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Calkins FM, Pagani NR, Bragg J, Gauthier Z, Salzler M. Neighborhood socioeconomic disadvantage does not predict need for manipulation under anesthesia or range of motion following total knee arthroplasty. J Orthop 2024; 58:146-149. [PMID: 39100542 PMCID: PMC11293519 DOI: 10.1016/j.jor.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 08/06/2024] Open
Abstract
Background Studies have linked socioeconomic factors including lower income and minority race with worse functional outcomes following total knee arthroplasty (TKA). Arthrofibrosis is a common complication following TKA, and manipulation under anesthesia (MUA) is an effective treatment option for arthrofibrosis. This study aimed to determine if neighborhood-level socioeconomic disadvantage predicts need for MUA and postoperative range of motion (ROM) among patients undergoing primary elective TKA. Methods We performed a retrospective cohort study of primary TKAs performed at a single institution over a three-year duration. Area Deprivation Index (ADI) was used to determine each patient's level of socioeconomic disadvantage based on their home address. Patients were allocated into three groups based on ADI: least socioeconomic disadvantage (ADI 1-3), middle socioeconomic disadvantage (ADI 4-6), and most socioeconomic disadvantage (ADI 7-10). Demographic factors and comorbid conditions were recorded. Bivariate analysis was used to evaluate the relationship between degree of socioeconomic disadvantage and need for MUA and postoperative ROM. Results In total, 600 patients were included and 26.7 % were categorized as most disadvantaged. In comparison to the middle and least disadvantaged groups, these patients were more likely to be Women (71.2 vs. 67.9 and 58.6 %; p = 0.027), younger (60.7 vs. 62.9 and 66.3 years; p < 0.001) and have higher BMI (34.9 vs. 33 and 31.7; p < 0.001) (most disadvantaged vs. middle and least). Analysis revealed no difference in rate of MUA (6.3 vs. 2.5 vs. 4 %; p = 0.179) or postoperative ROM (98 vs. 98 vs. 100°; p = 0.753) between the three groups (most, middle, and least disadvantaged, respectively). Conclusion Neighborhood socioeconomic disadvantage does not predict rate of MUA or postoperative ROM following TKA. Patients residing in neighborhoods with higher ADI who underwent TKA were more likely to be younger, Women, and have higher BMI, consistent with previous literature. Our results support efforts to improve access to orthopaedic care, including TKA, to patients of all socioeconomic levels.
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Affiliation(s)
| | - Nicholas R. Pagani
- Department of Orthopaedics, New England Baptist Hospital, Boston, MA, USA
| | - Jack Bragg
- Department of Orthopaedics, Tufts Medical Center, Boston, MA, USA
| | | | - Matthew Salzler
- Department of Orthopaedics, Tufts Medical Center, Boston, MA, USA
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Hernandez Sevillano J, Babagoli MA, Chen Y, Liu SH, Mellacheruvu P, Johnson J, Ibanez B, Lorenzo O, Mechanick JI. Higher neighborhood disadvantage is associated with weaker interactions among cardiometabolic drivers. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 23:200322. [PMID: 39282603 PMCID: PMC11399558 DOI: 10.1016/j.ijcrp.2024.200322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/23/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024]
Abstract
Background Adiposity, dysglycemia, and hypertension are metabolic drivers that have causal interactions with each other. However, the effect of neighborhood-level disadvantage on the intensity of interactions among these metabolic drivers has not been studied. The objective of this study is to determine whether the strength of the interplay between these drivers is affected by neighborhood-level disadvantage. Methods This cross-sectional study analyzed patients presenting to a multidisciplinary preventive cardiology center in New York City, from March 2017 to February 2021. Patients' home addresses were mapped to the Area Deprivation Index to determine neighborhood disadvantage. The outcomes of interest were correlation coefficients (range from -1 to +1) among the various stages (0 - normal, 1 - risk, 2 - predisease, 3 - disease, and 4 - complications) of abnormal adiposity, dysglycemia, and hypertension at presentation, stratified by neighborhood disadvantage. Results The cohort consisted of 963 patients (age, median [IQR] 63.8 [49.7-72.5] years; 624 [65.1 %] female). The correlation among the various stages of adiposity, dysglycemia, and hypertension was weaker with increasing neighborhood disadvantage (P for trend <0.001). Specifically, the correlation describing adiposity, dysglycemia, and hypertension interaction was weaker in the high neighborhood disadvantage group compared to the intermediate neighborhood disadvantage group (median [IQR]: 0.34 [0.27, 0.44] vs. median [IQR]: 0.39 [0.34, 0.45]; P < 0.001) and compared to the low neighborhood disadvantage group (median [IQR]: 0.34 [0.27, 0.44] vs. median [IQR]: 0.54 [0.52, 0.57]; P < 0.001), as well as weaker in the intermediate neighborhood disadvantage group compared to the low neighborhood disadvantage group (median [IQR]: 0.39 [0.34, 0.45] vs. 0.54 median [IQR]: 0.54 [0.52, 0.57]; P < 0.001). Conclusions Interactions among the various stages of abnormal adiposity, dysglycemia, and hypertension with each other are weaker with increasing neighborhood disadvantage. Factors related to neighborhood-level disadvantage, other than abnormal adiposity, might play a crucial role in the development of dysglycemia and hypertension.
