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Choudhry HS, Patel RH, Salloum L, McCloskey J, Goshe JM. Association Between Neighborhood Deprivation and Number of Ophthalmology Providers. Ophthalmic Epidemiol 2024:1-8. [PMID: 39389151 DOI: 10.1080/09286586.2024.2406503] [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: 04/03/2024] [Revised: 08/31/2024] [Accepted: 09/14/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE The Area Deprivation Index (ADI) is a quantitative measurement of neighborhood socioeconomic disadvantage used to identify high-risk communities. The distribution of physicians with respect to ADI can indicate decreased healthcare access in deprived neighborhoods. This study applies ADI to the distribution of ophthalmologists and demonstrates how practice patterns in the national Medicare Part D program may vary with ADI. METHODS The Centers for Medicare and Medicaid Services Data "Medicare Part D Prescribers by Provider" data for 2021 was analyzed. Geocodio identified ADIs corresponding to the practice addresses listed in the dataset. The national rank ADIs were compared against the number of ophthalmologists. Spearman's correlation test and one-way ANOVA determined statistically significant differences in Medicare data extracted between quintiles of ADI ranks. RESULTS We identified 14,668 ophthalmologists who provided care to Medicare beneficiaries. Each time ADI increased by 10, there was an average 9.4% decrease in ophthalmologists (p < 0.001). The distribution of ophthalmologists practicing throughout the United States by increasing ADI quintile are: 32%, 23%, 19%, 16%, and 9%. Providers practicing in neighborhoods in the first-ADI quintile were more likely to see Medicare beneficiaries compared to providers in the fifth-ADI quintile (p < 0.001). CONCLUSION The lack of ophthalmologists in high-ADI areas results in reduced eye care access in deprived neighborhoods. Many factors contribute to these disparities including limited access to metropolitan areas/academic institutions and fewer residency programs. Future programs and policies should focus efforts on creating an even distribution of ophthalmologists across the United States and improving access to eye care.
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Affiliation(s)
- Hassaam S Choudhry
- Department of Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Riya H Patel
- Department of Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Lana Salloum
- Department of Ophthalmology Visual Sciences, Albert Einstein College of Medicine, New York, NY, USA
| | - Jack McCloskey
- Department of Ophthalmology & Visual Sciences, Rutgers University, New Brunswick, NJ, USA
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Iriarte E, Cooley S, Wisch J, Erlandson KM, Ances BM, Jankowski C. Area Deprivation Index and Frailty Among Older People With HIV. J Appl Gerontol 2024:7334648241262658. [PMID: 39025783 DOI: 10.1177/07334648241262658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
We evaluated the relationship between neighborhood disadvantage (measured by the Area Deprivation Index [ADI]) and frailty. We performed a secondary analysis, pooling cross-sectional data collected from 209 people with HIV (PWH) aged ≥50 years enrolled in studies in Colorado (CO) and Missouri (MO). MO participants (N = 137) had a higher ADI (µ= 70, ơ2 = 25) compared to CO (µ= 32, ơ2 = 15; p < .001). No significant differences in ADI were observed between frailty categories when cohorts were examined either separately or combined; however, when comparing individual frailty criteria, the most apparent differences by neighborhood disadvantage were seen among those with limited physical activity (μ = 67, ơ2 = 28) compared to those without (μ = 55, ơ2 = 29, p = .03). Neighborhood disadvantage was associated with low physical activity but not with overall frailty status. Future research should examine how access to physical activity spaces varies based on ADI, as this could be crucial in preventing frailty.
