Silver Spring, MD, USA.
| | - Carolyn Wolff
- Federal Trade Commission, Bureau of Economics, Washington, DC, USA
| | - Jing Xu
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
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Kanneganti M, Byhoff E, Serper M, Olthoff KM, Bittermann T. Neighborhood-level social determinants of health measures independently predict receipt of living donor liver transplantation in the United States. Liver Transpl 2024; 30:618-627. [PMID: 38100175 DOI: 10.1097/lvt.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
Disparities exist in the access to living donor liver transplantation (LDLT) in the United States. However, the association of neighborhood-level social determinants of health (SDoH) on the receipt of LDLT is not well-established. This was a retrospective cohort study of adult liver transplant recipients between January 1, 2005 and December 31, 2021 at centers performing LDLT using the United Network for Organ Sharing database, which was linked through patients' ZIP code to a set of 24 neighborhood-level SDoH measures from different data sources. Temporal trends and center differences in neighborhood Social Deprivation Index (SDI), a validated scale of socioeconomic deprivation ranging from 0 to 100 (0=least disadvantaged), were assessed by transplant type. Multivariable logistic regression evaluated the association of increasing SDI on receipt of LDLT [vs. deceased donor liver transplantation (DDLT)]. There were 51,721 DDLT and 4026 LDLT recipients at 59 LDLT-performing centers during the study period. Of the 24 neighborhood-level SDoH measures studied, the SDI was most different between the 2 transplant types, with LDLT recipients having lower SDI (ie, less socioeconomic disadvantage) than DDLT recipients (median SDI 37 vs. 47; p < 0.001). The median difference in SDI between the LDLT and DDLT groups significantly decreased from 13 in 2005 to 3 in 2021 ( p = 0.003). In the final model, the SDI quintile was independently associated with transplant type ( p < 0.001) with a threshold SDI of ~40, above which increasing SDI was significantly associated with reduced odds of LDLT (vs. reference SDI 1-20). As a neighborhood-level SDoH measure, SDI is useful for evaluating disparities in the context of LDLT. Center outreach efforts that aim to reduce disparities in LDLT could preferentially target US ZIP codes with SDI > 40.
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Affiliation(s)
- Mounika Kanneganti
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elena Byhoff
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Marina Serper
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim M Olthoff
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chea N, Eure T, Alkis Ramirez R, Zlotorzynska M, Blazek GT, Nadle J, Lee J, Czaja CA, Johnston H, Barter D, Kellogg M, Emanuel C, Meek J, Brackney M, Carswell S, Thomas S, Fridkin SK, Wilson LE, Perlmutter R, Marceaux-Galli K, Fell A, Lovett S, Lim S, Lynfield R, Shrum Davis S, Phipps EC, Sievers M, Dumyati G, Myers C, Hurley C, Licherdell E, Pierce R, Ocampo VLS, Hall EW, Wilson C, Adre C, Kirtz E, Markus TM, Billings K, Plumb ID, Abedi GR, James-Gist J, Magill SS, Grigg CT. Characteristics of healthcare personnel with SARS-CoV-2 infection: 10 emerging infections program sites in the United States, April 2020-December 2021. Infect Control Hosp Epidemiol 2024:1-9. [PMID: 38770586 DOI: 10.1017/ice.2024.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021. METHODS CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively. RESULTS Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles. CONCLUSIONS To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
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Affiliation(s)
- Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Taniece Eure
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Alkis Ramirez
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Zlotorzynska
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gregory T Blazek
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Chenega Enterprise Systems and Solutions, LLC, Chesapeake, VA, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA, USA
| | - Jane Lee
- California Emerging Infections Program, Oakland, CA, USA
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Melissa Kellogg
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Catherine Emanuel
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Monica Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Stacy Carswell
- Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Atlanta, GA, USA
| | - Stepy Thomas
- Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Atlanta, GA, USA
| | - Scott K Fridkin
- Georgia Emerging Infections Program, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Ashley Fell
- Minnesota Department of Health, St. Paul, MN, USA
| | - Sara Lovett
- Minnesota Department of Health, St. Paul, MN, USA
| | - Sarah Lim
- Minnesota Department of Health, St. Paul, MN, USA
| | | | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA
- New Mexico Department of Health, Santa Fe, NM, USA
| | | | - Ghinwa Dumyati
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher Myers
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Christine Hurley
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Erin Licherdell
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | - Eric W Hall
- Oregon Health and Science University and Portland State University School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | | | - Cullen Adre
- Tennessee Department of Health, Nashville, TN, USA
| | - Erika Kirtz
- Tennessee Department of Health, Nashville, TN, USA