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Affiliation(s)
- Joel Hernandez Sevillano
- Kravis Center for Clinical Cardiovascular Health at the Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Yitong Chen
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shelley H Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Janet Johnson
- Kravis Center for Clinical Cardiovascular Health at the Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Oscar Lorenzo
- IIS-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain
- Biomedical Research Network on Diabetes and Associated Metabolic Disorders (CIBERDEM), Carlos III National Health Institute, Madrid, Spain
| | - Jeffrey I Mechanick
- Kravis Center for Clinical Cardiovascular Health at the Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Werder E, Lawrence K, Deng X, Braxton Jackson W, Christenbury K, Buller I, Engel L, Sandler D. Residential air pollution, greenspace, and adverse mental health outcomes in the U.S. Gulf Long-term Follow-up Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:174434. [PMID: 38960154 PMCID: PMC11332601 DOI: 10.1016/j.scitotenv.2024.174434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Air pollution and greenness are environmental determinants of mental health, though existing evidence typically considers each exposure in isolation. We evaluated relationships between co-occurring air pollution and greenspace levels and depression and anxiety. We estimated cross-sectional associations among 9015 Gulf Long-term Follow-up Study participants living in the southeastern U.S. who completed the Patient Health Questionnaire-9 (depression: score ≥ 10) and Generalized Anxiety Disorder Questionnaire-7 (anxiety: score ≥ 10). Participant residential addresses were linked to annual average concentrations of particulate matter (1 km PM2.5) and nitrogen dioxide (1 km NO2), as well as satellite-based greenness (2 km Enhanced Vegetation Index (EVI)). We used adjusted log-binomial regression to estimate prevalence ratios (PR) and 95 % confidence intervals (CI) for associations between exposures (quartiles) and depression and anxiety. In mutually adjusted models (simultaneously modeling PM2.5, NO2, and EVI), the highest quartile of PM2.5 was associated with increased prevalence of depression (PR = 1.17, 95 % CI: 1.06-1.29), whereas the highest quartile of greenness was inversely associated with depression (PR = 0.89, 95 % CI: 0.80-0.99). Joint exposure to greenness mitigated the impact of PM2.5 on depression (PRPM only = 1.20, 95 % CI: 1.06-1.36; PRPM+green = 0.98, 95 % CI: 0.83-1.16) and anxiety (PRPM only = 1.10, 95 % CI: 1.00-1.22; PRPM+green = 0.95, 95 % CI: 0.83-1.09) overall and in subgroup analyses. Observed associations were stronger in urbanized areas and among nonwhite participants, and varied by neighborhood deprivation. NO2 exposure was not independently associated with depression or anxiety in this population. Relationships between PM2.5, greenness, and depression were strongest in the presence of characteristics that are highly correlated with lower socioeconomic status, underscoring the need to consider mental health as an environmental justice issue.
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Affiliation(s)
| | | | | | - W Braxton Jackson
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, USA
| | - Kate Christenbury
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, USA
| | - Ian Buller
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, USA
| | - Lawrence Engel
- Epidemiology Branch, NIEHS, NC, USA; Department of Epidemiology, UNC Gillings School of Public Health, NC, USA
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Seelye S, Cano J, Hogan CK, Prescott HC, Sussman JB. Social Determinants of Health and Risk-Adjusted Sepsis Mortality in the Nationwide Veterans Affairs Healthcare System. J Gen Intern Med 2024:10.1007/s11606-024-09104-y. [PMID: 39375318 DOI: 10.1007/s11606-024-09104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 09/27/2024] [Indexed: 10/09/2024]
Abstract
IMPORTANCE Traditional risk prediction and risk adjustment models have focused on clinical characteristics, but accounting for social determinants of health (SDOH) and complex health conditions could improve understanding of sepsis outcomes and our ability to predict outcomes, treat patients, and assess quality of care. OBJECTIVE To evaluate the impact of SDOH and health scales in sepsis mortality risk prediction and hospital performance assessment. DESIGN Observational cohort study. SETTING One hundred twenty-nine hospitals in the nationwide Veterans Affairs (VA) Healthcare System between 2017 and 2021. PARTICIPANTS Veterans admitted through emergency departments with community-acquired sepsis. EXPOSURES Individual- and community-level SDOH (race, housing instability, marital status, Area Deprivation Index [ADI], and rural residence) and two health scales (the Care Assessment Need [CAN] score and Claims-Based Frailty Index [CFI]). MAIN OUTCOMES AND MEASURES The primary outcome was 90-day mortality from emergency department arrival; secondary outcomes included 30-day mortality and in-hospital mortality. RESULTS Among 144,889 patients admitted to the hospital with community-acquired sepsis, 139,080 were men (96.0%), median (IQR) age was 71 (64-77) years, and median (IQR) ADI was 60 (38-81). Multivariable regression models had good calibration and discrimination across models that adjusted for different sets of variables (e.g., AUROC, 0.782; Brier score, 1.33; and standardized mortality rate, 1.00). Risk-adjusted hospital performance was similar across all models. Among 129 VA hospitals, three hospitals