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Affiliation(s)
- Evelyn Iriarte
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
- Pontificia Universidad Católica de Chile School of Nursing, Santiago, Chile
| | - Sarah Cooley
- Washington University in St. Louis, St Louis, MO, USA
| | - Julie Wisch
- Washington University in St. Louis, St Louis, MO, USA
| | - Kristine M Erlandson
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Beau M Ances
- Washington University in St. Louis, St Louis, MO, USA
| | - Catherine Jankowski
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
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Appaneal HJ, LaPlante KL, Lopes VV, Martin C, Puzniak L, Wiemken TL, Zasowski EJ, McLaughlin JM, Caffrey AR. Nirmatrelvir/Ritonavir Utilization for the Treatment of Non-hospitalized Adults with COVID-19 in the National Veterans Affairs (VA) Healthcare System. Infect Dis Ther 2024; 13:155-172. [PMID: 38217842 PMCID: PMC10828173 DOI: 10.1007/s40121-023-00910-1] [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: 10/20/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Limited data exist regarding real-world utilization of nirmatrelvir/ritonavir. We identified predictors of nirmatrelvir/ritonavir use among Veterans Affairs (VA) outpatients nationally. METHODS We conducted a retrospective cohort study among outpatients with coronavirus disease 2019 (COVID-19) who were eligible to receive nirmatrelvir/ritonavir between January and December of 2022, to identify factors associated with nirmatrelvir/ritonavir use (i.e., demographics, medical history, prior medication and healthcare exposures, frailty, and other clinical characteristics) using multivariable logistic regression. RESULTS We included 309,755 outpatients with COVID-19 who were eligible for nirmatrelvir/ritonavir, of whom 12.2% received nirmatrelvir/ritonavir. Nirmatrelvir/ritonavir uptake increased from 1.1% to 23.2% over the study period. Factors associated with nirmatrelvir/ritonavir receipt included receiving a COVID-19 booster vs. none (adjusted odds ratio [aOR] 2.19 [95% confidence interval [CI] 2.12-2.26]), age ≥ 50 vs. 18-49 years (aORs > 1.5 for all age groups ≥ 50 years), having HIV (aOR 1.36 [1.22-1.51]), being non-frail vs. severely frail (aOR 1.22 [1.13-1.33]), and having rheumatoid arthritis (aOR 1.12 [1.04-1.21). Those with concomitant use of potentially interacting antiarrhythmics (aOR 0.35 [0.28-0.45]), anticoagulants/antiplatelets (aOR 0.42 [0.40-0.45]), and/or psychiatric/sedatives (aOR 0.84 [0.81-0.87]) were less likely to receive nirmatrelvir/ritonavir. CONCLUSIONS Despite increases over time, overall utilization of nirmatrelvir/ritonavir was low. Predictors of nirmatrelvir/ritonavir utilization were consistent with known risk factors for progression to severe COVID-19, including older age and underlying medical conditions. Unvaccinated and undervaccinated patients and those receiving potentially interacting medications for cardiovascular or mental health conditions (antiarrhythmic, alpha-1 antagonist, anticoagulant/antiplatelet, sedative/hypnotic/psychiatric) were less likely to receive nirmatrelvir/ritonavir. Further education of prescribers and patients about nirmatrelvir/ritonavir treatment guidelines is needed to improve overall uptake and utilization in certain high-risk subpopulations.
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Affiliation(s)
- Haley J Appaneal
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd, 265B, Kingston, RI, 02881, USA
| | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd, 265B, Kingston, RI, 02881, USA
| | - Vrishali V Lopes
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | | | | | | | | | | | - Aisling R Caffrey
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA.
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA.
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd, 265B, Kingston, RI, 02881, USA.
- School of Public Health, Brown University, Providence, RI, USA.
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Henry OS, Batchu S, Lachant J, Armento I, Hunter K, Staffa SJ, Porter J, Egodage T. Disadvantaged Neighborhoods Continue to Bear the Burden of Gun Violence. J Surg Res 2024; 293:396-402. [PMID: 37806227 DOI: 10.1016/j.jss.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Gun violence is a pervasive and dynamic public health crisis causing substantial burden on communities and healthcare systems in the United States. Risk factor and outcome analyses are crucial to develop effective interventions. The aim of this study was to assess firearm injury in a diverse community setting as it relates to neighborhood socioeconomic disadvantage and changes over time following large-scale local interventions. METHODS All county residents with firearm injury presenting to a Level 1 Trauma Center from January 2012 to December 2021 were retrospectively reviewed. Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage based on a nine-digit zip code at patients' home address. Injuries were also stratified by 5-year time periods, 2012-2016 and 2017-2021. Demographics and clinical data were analyzed including injury severity, hospital course, and discharge location. Data were compared by ADI quintile and between time periods using chi-squared, one-way analysis of variance, and Cochran-Armitage test. RESULTS A total of 1044 injuries were evaluated. Patients were 93% male with mean age of 29 y (standard deviation 10.2) and were concentrated in the most disadvantaged neighborhoods (74% ADI Q5). Black or African American race was greater in the most disadvantaged ADI groups (76% versus 47%-66%; P <0.001). Percentage of total injuries in the most disadvantaged ADI group rose from 71% to 78% over time (P = 0.006). Mortality occurred in 154 (15%) patients overall, while most (71%) were discharged to home. Mortality declined from 18% to 11% over time (P <0.001). Medicaid utilization rose from 42% to 77% alongside a decrease in self-pay status from 44% to 4% (P <0.001). There were no clinically significant group differences in injury severity or clinical characteristics. CONCLUSIONS Firearm injury remains concentrated in the most socioeconomically disadvantaged neighborhoods, and this disparity is increasing over time. Medicaid utilization rose and mortality decreased in this population over time. This research presents a method to inform and monitor local gun violence interventions using ADI to address public health equity.