| | | | | | - Ian D Plumb
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Glen R Abedi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jade James-Gist
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cheri T Grigg
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Fenton D, Allen A, Kent JR, Nordgren R, Liu A, Rama N, Wang A, Rubin D, Gleason LJ, Justine Landi A, Huisingh-Scheetz M, Ferguson MK, Madariaga MLL. The association between neighborhood disadvantage and frailty: A retrospective case series. J Public Health Res 2024; 13:22799036241258876. [PMID: 38867913 PMCID: PMC11168058 DOI: 10.1177/22799036241258876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/16/2024] [Indexed: 06/14/2024] Open
Abstract
Background Frailty predicts poorer outcomes in surgical patients. Recent studies have found socioeconomic status to be an important characteristic for surgical outcomes. We evaluated the association of Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), two geospatial atlases that provide a multidimensional evaluation of neighborhood deprivation, with frailty in a surgery population. Design & methods A retrospective study of patients undergoing routine frailty screening was conducted 12/2020-8/2022. Frailty was measured using Fried's Frailty Phenotype (FFP) and the five-item Modified Frailty Index (mFI-5). ADI and SVI quartiles were determined using patient residence. Logistic regression models were used to evaluated associations of FFP (frail only vs not frail) and mFI-5 (≥2 vs 0-1) with ADI and SVI (α = 0.05). Results Of 372 screened patients, 41% (154) were women, median age was 68% (63-74), and 46% (170) identified as non-White. Across ADI and SVI quartiles, higher number of comorbidities, decreasing median income, and frailty were associated with increasing deprivation (p < 0.01). When controlling for age, sex, comorbidities, and BMI category, frailty by FFP was associated with the most deprived two quartiles of ADI (OR 2.61, CI: [1.35-5.03], p < 0.01) and the most deprived quartile of SVI (OR 2.33, [1.10-4.95], p < 0.05). These trends were also seen with mFI-5 scores ≥2 (ADI: OR 1.64, [1.02-2.63], p < 0.05; SVI: OR 1.71, [1.01-2.91], p < 0.05). Conclusions Surgical patients living in socioeconomically deprived neighborhoods are more likely to be frail. Interventions may include screening of disadvantaged populations and resource allocation to vulnerable neighborhoods.
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Affiliation(s)
- David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Amani Allen
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Johnathan R Kent
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Allison Liu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Nihar Rama
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ally Wang
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Daniel Rubin
- Department of Anesthesia & Critical Care, University of Chicago Medicine, Chicago, IL, USA
| | - Lauren J Gleason
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - A Justine Landi
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Mark K Ferguson
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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Ly KN, Yin S, Spradling PR. Disparities in Social Vulnerability and Premature Mortality among Decedents with Hepatitis B, United States, 2010-2019. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01968-4. [PMID: 38472630 PMCID: PMC11390983 DOI: 10.1007/s40615-024-01968-4] [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: 11/06/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Current US hepatitis B mortality rates remain three times higher than the national target. Mortality reduction will depend on addressing hepatitis B disparities influenced by social determinants of health. OBJECTIVES This study aims to describe characteristics of hepatitis B-listed decedents, which included US birthplace status and county social vulnerability attributes and quantify premature mortality. METHODS We conducted a cross-sectional analysis of 17,483 hepatitis B-listed decedents using the 2010-2019 US Multiple-Cause-of-Death data merged with the county-level Social Vulnerability Index (SVI). Outcomes included the distribution of decedents according to US birthplace status and residence in higher versus lower death burden counties by sociodemographic characteristics, years of potential life lost (YPLL), and SVI quartiles. RESULTS Most hepatitis B-listed decedents were US-born, male, and born during 1945-1965. Median YPLL was 17.2; 90.0% died prematurely. US-born decedents were more frequently White, non-college graduates, unmarried, and had resided in a county with < 500,000 people; non-US-born decedents were more frequently Asian/Pacific Islander, college graduates, married, and had resided in a county with ≥ 1 million people. Higher death burden (≥ 20) counties were principally located in coastal states. US-born decedents more frequently resided in counties in the highest SVI quartile for "Household Characteristics" and "Uninsured," whereas non-US-born decedents more frequently resided in counties in the highest SVI quartile for "Racial/Ethnic Minority Status" and "Housing Type/Transportation." CONCLUSION This analysis found substantial premature hepatitis B mortality and residence in counties ranked high in social vulnerability. Successful interventions should be tailored to disproportionately affected populations and the social vulnerability features of their geographic areas.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA.
| | - Shaoman Yin
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA.