shifted from the lowest or highest quintile of performance when comparing models that excluded SDOH to models that adjusted for all variables. Models that adjusted for ADI reported odds ratios (CI) of 1.00 (1.00-1.00), indicating that ADI does not significantly predict sepsis mortality in this cohort of patients. CONCLUSION AND RELEVANCE In patients with community-acquired sepsis, adjusting for community SDOH variables such as ADI did not improve 90-day sepsis mortality predictions in mortality models and did not substantively alter hospital performance within the VA Healthcare System. Understanding the role of SDOH in risk prediction and risk adjustment models is vital because it could prevent hospitals from being negatively evaluated for treating less advantaged patients. However, we found that in VA hospitals, the potential impact of SDOH on 90-day sepsis mortality was minimal.
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Affiliation(s)
- Sarah Seelye
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Jennifer Cano
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Cainnear K Hogan
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Hallie C Prescott
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy B Sussman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Huan T, Intrator O, Kind AJ, Hartronft S, Kinosian B. Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index. J Aging Soc Policy 2024:1-18. [PMID: 39369339 DOI: 10.1080/08959420.2024.2402110] [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: 03/22/2023] [Accepted: 03/06/2024] [Indexed: 10/07/2024]
Abstract
Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.
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Affiliation(s)
- Tianwen Huan
- Geriatrics & Extended Care Data & Analyses Center (GECDAC), Canandaigua, NY, USA
- Geriatrics & Extended Care Data & Analyses Center (GECDAC) Canandaigua VAMC, Canandaigua, NY, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Orna Intrator
- Geriatrics & Extended Care Data & Analyses Center (GECDAC), Canandaigua, NY, USA
- Geriatrics & Extended Care Data & Analyses Center (GECDAC) Canandaigua VAMC, Canandaigua, NY, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy Jh Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scotte Hartronft
- Veterans Health Administration, Department of Veterans Affairs, VA Central Office Geriatrics & Extended Care, Washington
| | - Bruce Kinosian
- Geriatrics & Extended Care Data & Analyses Center (GECDAC), Canandaigua, NY, USA
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Rollings KA, Noppert GA, Griggs JJ, Ibrahim AM, Clarke PJ. Comparing Deprivation vs Vulnerability Index Performance Using Medicare Beneficiary Surgical Outcomes. JAMA Surg 2024:2824306. [PMID: 39356528 PMCID: PMC11447624 DOI: 10.1001/jamasurg.2024.4195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/28/2024] [Indexed: 10/03/2024]
Abstract
Importance Health care researchers, professionals, payers, and policymakers are increasingly relying on publicly available composite indices of area-level socioeconomic deprivation to address health equity. Implications of index selection, however, are not well understood. Objective To compare the performance of 2 frequently used deprivation indices using policy-relevant outcomes among Medicare beneficiaries undergoing 3 common surgical procedures. Design, Setting, and Participants This cross-sectional study examined outcomes among Medicare beneficiaries (65 to 99 years old) undergoing 1 of 3 common surgical procedures (hip replacement, knee replacement, or coronary artery bypass grafting) between 2016 and 2019. Index discriminative performance was compared for beneficiaries residing in tracts with high- and low-deprivation levels (deciles) according to each index. Analyses were conducted between December 2022 and August 2023. Main Outcomes and Measures Tract-level deprivation was operationalized using 2020 releases of the area deprivation index (ADI) and the social vulnerability index (SVI). Binary outcomes were unplanned surgery, 30-day readmissions, and 30-day mortality. Multivariable logistic regression models, stratified by each index, accounted for beneficiary and hospital characteristics. Results A total of 2 433 603 Medicare beneficiaries (mean [SD] age, 73.8 [6.1] years; 1 412 968 female beneficiaries [58.1%]; 24 165 Asian [1.0%], 158 582 Black [6.5%], and 2 182 052 White [89.7%]) were included in analyses. According to both indices, beneficiaries residing in high-deprivation tracts had significantly greater adjusted odds of all outcomes for all procedures when compared with beneficiaries living in low-deprivation tracts. However, compared to ADI, SVI resulted in higher adjusted odds ratios (adjusted odds ratios, 1.17-1.31 for SVI vs 1.09-1.23 for ADI), significantly larger outcome rate differences (outcome rate difference, 0.07%-5.17% for SVI vs outcome rate difference, 0.05%-2.44% for ADI; 95% CIs excluded 0), and greater effect sizes (Cohen d, 0.076-0.546 for SVI vs 0.044-0.304 for ADI) for beneficiaries residing in high- vs low-deprivation tracts. Conclusions and Relevance In this cross-sectional study of Medicare beneficiaries, SVI had significantly better discriminative performance-stratifying surgical outcomes over a wider range-than ADI for identifying and distinguishing between high- and low-deprivation tracts, as indexed by outcomes for common surgical procedures. Index selection requires careful consideration of index differences, index performance, and contextual factors surrounding use, especially when informing resource allocation and health care payment adjustment models to address health equity.