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Affiliation(s)
- Owen S Henry
- Cooper Medical School of Rowan University, Camden, New Jersey; Division of Trauma, Cooper University Hospital, Camden, New Jersey.
| | - Sai Batchu
- Cooper Medical School of Rowan University, Camden, New Jersey; Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Joseph Lachant
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Isabella Armento
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Krystal Hunter
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - John Porter
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Tanya Egodage
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
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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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Wong CG, Miller JB, Zhang F, Rissman RA, Raman R, Hall JR, Petersen M, Yaffe K, Kind AJ, O’Bryant SE. Evaluation of Neighborhood-Level Disadvantage and Cognition in Mexican American and Non-Hispanic White Adults 50 Years and Older in the US. JAMA Netw Open 2023; 6:e2325325. [PMID: 37647071 PMCID: PMC10469291 DOI: 10.1001/jamanetworkopen.2023.25325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Understanding how socioeconomic factors are associated with cognitive aging is important for addressing health disparities in Alzheimer disease. Objective To examine the association of neighborhood disadvantage with cognition among a multiethnic cohort of older adults. Design, Setting, and Participants In this cross-sectional study, data were collected between September 1, 2017, and May 31, 2022. Participants were from the Health and Aging Brain Study-Health Disparities, which is a community-based single-center study in the Dallas/Fort Worth area of Texas. A total of 1614 Mexican American and non-Hispanic White adults 50 years and older were included. Exposure Neighborhood disadvantage for participants' current residence was measured by the validated Area Deprivation Index (ADI); ADI Texas state deciles were converted to quintiles, with quintile 1 representing the least disadvantaged area and quintile 5 the most disadvantaged area. Covariates included age, sex, and educational level. Main Outcomes and Measures Performance on cognitive tests assessing memory, language, attention, processing speed, and executive functioning; measures included the Spanish-English Verbal Learning Test (SEVLT) Learning and Delayed Recall subscales; Wechsler Memory Scale, third edition (WMS-III) Digit Span Forward, Digit Span Backward, and Logical Memory 1 and 2 subscales; Trail Making Test (TMT) parts A and B; Digit Symbol Substitution Test (DSST); Letter Fluency; and Animal Naming. Raw scores were used for analyses. Associations between neighborhood disadvantage and neuropsychological performance were examined via demographically adjusted linear regression models stratified by ethnic group. Results Among 1614 older adults (mean [SD] age, 66.3 [8.7] years; 980 women [60.7%]), 853 were Mexican American (mean [SD] age, 63.9 [7.9] years; 566 women [66.4%]), and 761 were non-Hispanic White (mean [SD] age, 69.1 [8.7] years; 414 women [54.4%]). Older Mexican American adults were more likely to reside in the most disadvantaged areas (ADI quintiles 3-5), with 280 individuals (32.8%) living in ADI quintile 5, whereas a large proportion of older non-Hispanic White adults resided in ADI quintile 1 (296 individuals [38.9%]). Mexican American individuals living in more disadvantaged areas had worse performance than those living in ADI quintile 1 on 7 of 11 cognitive tests, including SEVLT Learning (ADI quintile 5: β = -2.50; 95% CI, -4.46 to -0.54), SEVLT Delayed Recall (eg, ADI quintile 3: β = -1.11; 95% CI, -1.97 to -0.24), WMS-III Digit Span Forward (eg, ADI quintile 4: β = -1.14; 95% CI, -1.60 to -0.67), TMT part A (ADI quintile 5: β = 7.85; 95% CI, 1.28-14.42), TMT part B (eg, ADI quintile 5: β = 31.5; 95% CI, 12.16-51.35), Letter Fluency (ADI quintile 4: β = -2.91; 95% CI, -5.39 to -0.43), and DSST (eg, ADI quintile 5: β = -4.45; 95% CI, -6.77 to -2.14). In contrast, only non-Hispanic White individuals living in ADI quintile 4 had worse performance than those living in ADI quintile 1 on 4 of 11 cognitive tests, including SEVLT Learning (β = -2.35; 95% CI, -4.40 to -0.30), SEVLT Delayed Recall (β = -0.95; 95% CI, -1.73 to -0.17), TMT part B (β = 15.95; 95% CI, 2.47-29.44), and DSST (β = -3.96; 95% CI, -6.49 to -1.43). Conclusions and Relevance In this cross-sectional study, aging in a disadvantaged area was associated with worse cognitive functioning, particularly for older Mexican American adults. Future studies examining the implications of exposure to neighborhood disadvantage across the life span will be important for improving cognitive outcomes in diverse populations.