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Morenz AM, Liao JM, Au DH, Hayes SA. Area-Level Socioeconomic Disadvantage and Health Care Spending: A Systematic Review. JAMA Netw Open 2024; 7:e2356121. [PMID: 38358740 PMCID: PMC10870184 DOI: 10.1001/jamanetworkopen.2023.56121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services research. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are 2 of the most commonly used measures. There is also early interest in incorporating area-level measures to create more equitable alternative payment models. Objective To review the evidence on the association of ADI and SVI with health care spending, including claims-based spending and patient-reported barriers to care due to cost. Evidence Review A systematic search for English-language articles and abstracts was performed in the PubMed, Web of Science, Embase, and Cochrane databases (from inception to March 1, 2023). Peer-reviewed articles and abstracts using a cross-sectional, case-control, or cohort study design and based in the US were identified. Data analysis was performed in March 2023. Findings This review included 24 articles and abstracts that used a cross-sectional, case-control, or cohort study design. In 20 of 24 studies (83%), ADI and SVI were associated with increased health care spending. No association was observed in the 4 remaining studies, mostly with smaller sample sizes from single centers. In adjusted models, the increase in spending associated with higher ADI or SVI residence was $574 to $1811 for index surgical hospitalizations, $3003 to $24 075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. In the studies that explored mechanisms, postoperative complications, readmission risk, and poor primary care access emerged as health care system-related drivers of increased spending. Conclusions and Relevance The findings of this systematic review suggest that both ADI and SVI can play important roles in efforts to understand drivers of health care spending and in the design of payment and care delivery programs that capture aspects of social risk. At the health care system level, higher health care spending and poor care access associated with ADI or SVI may represent opportunities to codesign interventions with patients from high ADI or SVI areas to improve access to high-value health care and health promotion more broadly.
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Affiliation(s)
- Anna M. Morenz
- Department of Medicine, University of Washington, Seattle
- Program on Policy Evaluation and Learning in the Pacific Northwest, Seattle, Washington
| | - Joshua M. Liao
- Department of Medicine, University of Washington, Seattle
- Program on Policy Evaluation and Learning in the Pacific Northwest, Seattle, Washington
- Now with Department of Medicine, University of Texas Southwestern Medical Center, Dallas
- Now with Program on Policy Evaluation and Learning, Dallas, Texas
| | - David H. Au
- Department of Medicine, University of Washington, Seattle
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Sophia A. Hayes
- Department of Medicine, University of Washington, Seattle
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Barber LE, Maliniak ML, Nash R, Moubadder L, Haynes D, Ward KC, McCullough LE. A Comparison of Three Area-Level Indices of Neighborhood Deprivation and Socioeconomic Status and their Applicability to Breast Cancer Mortality. J Urban Health 2024; 101:75-79. [PMID: 38158547 PMCID: PMC10897108 DOI: 10.1007/s11524-023-00811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Neighborhood deprivation indices are widely used in research, but the performance of these indices has rarely been directly compared in the same analysis. We examined the Area Deprivation Index, Neighborhood Deprivation Index, and Yost index, and compared their associations with breast cancer mortality. Indices were constructed for Georgia census block groups using 2011-2015 American Community Survey data. Pearson correlation coefficients and percent agreement were calculated. Associations between each index and breast cancer mortality were estimated among 36,795 women diagnosed with breast cancer using Cox proportional hazards regression. The indices were strongly correlated (absolute value of correlation coefficients > 0.77), exhibited moderate (41.4%) agreement, and were similarly associated with a 36% increase in breast cancer mortality. The similar associations with breast cancer mortality suggest the indices measure the same underlying construct, despite only moderate agreement. By understanding their correlations, agreement, and associations with health outcomes, researchers can choose the most appropriate index for analysis.
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Affiliation(s)
- Lauren E Barber
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA.
| | - Maret L Maliniak
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Rebecca Nash
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - David Haynes
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Kevin C Ward
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
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Zlotorzynska M, Chea N, Eure T, Alkis Ramirez R, Blazek GT, Czaja CA, Johnston H, Barter D, Kellogg M, Emanuel C, Lynfield R, Fell A, Lim S, Lovett S, Phipps EC, Shrum Davis S, Sievers M, Dumyati G, Concannon C, Myers C, McCullough K, Woods A, Hurley C, Licherdell E, Pierce R, Ocampo VL, Hall E, Magill SS, Grigg CT. Residential social vulnerability among healthcare personnel with and without severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in Five US states, May-December 2020. Infect Control Hosp Epidemiol 2024; 45:82-88. [PMID: 37462106 PMCID: PMC10782193 DOI: 10.1017/ice.2023.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection. DESIGN Case-control study. SETTING This study analyzed data collected in May-December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon. PARTICIPANTS Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed. METHODS HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase- polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression. RESULTS Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37-2.26). CONCLUSIONS These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.