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Affiliation(s)
- Kimberly A. Rollings
- Health & Design Research Fellowship Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Grace A. Noppert
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Jennifer J. Griggs
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
- School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor
| | | | - Philippa J. Clarke
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
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D'Abreu A, Bankole A, Kapur J, Manning CA, Chernyavskiy P. Association of the Area Deprivation Index With Dementia Basic Workup and Diagnosis in Central and Western Virginia: A Cross-Sectional Study. Neurol Clin Pract 2024; 14:e200323. [PMID: 38919929 PMCID: PMC11195434 DOI: 10.1212/cpj.0000000000200323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/02/2024] [Indexed: 06/27/2024]
Abstract
Background and Objectives The Area Deprivation Index (ADI) provides a validated and multidimensional metric of areal disadvantage. Our goals were to determine if the ADI influences the likelihood of receiving workup based on published guidelines and an etiologic diagnosis of dementia in Central and Western Virginia. Methods We collected deidentified data from the electronic health record of individuals aged 50-105 years diagnosed with dementia at the University of Virginia (UVA) Medical Center (2016-2021) and at Carillion Clinic (2018-2021). Visit-specific ICD-10 codes were used to classify each dementia diagnosis as "disease-specific" (e.g., Alzheimer disease) or "general" (e.g., unspecified dementia). Following the American Academy of Neurology guidelines, we considered the evaluation performed as "adequate" if patients had vitamin B12, thyroid-stimulating hormone, and brain CT or magnetic resonance imaging within 6 months of the initial diagnosis. Census tract ADI was linked to study participants using the unique census tract identifier derived from the participants' home addresses at the time of diagnosis. Statistical modeling occurred under a Bayesian paradigm implemented using a standard code in R. Results The study included 13,431 individuals diagnosed with dementia at UVA (n = 7,152) and Carillion Clinic (n = 6,279). Of those, 32.5% and 20.4% received "disease-specific" diagnoses at UVA and Carillion Clinic and 8.2% and 20.4% underwent "adequate" workup, respectively. The adjusted relationship between census tract ADI and the likelihood of a disease-specific diagnosis was U-shaped: Residence in moderately disadvantaged areas was associated with the lowest likelihood of disease-specific diagnosis. Discussion Most patients diagnosed with dementia did not receive an adequate evaluation or an etiologic diagnosis. Those living in locations just above the national median ADI levels had the lowest likelihood of receiving an etiologic diagnosis, lower than those in the least and most deprived areas. Renewed awareness efforts among providers are needed to increase compliance with diagnostic guidelines.
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Affiliation(s)
- Anelyssa D'Abreu
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Azziza Bankole
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Jaideep Kapur
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Carol A Manning
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Pavel Chernyavskiy
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
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Wang C, Frost J, Tang M, Shah R, Kim E, Shamamian PE, Montalmant KE, Oleru O, Seyidova N, Henderson PW. Neighborhood Deprivation is Associated With Increased Postoperative Complications After Implant-Based Breast Reconstruction. Clin Breast Cancer 2024; 24:604-610. [PMID: 39019728 DOI: 10.1016/j.clbc.2024.06.017] [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: 05/28/2024] [Revised: 06/22/2024] [Accepted: 06/22/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE The Area Deprivation Index (ADI) ranks neighborhoods by deprivation based on US Census data. This study utilizes ADI scores to investigate the impact of neighborhood deprivation on complication rates following breast reconstruction. PATIENTS AND METHODS Patients who received implant-based reconstruction from 2019 to 2023 were identified at a single institution in New York. Patients were linked to a state-specific ADI score and categorized into groups: "High ADI" (6-10) and "Low ADI" (1-5). Patient characteristics and complication rates were compared between the ADI groups with Chi-Square analysis and t-tests. The predictive value of ADI scores on complication rates was assessed using logistic regression models. RESULTS In total, 471 patients were included, of which 16% (n = 73) were in the High ADI group, and 84% (n = 398) were in the Low ADI group. There were no baseline differences between the 2 groups, except that there were more patients of Hispanic descent in the High ADI group (30% vs. 15%, P < .01). The High ADI group had a higher overall complication rate than the Low ADI group (34% vs. 21%, P < .01), as well as higher individual rates of hematoma (12% vs. 3%, P < .01) and unexpected reoperations (18% vs. 7%, P < .01). After adjusting for differences in race, High ADI scores predicted hematoma, reoperations, and any complication (P < .05). CONCLUSION Patients living in neighborhoods with high ADI had a higher incidence of postoperative complications, independent of comorbidities and race. This measure of disparity should be considered when counselling patients about their risk of complications following procedures like implant-based breast reconstruction.