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Affiliation(s)
- Christina G. Wong
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada
| | - Justin B. Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada
| | - Fan Zhang
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth
| | - Robert A. Rissman
- Department of Neurosciences, University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego
| | - James R. Hall
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
| | - Melissa Petersen
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
| | - Amy J. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sid E. O’Bryant
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth
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Edmiston JB, Cohn EG, Teruya SL, Sabogal N, Massillon D, Muralidhar V, Rodriguez C, Helmke S, Fine D, Winburn M, Chiuzan C, Hod EA, Raiszadeh F, Kurian D, Maurer MS, Ruberg FL. Clinical and social determinants of health features of SARS-CoV-2 infection among Black and Caribbean Hispanic patients with heart failure: The SCAN-MP Study. PLoS One 2023; 18:e0283730. [PMID: 36996149 PMCID: PMC10062570 DOI: 10.1371/journal.pone.0283730] [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: 07/14/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Patients with heart failure (HF) often have multiple chronic conditions and are at increased risk for severe disease and mortality when infected by SARS-CoV-2, the virus that causes COVID-19. Furthermore, disparities in outcomes with COVID-19 have been associated with both racial/ethnic identity but also social determinants of health. Among older, urban-dwelling, minority patients with HF, we sought to characterize medical and non-medical factors associated with SARS-CoV-2 infection. Patients with HF living in Boston and New York City over 60 years of age participating in the Screening for Cardiac Amyloidosis with Nuclear Imaging (SCAN-MP) study between 12/1/2019 and 10/15/2021 (n = 180) were tested for nucleocapsid antibodies to SARS-CoV-2 and queried for symptomatic infection with PCR verification. Baseline testing included the Kansas City Cardiomyopathy Questionnaire (KCCQ), assessment of health literacy, biochemical, functional capacity, echocardiography, and a novel survey tool that determined living conditions, perceived risk of infection, and attitudes towards COVID-19 mitigation. The association of infection with prevalent socio-economic conditions was assessed by the area deprivation index (ADI). There were 50 overall cases of SARS-CoV-2 infection (28%) including 40 demonstrating antibodies to SARS-CoV-2 (indicative of prior infection) and 10 positive PCR tests. There was no overlap between these groups. The first documented case from New York City indicated infection prior to January 17, 2020. Among active smokers, none tested positive for prior SARS-CoV-2 infection (0 (0%) vs. 20 (15%), p = 0.004) vs. non-smokers. Cases were more likely to be taking ACE-inhibitors/ARBs compared to non-cases (78% vs 62%, p = 0.04). Over a mean follow-up of 9.6 months, there were 6 total deaths (3.3%) all unrelated to COVID-19. Death and hospitalizations (n = 84) were not associated with incident (PCR tested) or prior (antibody) SARS-CoV-2 infection. There was no difference in age, co-morbidities, living conditions, attitudes toward mitigation, health literacy, or ADI between those with and without infection. SARS-CoV-2 infection was common among older, minority patients with HF living in New York City and Boston, with evidence of infection documented in early January 2020. Health literacy and ADI were not associated with infection, and there was no increased mortality or hospitalizations among those infected with SARS-CoV-2.