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Affiliation(s)
- Maria Zlotorzynska
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taniece Eure
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Alkis Ramirez
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory T. Blazek
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Chenega Enterprise Systems & Solutions, LLC, Chesapeake, Virginia
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Melissa Kellogg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Catherine Emanuel
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Ashley Fell
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Sarah Lim
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Sara Lovett
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Erin C. Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Marla Sievers
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Ghinwa Dumyati
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Cathleen Concannon
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Christopher Myers
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Kathryn McCullough
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Amy Woods
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Christine Hurley
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Erin Licherdell
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | | | - Eric Hall
- School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Shelley S. Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheri T. Grigg
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ransome Y, Luan H, Song I, Duncan DT. Church Closings Were Associated with Higher COVID-19 Infection Rates: Implications for Community Health Equity. J Urban Health 2023; 100:1258-1263. [PMID: 37989815 PMCID: PMC10728374 DOI: 10.1007/s11524-023-00791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/23/2023]
Abstract
This study investigates the changes in physical church closings years 2013 to 2019 in New York City (NYC), Philadelphia, and Baltimore and the association with COVID-19 infection rates. We applied Bayesian spatial binomial models to analyze confirmed cases of COVID-19 as of February 28, 2022, in each city at the zip code-level. A one unit increase in the number of churches closed corresponded to a 5% higher COVID-19 infection rate, in NYC (rate ratio = 1.05, 95% credible interval = 1.02-1.08%), where the association was significant. Church closings appears to be an important indicator of neighborhood social vulnerability. Church closings should be routinely monitored as a structural determinant of community health and to advance health equity.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, LEPH, New Haven, CT, 06511, USA.
| | - Hui Luan
- Department of Geography, University of Oregon, Eugene, OR, 97403, USA
| | - Insang Song
- Department of Geography, University of Oregon, Eugene, OR, 97403, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA
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13
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Schmidt H. Equity needs to be (even) more central under the WHO Pandemic Agreement. JOURNAL OF MEDICAL ETHICS 2023; 49:797-798. [PMID: 37996111 DOI: 10.1136/jme-2023-109720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Harald Schmidt
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Sheehan JL, Jordan AA, Newman KL, Johnson LA, Eloubeidi D, Cohen-Mekelburg S, Berinstein JA, Tipirneni R, Higgins PDR. Are Depression and Anxiety Underdiagnosed in Socially Vulnerable Patients With Inflammatory Bowel Disease? Inflamm Bowel Dis 2023:izad246. [PMID: 37878586 DOI: 10.1093/ibd/izad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Depression and anxiety are highly prevalent among individuals with inflammatory bowel disease (IBD); however, little is understood about how social determinants of health (SDOH) may impact mental health diagnoses in this population. The social vulnerability index (SVI) is a publicly available tool that can be used to study SDOH in IBD patients. METHODS Home addresses from a retrospective cohort of IBD patients at a single center were used to geocode patients to their individual census tract and corresponding SVI. We used multivariable logistic regression to examine the relationship between SVI and comorbid mental health diagnoses in patients with IBD. Secondarily, data from standardized health questionnaires were then used to determine if patients were adequately screened for depression and anxiety. RESULTS In all, 9644 patients were included; 18% had a diagnosis of depression, 21% anxiety, and 32% had a composite of "any mental health diagnosis." Depression (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.02-1.56) but not anxiety (OR, 0.87; 95% CI, 0.71-1.06) nor "any mental health diagnosis" (OR, 1.09; 95% CI, 0.92-1.30) was associated with higher levels of social vulnerability. However, overall rates of screening for depression and anxiety were low (15% and 8%, respectively), with the lowest screening rates among the most socially vulnerable (depression 8.2%, anxiety 6.3%). CONCLUSIONS Disparities in the diagnoses of depression and anxiety for socially vulnerable patients with IBD exist. Awareness of these inequities is the first step toward developing interventions to improve mental health screening, eliminate barriers and bias, and promote referrals for appropriate mental health management.