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Affiliation(s)
- Carol Wang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jamie Frost
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Megan Tang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Reanna Shah
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Esther Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter E Shamamian
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keisha E Montalmant
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Olachi Oleru
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nargiz Seyidova
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter W Henderson
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Woodward MA, Hicks PM, Harris-Nwanyanwu K, Modjtahedi B, Chan RVP, Vogt EL, Lu MC, Newman-Casey PA. Eye Care in Federally Qualified Health Centers. Ophthalmology 2024; 131:1225-1233. [PMID: 38697267 PMCID: PMC11416322 DOI: 10.1016/j.ophtha.2024.04.019] [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: 02/06/2024] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024] Open
Abstract
PURPOSE To assess changes in vision care availability at Federally Qualified Health Centers (FQHCs) between 2017 and 2021 and whether neighborhood-level demographic social risk factors (SRFs) associated with eye care services provided by FQHCs. DESIGN Secondary data analysis of the Health Resources and Services Administration (HRSA) data and 2017-2021 American Community Survey (ACS). PARTICIPANTS Federally Qualified Health Centers. METHODS Patient and neighborhood characteristics for SRFs were summarized. Differences in FQHCs providing and not providing vision care were compared via Wilcoxon-Mann-Whitney tests for continuous measures and chi-square tests for categorical measures. Logistic regression models were used to test the associations between neighborhood measures and FQHCs providing vision care, adjusted for patient characteristics. MAIN OUTCOME MEASURES Odds ratios (ORs) with 95% confidence intervals (CIs) for neighborhood-level predictors of FQHCs providing vision care services. RESULTS Overall, 28.5% of FQHCs (n = 375/1318) provided vision care in 2017 versus 32% (n = 435/1362) in 2021 with some increases and decreases in both the number of FQHCs and those with and without vision services. Only 2.6% of people who accessed FQHC services received eye care in 2021. Among the 435 FQHCs that provided vision care in 2021, 27.1% (n = 118) had added vision services between 2017 and 2021, 71.5% (n = 311) had been offering vision services since at least 2017, and 1.4% (n = 6) were newly established. FQHCs providing vision care in 2021 were more likely to be in neighborhoods with a higher percentage of Hispanic/Latino individuals (OR, 1.08, 95% CI, 1.02-1.14, P = 0.0094), Medicaid-insured individuals (OR, 1.08, 95% CI, 1.02-1.14, P = 0.0120), and no car households (OR, 1.07, 95% CI, 1.01-1.13, P = 0.0142). However, FQHCs with vision care, compared to FQHCs without vision care, served a lower percentage of Hispanic/Latino individuals (27.2% vs. 33.9%, P = 0.0007), Medicaid-insured patients (42.8% vs. 46.8%, P < 0.0001), and patients living at or below 100% of the federal poverty line (61.3% vs. 66.3%, P < 0.0001). CONCLUSIONS Vision care services are available at a few FQHCs, localized to a few states. Expanding eye care access at FQHCs would meet patients where they seek care to mitigate vision loss to underserved communities. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | - Bobeck Modjtahedi
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Emily L Vogt
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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10
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Allan AC, Gamaldo AA, Wright RS, Aiken-Morgan AT, Lee AK, Allaire JC, Thorpe RJ, Whitfield KE. Social support moderates association between area deprivation index and changes in physical health among adults in the Baltimore Study of Black Aging (BSBA). ETHNICITY & HEALTH 2024; 29:774-792. [PMID: 39003724 PMCID: PMC11410518 DOI: 10.1080/13557858.2024.2376035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/28/2024] [Indexed: 07/15/2024]
Abstract
Despite the association of neighborhood quality with poorer adult health, limited research has explored the association between neighborhood disadvantage, e.g. Area Deprivation Index (ADI), and older Black adults' health, prospectively. This observational study examined the association between ADI and changes in longitudinal physical health within older Black adults. The analytic sample (n = 317) included data from waves 1 & 2 of the Baltimore Study of Black Aging: Patterns of Cognitive Aging (BSBA-PCA). Study variables included the Area Deprivation Index (ADI), objective (e.g. average heart rate) and subjective (e.g. activities of daily living) measures of physical health. Multiple linear regression models were conducted controlling for sociodemographic and social support characteristics. Participants living in more disadvantaged neighborhoods, based on national and state ADIs, were more likely to have a decreasing heart rate even after adjusting for covariates. Likewise, participants reporting increasing levels of ADL difficulty were living in a neighborhood with greater disadvantage based on national and state ADI rankings. Significant social support received and ADI (national and state) interactions were observed for average heart rate. The findings suggest that research on the effect of neighborhood quality and social support can enhance our understanding of its impact on older Black adults' health prospectively.