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Affiliation(s)
- Jonathan B. Edmiston
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Elizabeth G. Cohn
- Hunter College, City University of New York, New York, New York, United States of America
| | - Sergio L. Teruya
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Natalia Sabogal
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Daniel Massillon
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Varsha Muralidhar
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Carlos Rodriguez
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Stephen Helmke
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Denise Fine
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Morgan Winburn
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Codruta Chiuzan
- Feinstein Institute for Medical Research, Northwell Health, New York, New York, United States of America
| | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, United States of America
| | - Farbod Raiszadeh
- Division of Cardiology, Harlem Hospital Center, New York City Health and Hospital Corporation, New York, New York, United States of America
| | - Damien Kurian
- Division of Cardiology, Harlem Hospital Center, New York City Health and Hospital Corporation, New York, New York, United States of America
| | - Mathew S. Maurer
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Frederick L. Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
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If you build it, will they come? Is test site availability a root cause of geographic disparities in COVID-19 testing? Public Health 2023; 216:21-26. [PMID: 36764116 PMCID: PMC9485419 DOI: 10.1016/j.puhe.2022.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the relationship between test site availability and testing rate within the context of social determinants of health. STUDY DESIGN A retrospective ecological investigation was conducted using statewide COVID-19 testing data between March 2020 and December 2021. METHODS Ordinary least squares and geographically weighted regression were used to estimate state and ZIP code level associations between testing rate and testing sites per capita, adjusting for neighbourhood-level confounders. RESULTS The findings indicate that site availability is positively associated with the ZIP code level testing rate and that this association is amplified in communities of greater economic deprivation. In addition, economic deprivation is a key factor for consideration when examining ethnic differences in testing in medically underserved states. CONCLUSION The study findings could be used to guide the delivery of testing facilities in resource-constrained states.
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Wong MS, Brown AF, Washington DL. Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users. JAMA Netw Open 2023; 6:e231471. [PMID: 36867407 PMCID: PMC9984969 DOI: 10.1001/jamanetworkopen.2023.1471] [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: 09/30/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023] Open
Abstract
Importance Despite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation. Objective To examine the associations by race and ethnicity among California's Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19-related hospitalization. Design, Setting, and Participants This cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021. Main Outcomes and Measures Rates of COVID-19-related hospitalization among veterans with COVID-19. Results The sample available for analysis included 19 495 veterans with COVID-19 (mean [SD] age, 57.21 [17.68] years), of whom 91.0% were men, 27.7% were Hispanic, 16.1% were non-Hispanic Black, and 45.0% were non-Hispanic White. For Black veterans, living in lower-HPI (ie, less healthy) neighborhoods was associated with higher rates of hospitalization (odds ratio [OR], 1.07 [95% CI, 1.03-1.12]), even after accounting for Black segregation (OR, 1.06 [95% CI, 1.02-1.11]). Among Hispanic veterans, living in lower-HPI neighborhoods was not associated with hospitalization with (OR, 1.04 [95% CI, 0.99-1.09]) and without (OR, 1.03 [95% CI, 1.00-1.08]) Hispanic segregation adjustment. For non-Hispanic White veterans, lower HPI was associated with more frequent hospitalization (OR, 1.03 [95% CI, 1.00-1.06]). The HPI was no longer associated with hospitalization after accounting for Black (OR, 1.02 [95% CI, 0.99-1.05]) or Hispanic (OR, 0.98 [95% CI, 0.95-1.02]) segregation. Hospitalization was higher for White (OR, 4.42 [95% CI, 1.62-12.08]) and Hispanic (OR, 2.90 [95% CI, 1.02-8.23]) veterans living in neighborhoods with greater Black segregation and for White veterans in more Hispanic-segregated neighborhoods (OR, 2.81 [95% CI, 1.96-4.03]), adjusting for HPI. Living in higher SVI (ie, more vulnerable) neighborhoods was associated with greater hospitalization for Black (OR, 1.06 [95% CI, 1.02-1.10]) and non-Hispanic White (OR, 1.04 [95% CI, 1.01-1.06]) veterans. Conclusions and Relevance In this cohort study of US veterans with COVID-19, HPI captured neighborhood-level risk for COVID-19-related hospitalization for Black, Hispanic, and White veterans comparably with SVI. These findings have implications for the use of HPI and other composite neighborhood deprivation indices that do not explicitly account for segregation. Understanding associations between place and health requires ensuring composite measures accurately account for multiple aspects of neighborhood deprivation and, importantly, variation by race and ethnicity.