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Affiliation(s)
- Jessica L Sheehan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ariel A Jordan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Kira L Newman
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Laura A Johnson
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Dala Eloubeidi
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Shirley Cohen-Mekelburg
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Jeffrey A Berinstein
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Peter D R Higgins
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
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15
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Rollings KA, Noppert GA, Griggs JJ, Melendez RA, Clarke PJ. Comparison of two area-level socioeconomic deprivation indices: Implications for public health research, practice, and policy. PLoS One 2023; 18:e0292281. [PMID: 37797080 PMCID: PMC10553799 DOI: 10.1371/journal.pone.0292281] [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: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES To compare 2 frequently used area-level socioeconomic deprivation indices: the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI). METHODS Index agreement was assessed via pairwise correlations, decile score distribution and mean comparisons, and mapping. The 2019 ADI and 2018 SVI indices at the U.S. census tract-level were analyzed. RESULTS Index correlation was modest (R = 0.51). Less than half (44.4%) of all tracts had good index agreement (0-1 decile difference). Among the 6.3% of tracts with poor index agreement (≥6 decile difference), nearly 1 in 5 were classified by high SVI and low ADI scores. Index items driving poor agreement, such as high rents, mortgages, and home values in urban areas with characteristics indicative of socioeconomic deprivation, were also identified. CONCLUSIONS Differences in index dimensions and agreement indicated that ADI and SVI are not interchangeable measures of socioeconomic deprivation at the tract level. Careful consideration is necessary when selecting an area-level socioeconomic deprivation measure that appropriately defines deprivation relative to the context in which it will be used. How deprivation is operationalized affects interpretation by researchers as well as public health practitioners and policymakers making decisions about resource allocation and working to address health equity.
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Affiliation(s)
- Kimberly A. Rollings
- Institute for Healthcare Policy and Innovation, Health & Design Research Fellowship Program, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Grace A. Noppert
- Institute for Social Research, Social Environment and Health, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jennifer J. Griggs
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Robert A. Melendez
- Institute for Social Research, Social Environment and Health, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Philippa J. Clarke
- Institute for Social Research, Social Environment and Health, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States of America
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Kowal S, Ng CD, Schuldt R, Sheinson D, Jinnett K, Basu A. Estimating the US Baseline Distribution of Health Inequalities Across Race, Ethnicity, and Geography for Equity-Informative Cost-Effectiveness Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1485-1493. [PMID: 37414278 DOI: 10.1016/j.jval.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Information on how life expectancy, disability-free life expectancy, and quality-adjusted life expectancy varies across equity-relevant subgroups is required to conduct distributional cost-effectiveness analysis. These summary measures are not comprehensively available in the United States, given limitations in nationally representative data across racial and ethnic groups. METHODS Through linkage of US national survey data sets and use of Bayesian models to address missing and suppressed mortality data, we estimate health outcomes across 5 racial and ethnic subgroups (non-Hispanic American Indian or Alaska Native, non-Hispanic Asian and Pacific Islander, non-Hispanic black, non-Hispanic white, and Hispanic). Mortality, disability, and social determinant of health data were combined to estimate sex- and age-based outcomes for equity-relevant subgroups based on race and ethnicity, as well as county-level social vulnerability. RESULTS Life expectancy, disability-free life expectancy, and quality-adjusted life expectancy at birth declined from 79.5, 69.4, and 64.3 years, respectively, among the 20% least socially vulnerable (best-off) counties to 76.8, 63.6, and 61.1 years, respectively, among the 20% most socially vulnerable (worst-off) counties. Considering differences across racial and ethnic subgroups, as well as geography, gaps between the best-off (Asian and Pacific Islander; 20% least socially vulnerable counties) and worst-off (American Indian/Alaska Native; 20% most socially vulnerable counties) subgroups were large (17.6 life-years, 20.9 disability-free life-years, and 18.0 quality-adjusted life-years) and increased with age. CONCLUSIONS Existing disparities in health across geographies and racial and ethnic subgroups may lead to distributional differences in the impact of health interventions. Data from this study support routine estimation of equity effects in healthcare decision making, including distributional cost-effectiveness analysis.
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Affiliation(s)
| | - Carmen D Ng
- Genentech, Inc, South San Francisco, CA, USA
| | | | | | | | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA; Salutis Consulting LLC, Bellevue, Washington, WA, USA
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17
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Rodriquez J, Bullock D, Cotsonis G, Clark PC, Blanton S. Neighborhood socioeconomic disadvantage measures in rehabilitation clinical trials: Lessons learned in recruitment. Appl Nurs Res 2023; 73:151718. [PMID: 37722786 DOI: 10.1016/j.apnr.2023.151718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/19/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity. METHODS Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device. RESULTS Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5-5, range 1-9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related. CONCLUSIONS The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.
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Affiliation(s)
- Josue Rodriquez
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - DeAndrea Bullock
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, United States of America.
| | - Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
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Nelson SB, Dugdale CM, Brenner IR, Crawford A, Bilinski A, Cosar D, Pollock NR, Ciaranello A. Prevalence and Risk Factors for School-Associated Transmission of SARS-CoV-2. JAMA HEALTH FORUM 2023; 4:e232310. [PMID: 37540523 PMCID: PMC10403780 DOI: 10.1001/jamahealthforum.2023.2310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 08/05/2023] Open
Abstract
Importance School-associated SARS-CoV-2 transmission is described as uncommon, although the true transmission rate is unknown. Objective To identify the SARS-CoV-2 secondary attack rate (SAR) in schools and factors associated with transmission. Design, Setting, and Participants This cohort study examined the risk of school-based transmission of SARS-CoV-2 among kindergarten through grade 12 students and staff in 10 Massachusetts school districts during 2 periods: fall 2020/spring 2021 (F20/S21) and fall 2021 (F21). School staff collected data on SARS-CoV-2 index cases and school-based contacts, and SAR was defined as the proportion of contacts acquiring SARS-CoV-2 infection. Exposure SARS-CoV-2. Main Outcomes and Measures Potential factors associated with transmission, including grade level, masking, exposure location, vaccination history, and Social Vulnerability Index (SVI), were analyzed using univariable and multivariable logistic regression models. Results For F20/S21, 8 school districts (70 schools, >33 000 students) were included and reported 435 index cases (151 staff, 216 students, and 68 missing role) with 1771 school-based contacts (278 staff, 1492 students, and 1 missing role). For F21, 5 districts (34 schools, >18 000 students) participated and reported 309 index cases (37 staff, 207 students, and 65 missing role) with 1673 school-based contacts (107 staff and 1566 students). The F20/S21 SAR was 2.2% (lower bound, 1.6%; upper bound, 26.7%), and the F21 SAR was 2.8% (lower bound, 2.6%; upper bound, 7.4%). In multivariable analysis, during F20/S21, masking was associated with a lower odds of transmission compared with not masking (odds radio [OR], 0.12; 95% CI, 0.04-0.40; P < .001). In F21, classroom exposure vs out-of-classroom exposure was associated with increased odds of transmission (OR, 2.47; 95% CI, 1.07-5.66; P = .02); a fully vaccinated vs unvaccinated contact was associated with a lower odds of transmission (OR, 0.04; 95% CI, 0.00-0.62; P < .001). In both periods, a higher SVI was associated with a greater odds of transmission. Conclusions and Relevance In this study of Massachusetts schools, the SAR for SARS-CoV-2 among school-based contacts was low during 2 periods, and factors associated with transmission risk varied over time. These findings suggest that ongoing surveillance efforts may be essential to ensure that both targeted resources and mitigation practices remain optimal and relevant for disease prevention.
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Affiliation(s)
- Sandra B. Nelson
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Caitlin M. Dugdale
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Isaac Ravi Brenner
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Allison Crawford
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Alyssa Bilinski
- Department of Health Services, Policy and Practice and Department of Biostatistics, Brown School of Public Health, Providence, Rhode Island
| | - Duru Cosar
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Nira R. Pollock
- Harvard Medical School, Boston, Massachusetts
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Andrea Ciaranello
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
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19
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Li X, Liu H, Gao L, Sherchan SP, Zhou T, Khan SJ, van Loosdrecht MCM, Wang Q. Wastewater-based epidemiology predicts COVID-19-induced weekly new hospital admissions in over 150 USA counties. Nat Commun 2023; 14:4548. [PMID: 37507407 PMCID: PMC10382499 DOI: 10.1038/s41467-023-40305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Although the coronavirus disease (COVID-19) emergency status is easing, the COVID-19 pandemic continues to affect healthcare systems globally. It is crucial to have a reliable and population-wide prediction tool for estimating COVID-19-induced hospital admissions. We evaluated the feasibility of using wastewater-based epidemiology (WBE) to predict COVID-19-induced weekly new hospitalizations in 159 counties across 45 states in the United States of America (USA), covering a population of nearly 100 million. Using county-level weekly wastewater surveillance data (over 20 months), WBE-based models were established through the random forest algorithm. WBE-based models accurately predicted the county-level weekly new admissions, allowing a preparation window of 1-4 weeks. In real applications, periodically updated WBE-based models showed good accuracy and transferability, with mean absolute error within 4-6 patients/100k population for upcoming weekly new hospitalization numbers. Our study demonstrated the potential of using WBE as an effective method to provide early warnings for healthcare systems.