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Affiliation(s)
- Alexa C Allan
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | | | | | - Anna K Lee
- Department of Psychology, North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Jason C Allaire
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith E Whitfield
- President, Department of Psychology, University of Nevada, Las Vegas, NV, USA
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11
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Harlan EA, Ghous M, Moscovice IS, Valley TS. Characteristics of Patients Hospitalized in Rural and Urban ICUs From 2010 to 2019. Crit Care Med 2024; 52:1577-1586. [PMID: 38920619 PMCID: PMC11408111 DOI: 10.1097/ccm.0000000000006369] [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] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Rural hospitals are threatened by workforce shortages and financial strain. To optimize regional critical care delivery, it is essential to understand what types of patients receive intensive care in rural and urban hospitals. DESIGN A retrospective cohort study. SETTING AND PATIENTS All fee-for-service Medicare beneficiaries in the United States who were 65 years old or older hospitalized in an ICU between 2010 and 2019 were included. Rural and urban hospitals were classified according to the 2013 National Center For Health Statistics Urban-Rural Classification Scheme for Counties. Patient comorbidities, primary diagnoses, organ dysfunction, and procedures were measured using the International Classification of Diseases , 9th and 10th revisions diagnosis and procedure codes. Standardized differences were used to compare rural and urban patient admission characteristics. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 12,224,097 ICU admissions between 2010 and 2019, and 1,488,347 admissions (12.2%) were to rural hospitals. The most common diagnoses in rural hospitals were cardiac (30.3%), infectious (24.6%), and respiratory (10.9%). Patients in rural ICUs had similar organ dysfunction compared with urban hospitals (mean organ failures in rural ICUs 0.5, sd 0.8; mean organ failures in urban ICUs 0.6, sd 0.9, absolute standardized mean difference 0.096). Organ dysfunction among rural ICU admissions increased over time (0.4 mean organ failures in 2010 to 0.7 in 2019, p < 0.001). CONCLUSIONS Rural hospitals care for an increasingly complex critically ill patient population with similar organ dysfunction as urban hospitals. There is a pressing need to develop policies at federal and regional healthcare system levels to support the continued provision of high-quality ICU care within rural hospitals.
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Affiliation(s)
- Emily A Harlan
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Muhammad Ghous
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Ira S Moscovice
- Division of Health Policy and Management, University of Minnesota Rural Health Research Center, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Thomas S Valley
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI
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12
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Dasa O, Bai C, Sajdeya R, Kimmel SE, Pepine CJ, Gurka J MJ, Laubenbacher R, Pearson TA, Mardini MT. Identifying Potential Factors Associated With Racial Disparities in COVID-19 Outcomes: Retrospective Cohort Study Using Machine Learning on Real-World Data. JMIR Public Health Surveill 2024; 10:e54421. [PMID: 39326040 DOI: 10.2196/54421] [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: 11/12/2023] [Revised: 04/01/2024] [Accepted: 05/29/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Racial disparities in COVID-19 incidence and outcomes have been widely reported. Non-Hispanic Black patients endured worse outcomes disproportionately compared with non-Hispanic White patients, but the epidemiological basis for these observations was complex and multifaceted. OBJECTIVE This study aimed to elucidate the potential reasons behind the worse outcomes of COVID-19 experienced by non-Hispanic Black patients compared with non-Hispanic White patients and how these variables interact using an explainable machine learning approach. METHODS In this retrospective cohort study, we examined 28,943 laboratory-confirmed COVID-19 cases from the OneFlorida Research Consortium's data trust of health care recipients in Florida through April 28, 2021. We assessed the prevalence of pre-existing comorbid conditions, geo-socioeconomic factors, and health outcomes in the structured electronic health records of COVID-19 cases. The primary outcome was a composite of hospitalization, intensive care unit admission, and mortality at index admission. We developed and validated a machine learning model using Extreme Gradient Boosting to evaluate predictors of worse outcomes of COVID-19 and rank them by importance. RESULTS Compared to non-Hispanic White patients, non-Hispanic Blacks patients were younger, more likely to be uninsured, had a higher prevalence of emergency department and inpatient visits, and were in regions with higher area deprivation index rankings and pollutant concentrations. Non-Hispanic Black patients had the highest burden of comorbidities and rates of the primary outcome. Age was a key predictor in all models, ranking highest in non-Hispanic White patients. However, for non-Hispanic Black patients, congestive heart failure was a primary predictor. Other variables, such as food environment measures and air pollution indicators, also ranked high. By consolidating comorbidities into the Elixhauser Comorbidity Index, this became the top predictor, providing a comprehensive risk measure. CONCLUSIONS The study reveals that individual and geo-socioeconomic factors significantly influence the outcomes of COVID-19. It also highlights varying risk profiles among different racial groups. While these findings suggest potential disparities, further causal inference and statistical testing are needed to fully substantiate these observations. Recognizing these relationships is vital for creating effective, tailored interventions that reduce disparities and enhance health outcomes across all racial and socioeconomic groups.