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Affiliation(s)
- Michelle S. Wong
- Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
- Olive View–UCLA Medical Center, Sylmar, California
| | - Donna L. Washington
- Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
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Huang Q, Cutter SL. Spatial-temporal differences of COVID-19 vaccinations in the U.S. URBAN INFORMATICS 2022; 1:19. [PMID: 36569987 PMCID: PMC9760536 DOI: 10.1007/s44212-022-00019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Although the disparities in COVID-19 outcomes have been proved, they have not been explicitly associated with COVID-19 full vaccinations. This paper examines the spatial and temporal patterns of the county-level COVID-19 case rates, fatality rates, and full vaccination rates in the United States from December 24, 2020 through September 30, 2021. Statistical and geospatial analyses show clear temporal and spatial patterns of the progression of COVID-19 outcomes and vaccinations. In the relationship between two time series, the fatality rates series was positively related to past lags of the case rates series. At the same time, case rates series and fatality rates series were negatively related to past lags of the full vaccination rates series. The lag level varies across urban and rural areas. The results of partial correlation, ordinary least squares (OLS) and Geographically Weighted Regression (GWR) also confirmed that the existing COVID-19 infections and different sets of socioeconomic, healthcare access, health conditions, and environmental characteristics were independently associated with COVID-19 vaccinations over time and space. These results empirically identify the geographic health disparities with COVID-19 vaccinations and outcomes and provide the evidentiary basis for targeting pandemic recovery and public health mitigation actions. Supplementary Information The online version contains supplementary material available at 10.1007/s44212-022-00019-9.
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Affiliation(s)
- Qian Huang
- Hazards Vulnerability and Resilience Institute, Department of Geography, University of South Carolina, 709 Bull Street, Columbia, SC 29208 USA
| | - Susan L. Cutter
- Hazards Vulnerability and Resilience Institute, Department of Geography, University of South Carolina, 709 Bull Street, Columbia, SC 29208 USA
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11
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Bartolomeo N, Giotta M, Tafuri S, Trerotoli P. Impact of Socioeconomic Deprivation on the Local Spread of COVID-19 Cases Mediated by the Effect of Seasons and Restrictive Public Health Measures: A Retrospective Observational Study in Apulia Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811410. [PMID: 36141682 PMCID: PMC9517341 DOI: 10.3390/ijerph191811410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 05/22/2023]
Abstract
The aim of this study was to investigate the spatiotemporal association between socioeconomic deprivation and the incidence of COVID-19 and how this association changes through the seasons due to the existence of restrictive public health measures. A retrospective observational study was conducted among COVID-19 cases that occurred in the Apulia region from 29 February 2020 to 31 December 2021, dividing the period into four phases with different levels of restrictions. A generalized estimating equation (GEE) model was applied to test the independent effect of deprivation on the incidence of COVID-19, taking into account age, sex, and regional incidence as possible confounding effects and covariates, such as season and levels of restrictions, as possible modifying effects. The highest incidence was in areas with a very high deprivation index (DI) in winter. During total lockdown, no rate ratio between areas with different levels of DI was significant, while during soft lockdown, areas with very high DI were more at risk than all other areas. The effects of social inequalities on the incidence of COVID-19 changed in association with the seasons and restrictions on public health. Disadvantaged areas showed a higher incidence of COVID-19 in the cold seasons and in the phases of soft lockdown.