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Affiliation(s)
- Xuan Li
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Huan Liu
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Li Gao
- South East Water, 101 Wells Street, Frankston, VIC, 3199, Australia
| | - Samendra P Sherchan
- Department of Biology, Morgan State University, Baltimore, MD, USA
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ting Zhou
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Stuart J Khan
- Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mark C M van Loosdrecht
- Department of Biotechnology, Delft University of Technology, Julianalaan 67, 2628 BC, Delft, the Netherlands
| | - Qilin Wang
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
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Zolotor A, Huang RW, Bhavsar NA, Cholera R. Quantifying Associations Between Child Health and Neighborhood Social Vulnerability: Does the Choice of Index Matter? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.20.23291679. [PMID: 37461577 PMCID: PMC10350141 DOI: 10.1101/2023.06.20.23291679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Importance Policymakers have increasingly utilized place-based social disadvantage indices to quantify the impacts of place on health and inform equitable resource allocation. Indices vary in design, content, and purpose but are often used interchangeably, potentially resulting in differential assignments of relative disadvantage depending on index choice. Objective To compare associations between three commonly used disadvantage indices (Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI)) and two epidemiologically distinct child health outcomes-infant well-child check (WCC) attendance and adolescent obesity. Design Cross-sectional analysis of Duke University Health System electronic health record (EHR) data from January 2014 to December 2019. Participants Children ≤18 years of age with outpatient encounters between January 2014 and December 2019, and who were Durham County residents were eligible. WCC attendance was assessed for infants ages 0-15 months; obesity was assessed for children ages 11-17 years. Exposures 2014 Social Vulnerability Index (SVI), 2015 Area Deprivation Index (ADI), and 2015 Child Opportunity Index (COI) 2.0. Main Outcomes 1) Infant WCC attendance: attending less than the minimum recommended six WCCs in the first 15 months of life, and 2) Adolescent obesity: BMI ≥ the 95th percentile at both the most recent encounter and an encounter within the prior 9-36 months. Results Of 10175 patients in the WCC cohort, 20% (n = 2073) had less than six WCCs. Of 14961 patients in the obesity cohort, 20% (n = 2933) had obesity. All three indices were associated with both WCCs (OR for SVI 1.10, 95% CI 1.08-1.12; OR for ADI 1.10, 95% CI 1.08-1.12; OR for COI 1.12, 95% CI 1.10-1.14) and obesity (OR for SVI 1.05, 95% CI 1.04-1.08; OR for ADI 1.08, 95% CI 1.06-1.10; OR for COI 1.07, 95% CI 1.05-1.08). Conclusions and relevance Higher social disadvantage as defined by all three indices was similarly associated with both adolescent obesity and decreased infant WCC attendance. While the COI incorporates a broader set of child-specific variables, the SVI and ADI may often be just as suitable for pediatric research. Users should consider population and outcome characteristics when selecting an index.
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Affiliation(s)
- Anna Zolotor
- Trinity College of Arts & Sciences, Duke University
- Duke-Margolis Center for Health Policy
| | - Ro W. Huang
- Trinity College of Arts & Sciences, Duke University
- Duke-Margolis Center for Health Policy
| | - Nrupen A. Bhavsar
- Duke University School of Medicine (DUSM) Department of Surgery
- DUSM Department of Biostatistics and Bioinformatics and Bioinformatics
| | - Rushina Cholera
- Duke-Margolis Center for Health Policy
- DUSM Department of Population Health Sciences
- DUSM Department of Pediatrics
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Tran T, Rousseau MA, Farris DP, Bauer C, Nelson KC, Doan HQ. The social vulnerability index as a risk stratification tool for health disparity research in cancer patients: a scoping review. Cancer Causes Control 2023; 34:407-420. [PMID: 37027053 PMCID: PMC10080510 DOI: 10.1007/s10552-023-01683-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE The social vulnerability index (SVI), developed by the Centers for Disease Control and Prevention, is a novel composite measure encompassing multiple variables that correspond to key social determinants of health. The objective of this review was to investigate innovative applications of the SVI to oncology research and to employ the framework of the cancer care continuum to elucidate further research opportunities. METHODS A systematic search for relevant articles was performed in five databases from inception to 13 May 2022. Included studies applied the SVI to analyze outcomes in cancer patients. Study characteristics, patent populations, data sources, and outcomes were extracted from each article. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS In total, 31 studies were included. Along the cancer care continuum, five applied the SVI to examine geographic disparities in potentially cancer-causing exposures; seven in cancer diagnosis; fourteen in cancer treatment; nine in treatment recovery; one in survivorship care; and two in end-of-life care. Fifteen examined disparities in mortality. CONCLUSION In highlighting place-based disparities in patient outcomes, the SVI represents a promising tool for future oncology research. As a reliable geocoded dataset, the SVI may inform the development and implementation of targeted interventions to prevent cancer morbidity and mortality at the neighborhood level.