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Affiliation(s)
- Osama Dasa
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Chen Bai
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Ruba Sajdeya
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States
| | - Stephen E Kimmel
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Matthew J Gurka J
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Reinhard Laubenbacher
- Laboratory for Systems Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Thomas A Pearson
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States
| | - Mamoun T Mardini
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
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13
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Lee SY, Hayes LW, Ozaydin B, Howard S, Garretson AM, Bradley HM, Land AM, DeLaney EW, Pritchett AO, Furr AL, Allgood A, Wyatt MC, Hall AG, Banaszak-Holl JC. Integrating Social Determinants of Health in Machine Learning-Driven Decision Support for Diabetes Case Management: Protocol for a Sequential Mixed Methods Study. JMIR Res Protoc 2024; 13:e56049. [PMID: 39321449 DOI: 10.2196/56049] [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: 01/03/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND The use of both clinical factors and social determinants of health (SDoH) in referral decision-making for case management may improve optimal use of resources and reduce outcome disparities among patients with diabetes. OBJECTIVE This study proposes the development of a data-driven decision-support system incorporating interactions between clinical factors and SDoH into an algorithm for prioritizing who receives case management services. The paper presents a design for prediction validation and preimplementation assessment that uses a mixed methods approach to guide the implementation of the system. METHODS Our study setting is a large, tertiary care academic medical center in the Deep South of the United States, where SDoH contribute to disparities in diabetes-specific hospitalizations and emergency department (ED) visits. This project will develop an interpretable artificial intelligence model for a population with diabetes using SDoH and clinical data to identify which posthospitalization cases have a higher likelihood of subsequent ED use. The electronic health record data collected for the study include demographics, SDoH, comorbidities, hospitalization-related factors, laboratory test results, and medication use to predict posthospitalization ED visits. Subsequently, a mixed methods approach will be used to validate prediction outcomes and develop an implementation strategy from insights into patient outcomes from case managers, clinicians, and quality and patient safety experts. RESULTS As of December 2023, we had abstracted data on 174,871 inpatient encounters between January 2018 and September 2023, involving 89,355 unique inpatients meeting inclusion criteria. Both clinical and SDoH data items were included for these patient encounters. In total, 85% of the inpatient visits (N=148,640) will be used for training (learning from the data) and the remaining 26,231 inpatient visits will be used for mixed-methods validation (testing). CONCLUSIONS By integrating a critical suite of SDoH with clinical data related to diabetes, the proposed data-driven risk stratification model can enable individualized risk estimation and inform health professionals (eg, case managers) about the risk of patients' upcoming ED use. The prediction outcome could potentially automate case management referrals, helping to better prioritize services. By taking a mixed methods approach, we aim to align the model with the hospital's specific quality and patient safety considerations for the quality of patient care and the optimization of case management resource allocation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56049.