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12
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Manz KM, Schwettmann L, Mansmann U, Maier W. Area Deprivation and COVID-19 Incidence and Mortality in Bavaria, Germany: A Bayesian Geographical Analysis. Front Public Health 2022; 10:927658. [PMID: 35910894 PMCID: PMC9334899 DOI: 10.3389/fpubh.2022.927658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Area deprivation has been shown to be associated with various adverse health outcomes including communicable as well as non-communicable diseases. Our objective was to assess potential associations between area deprivation and COVID-19 standardized incidence and mortality ratios in Bavaria over a period of nearly 2 years. Bavaria is the federal state with the highest infection dynamics in Germany and demographically comparable to several other European countries. Methods In this retrospective, observational ecological study, we estimated the strength of associations between area deprivation and standardized COVID-19 incidence and mortality ratios (SIR and SMR) in Bavaria, Germany. We used official SARS-CoV-2 reporting data aggregated in monthly periods between March 1, 2020 and December 31, 2021. Area deprivation was assessed using the quintiles of the 2015 version of the Bavarian Index of Multiple Deprivation (BIMD 2015) at district level, analyzing the overall index as well as its single domains. Results Deprived districts showed higher SIR and SMR than less deprived districts. Aggregated over the whole period, the SIR increased by 1.04 (95% confidence interval (95% CI): 1.01 to 1.07, p = 0.002), and the SMR by 1.11 (95% CI: 1.07 to 1.16, p < 0.001) per BIMD quintile. This represents a maximum difference of 41% between districts in the most and least deprived quintiles in the SIR and 110% in the SMR. Looking at individual months revealed clear linear association between the BIMD quintiles and the SIR and SMR in the first, second and last quarter of 2021. In the summers of 2020 and 2021, infection activity was low. Conclusions In more deprived areas in Bavaria, Germany, higher incidence and mortality ratios were observed during the COVID-19 pandemic with particularly strong associations during infection waves 3 and 4 in 2020/2021. Only high infection levels reveal the effect of risk factors and socioeconomic inequalities. There may be confounding between the highly deprived areas and border regions in the north and east of Bavaria, making the relationship between area deprivation and infection burden more complex. Vaccination appeared to balance incidence and mortality rates between the most and least deprived districts. Vaccination makes an important contribution to health equality.
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Affiliation(s)
- Kirsi Marjaana Manz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- *Correspondence: Kirsi Marjaana Manz
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Werner Maier
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
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13
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Unruh LH, Dharmapuri S, Xia Y, Soyemi K. Health disparities and COVID-19: A retrospective study examining individual and community factors causing disproportionate COVID-19 outcomes in Cook County, Illinois. PLoS One 2022; 17:e0268317. [PMID: 35576226 PMCID: PMC9109922 DOI: 10.1371/journal.pone.0268317] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/27/2022] [Indexed: 12/29/2022] Open
Abstract
Early data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color with higher infection and mortality rates within those communities. This study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiner’s office, and testing results from the Illinois Department of Public Health to perform bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels. We used the ZCTA Social Deprivation Index (SDI), a measure of ZCTA area level deprivation based on seven demographic characteristics to quantify the socio-economic variation in health outcomes and levels of disadvantage across ZCTAs. Principal findings showed that: 1) while Black individuals make up 22% of Cook County’s population, they account for 28% of the county’s COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for Non-White compared with White decedents; 3) residents of Minority ZCTA areas were 1.02 times as likely to test positive for COVID-19, (Incidence Rate Ratio (IRR) 1.02, [95% CI 0.95, 1.10]); 1.77 times as likely to die (IRR 1.77, [95% CI 1.17, 2.66]); and were 1.15 times as likely to be tested (IRR 1.15, [95% CI 0.99, 1.33]). There are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. This study illustrates the health disparities and underlying systemic inequalities experienced by communities of color.
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Affiliation(s)
- Larissa H. Unruh
- Department of Emergency Medicine, John H. Stroger Jr. Hospital of Cook County Health, Chicago, Illinois, United States of America
| | - Sadhana Dharmapuri
- Cermak Health Services, Cook County Juvenile Temporary Detention Center, Chicago, Illinois, United States of America
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States of America
| | - Yinglin Xia
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Kenneth Soyemi
- Cermak Health Services, Cook County Juvenile Temporary Detention Center, Chicago, Illinois, United States of America
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States of America
- * E-mail:
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14
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Hoffmann S, Tschorn M, Michalski N, Hoebel J, Förstner BR, Rapp MA, Spallek J. Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany. Health Place 2022; 75:102794. [PMID: 35364469 DOI: 10.1016/j.healthplace.2022.102794] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration. METHOD We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children's school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high). RESULTS Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation. CONCLUSION Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.