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Affiliation(s)
- Tiffaney Tran
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Morgan A Rousseau
- The University of Texas Health Science Center at Houston John P. and Kathrine G. McGovern Medical School, Houston, TX, USA
| | - David P Farris
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cici Bauer
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hung Q Doan
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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22
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Salazar EG, Montoya-Williams D, Passarella M, McGann C, Paul K, Murosko D, Peña MM, Ortiz R, Burris HH, Lorch SA, Handley SC. County-Level Maternal Vulnerability and Preterm Birth in the US. JAMA Netw Open 2023; 6:e2315306. [PMID: 37227724 PMCID: PMC10214038 DOI: 10.1001/jamanetworkopen.2023.15306] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
Importance Appreciation for the effects of neighborhood conditions and community factors on perinatal health is increasing. However, community-level indices specific to maternal health and associations with preterm birth (PTB) have not been assessed. Objective To examine the association of the Maternal Vulnerability Index (MVI), a novel county-level index designed to quantify maternal vulnerability to adverse health outcomes, with PTB. Design, Setting, and Participants This retrospective cohort study used US Vital Statistics data from January 1 to December 31, 2018. Participants included 3 659 099 singleton births at 22 plus 0/7 to 44 plus 6/7 weeks of gestation born in the US. Analyses were conducted from December 1, 2021, through March 31, 2023. Exposure The MVI, a composite measure of 43 area-level indicators, categorized into 6 themes reflecting physical, social, and health care landscapes. Overall MVI and theme were stratified by quintile (very low to very high) by maternal county of residence. Main Outcomes and Measures The primary outcome was PTB (gestational age <37 weeks). Secondary outcomes were PTB categories: extreme (gestational age ≤28 weeks), very (gestational age 29-31 weeks), moderate (gestational age 32-33 weeks), and late (gestational age 34-36 weeks). Multivariable logistic regression quantified associations of MVI, overall and by theme, with PTB, overall and by PTB category. Results Among 3 659 099 births, 298 847 (8.2%) were preterm (male, 51.1%; female, 48.9%). Maternal race and ethnicity included 0.8% American Indian or Alaska Native, 6.8% Asian or Pacific Islander, 23.6% Hispanic, 14.5% non-Hispanic Black, 52.1% non-Hispanic White, and 2.2% with more than 1 race. Compared with full-term births, MVI was higher for PTBs across all themes. Very high MVI was associated with increased PTB in unadjusted (odds ratio [OR], 1.50 [95% CI, 1.45-1.56]) and adjusted (OR, 1.07 [95% CI, 1.01-1.13]) analyses. In adjusted analyses of PTB categories, MVI had the largest association with extreme PTB (adjusted OR, 1.18 [95% CI, 1.07-1.29]). Higher MVI in the themes of physical health, mental health and substance abuse, and general health care remained associated with PTB overall in adjusted models. While the physical health and socioeconomic determinant themes were associated with extreme PTB, physical health, mental health and substance abuse, and general health care themes were associated with late PTB. Conclusions and Relevance The findings of this cohort study suggest that MVI was associated with PTB even after adjustment for individual-level confounders. The MVI is a useful measure for county-level PTB risk that may have policy implications for counties working to lower preterm rates and improve perinatal outcomes.
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Affiliation(s)
- Elizabeth G. Salazar
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Diana Montoya-Williams
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Molly Passarella
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carolyn McGann
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn Paul
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daria Murosko
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle-Marie Peña
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Robin Ortiz
- Department of Pediatrics, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
| | - Heather H. Burris
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Lou S, Giorgi S, Liu T, Eichstaedt JC, Curtis B. Measuring disadvantage: A systematic comparison of United States small-area disadvantage indices. Health Place 2023; 80:102997. [PMID: 36867991 PMCID: PMC10038931 DOI: 10.1016/j.healthplace.2023.102997] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
Extensive evidence demonstrates the effects of area-based disadvantage on a variety of life outcomes, such as increased mortality and low economic mobility. Despite these well-established patterns, disadvantage, often measured using composite indices, is inconsistently operationalized across studies. To address this issue, we systematically compared 5 U.S. disadvantage indices at the county-level on their relationships to 24 diverse life outcomes related to mortality, physical health, mental health, subjective well-being, and social capital from heterogeneous data sources. We further examined which domains of disadvantage are most important when creating these indices. Of the five indices examined, the Area Deprivation Index (ADI) and Child Opportunity Index 2.0 (COI) were most related to a diverse set of life outcomes, particularly physical health. Within each index, variables from the domains of education and employment were most important in relationships with life outcomes. Disadvantage indices are being used in real-world policy and resource allocation decisions; an index's generalizability across diverse life outcomes, and the domains of disadvantage which constitute the index, should be considered when guiding such decisions.
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Affiliation(s)
- Sophia Lou
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA
| | - Salvatore Giorgi
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA; Department of Computer and Information Science, University of Pennsylvania, 3330 Walnut St, Philadelphia, PA, 19104, USA
| | - Tingting Liu
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA; Positive Psychology Center, Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104, USA
| | - Johannes C Eichstaedt
- Department of Psychology and Institute for Human-Centered AI, Stanford University, 210 Panama St., Stanford, CA, 94305, USA
| | - Brenda Curtis
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA.
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