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Affiliation(s)
- Stephanie Hoffmann
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Germany
| | - Mira Tschorn
- Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, University of Potsdam, Potsdam, Germany; Social and Preventive Medicine, Department of Sports and Health Sciences, Intra-faculty Unit "Cognitive Sciences", Faculty of Human Science, University of Potsdam, Potsdam, Germany
| | - Niels Michalski
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Bernd R Förstner
- Social and Preventive Medicine, Department of Sports and Health Sciences, Intra-faculty Unit "Cognitive Sciences", Faculty of Human Science, University of Potsdam, Potsdam, Germany
| | - Michael A Rapp
- Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, University of Potsdam, Potsdam, Germany; Social and Preventive Medicine, Department of Sports and Health Sciences, Intra-faculty Unit "Cognitive Sciences", Faculty of Human Science, University of Potsdam, Potsdam, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Germany; Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, University of Potsdam, Potsdam, Germany.
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15
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Kurani SS, Heien HC, Sangaralingham LR, Inselman JW, Shah ND, Golden SH, McCoy RG. Association of Area-Level Socioeconomic Deprivation With Hypoglycemic and Hyperglycemic Crises in US Adults With Diabetes. JAMA Netw Open 2022; 5:e2143597. [PMID: 35040969 PMCID: PMC8767428 DOI: 10.1001/jamanetworkopen.2021.43597] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Social determinants of health play a role in diabetes management and outcomes, including potentially life-threatening complications of severe hypoglycemia and diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS). Although several person-level socioeconomic factors have been associated with these complications, the implications of area-level socioeconomic deprivation are unknown. OBJECTIVE To examine the association between area-level deprivation and the risks of experiencing emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises (ie, DKA or HHS). DESIGN, SETTING, AND PARTICIPANTS This cohort study used deidentified administrative claims data for privately insured individuals and Medicare Advantage beneficiaries across the US. The analysis included adults with diabetes who met the claims criteria for diabetes between January 1, 2016, and December 31, 2017. Data analyses were performed from November 17, 2020, to November 11, 2021. EXPOSURES Area deprivation index (ADI) was derived for each county for 2016 and 2017 using 17 county-level indicators from the American Community Survey. ADI values were applied to patients who were living in each county based on their index dates and were categorized according to county-level ADI quintile (with quintile 1 having the least deprivation and quintile 5 having the most deprivation). MAIN OUTCOMES AND MEASURES The numbers of emergency department visits or hospitalizations related to the primary diagnoses of hypoglycemia and DKA or HHS (ascertained using validated diagnosis codes in the first or primary position of emergency department or hospital claims) between 2016 and 2019 were calculated for each ADI quintile using negative binomial regression models and adjusted for patient age, sex, health plan type, comorbidities, glucose-lowering medication type, and percentage of White residents in the county. RESULTS The study population included 1 116 361 individuals (563 943 women [50.5%]), with a mean (SD) age of 64.9 (13.2) years. Of these patients, 343 726 (30.8%) resided in counties with the least deprivation (quintile 1) and 121 810 (10.9%) lived in counties with the most deprivation (quintile 5). Adjusted rates of severe hypoglycemia increased from 13.54 (95% CI, 12.91-14.17) per 1000 person-years in quintile 1 counties to 19.13 (95% CI, 17.62-20.63) per 1000 person-years in quintile 5 counties, corresponding to an incidence rate ratio of 1.41 (95% CI, 1.29-1.54; P < .001). Adjusted rates of DKA or HHS increased from 7.49 (95% CI, 6.96-8.02) per 1000 person-years in quintile 1 counties to 8.37 (95% CI, 7.50-9.23) per 1000 person-years in quintile 5 counties, corresponding to an incidence rate ratio of 1.12 (95% CI, 1.00-1.25; P = .049). CONCLUSIONS AND RELEVANCE This study found that living in counties with a high area-level deprivation was associated with an increased risk of severe hypoglycemia and DKA or HHS. The concentration of these preventable events in areas of high deprivation signals the need for interventions that target the structural barriers to optimal diabetes management and health.
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Affiliation(s)
- Shaheen Shiraz Kurani
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Herbert C. Heien
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Lindsey R. Sangaralingham
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
- OptumLabs, Eden Prairie, Minnesota
| | - Jonathan W. Inselman
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Nilay D. Shah
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Sherita Hill Golden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
- Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Rozalina G. McCoy
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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