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Affiliation(s)
- Seung-Yup Lee
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Leslie W Hayes
- Department of Quality and Patient Safety, University of Alabama at Birmingham Medicine, Birmingham, AL, United States
| | - Bunyamin Ozaydin
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Steven Howard
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alison M Garretson
- Department of Care Transitions, University of Alabama at Birmingham Medicine, Birmingham, AL, United States
| | - Heather M Bradley
- Cooper Green Mercy Health Service Authority, Birmingham, AL, United States
| | - Andrew M Land
- Primary Care Line, University of Alabama at Birmingham Medicine, Birmingham, AL, United States
| | - Erin W DeLaney
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy O Pritchett
- Department of Quality and Patient Safety, University of Alabama at Birmingham Medicine, Birmingham, AL, United States
| | - Amanda L Furr
- Cardiovascular Institute, University of Alabama at Birmingham Medicine, Birmingham, AL, United States
| | - Ashleigh Allgood
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew C Wyatt
- Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson G Hall
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jane C Banaszak-Holl
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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14
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Wang WE, Asken BM, DeSimone JC, Levy SA, Barker W, Fiala JA, Velez-Uribe I, Curiel Cid RE, Rósselli M, Marsiske M, Adjouadi M, Loewenstein DA, Duara R, Smith GE, Armstrong MJ, Barnes LL, Vaillancourt DE, Coombes SA. Neuroimaging and biofluid biomarkers across race and ethnicity in older adults across the spectrum of cognition. Ageing Res Rev 2024; 101:102507. [PMID: 39306249 DOI: 10.1016/j.arr.2024.102507] [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: 08/08/2024] [Accepted: 09/14/2024] [Indexed: 09/27/2024]
Abstract
Neuroimaging and biofluid biomarkers provide a proxy of pathological changes for Alzheimer's disease (AD) and are useful in improving diagnosis and assessing disease progression. However, it is not clear how race/ethnicity and different prevalence of AD risks impact biomarker levels. In this narrative review, we survey studies focusing on comparing biomarker differences between non-Hispanic White American(s) (NHW), African American(s) (AA), Hispanic/Latino American(s) (HLA), and Asian American(s) with normal cognition, mild cognitive impairment, and dementia. We found no strong evidence of racial and ethnic differences in imaging biomarkers after controlling for cognitive status and cardiovascular risks. For biofluid biomarkers, in AA, higher levels of plasma Aβ42/Aβ40, and lower levels of CSF total tau and p-tau 181, were observed after controlling for APOE status and comorbidities compared to NHW. Examining the impact of AD risks and comorbidities on biomarkers and their contributions to racial/ethnic differences in cognitive impairment are critical to interpreting biomarkers, understanding their generalizability, and eliminating racial/ethnic health disparities.
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Affiliation(s)
- Wei-En Wang
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Breton M Asken
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Jesse C DeSimone
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Shellie-Anne Levy
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Warren Barker
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Wien Center for Alzheimer's Disease and Memory Disorders, Mt. Sinai Medical Center, Miami, FL, USA
| | - Jacob A Fiala
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Idaly Velez-Uribe
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Wien Center for Alzheimer's Disease and Memory Disorders, Mt. Sinai Medical Center, Miami, FL, USA
| | - Rosie E Curiel Cid
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Departments of Psychiatry and Behavioral Sciences and Neurology, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, USA
| | - Monica Rósselli
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Michael Marsiske
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Malek Adjouadi
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Center for Advanced Technology and Education, Department of Electrical and Computer Engineering, Florida International University, Miami, FL, USA
| | - David A Loewenstein
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Departments of Psychiatry and Behavioral Sciences and Neurology, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, USA
| | - Ranjan Duara
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Wien Center for Alzheimer's Disease and Memory Disorders, Mt. Sinai Medical Center, Miami, FL, USA
| | - Glenn E Smith
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melissa J Armstrong
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Neurology, Fixel Institute for Neurological Disease, University of Florida, Gainesville, FL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David E Vaillancourt
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Department of Neurology, Fixel Institute for Neurological Disease, University of Florida, Gainesville, FL, USA
| | - Stephen A Coombes
- 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL, USA; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
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15
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Field C, Wang XY, Costantine MM, Landon MB, Grobman WA, Venkatesh KK. Social Determinants of Health and Diabetes in Pregnancy. Am J Perinatol 2024. [PMID: 39209304 DOI: 10.1055/a-2405-2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. SDOH are systemic factors that may explain, perpetuate, and exacerbate disparities in health outcomes for different populations and can be measured at both an individual and neighborhood or community level (iSDOH, nSDOH). In pregnancy, increasing evidence shows that adverse iSDOH and/or nSDOH are associated with a greater likelihood that diabetes develops, and that when it develops, there is worse glycemic control and a greater frequency of adverse pregnancy outcomes. Future research should not only continue to examine the relationships between SDOH and adverse pregnancy outcomes with diabetes but should determine whether multi-level interventions that seek to mitigate adverse SDOH result in equitable maternal care and improved patient health outcomes for pregnant individuals living with diabetes. KEY POINTS: · SDOH are conditions in which people are born, grow, work, live, and age.. · SDOH are systemic factors that may explain, perpetuate, and exacerbate disparities in health outcomes.. · SDOH can be measured at the individual and neighborhood level.. · Adverse SDOH are associated with worse outcomes for pregnant individuals living with diabetes.. · Interventions that mitigate adverse SDOH to improve maternal health equity and outcomes are needed..
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Affiliation(s)
- Christine Field
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Xiao-Yu Wang
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Mark B Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - William A Grobman
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
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16
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Albrecht JS, Kirk J, Ryan KA, Falvey JR. Neighborhood Deprivation and Recovery Following Traumatic Brain Injury Among Older Adults. J Head Trauma Rehabil 2024:00001199-990000000-00204. [PMID: 39293072 DOI: 10.1097/htr.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
OBJECTIVE Understanding the extent to which neighborhood impacts recovery following traumatic brain injury (TBI) among older adults could spur targeting of rehabilitation and other services to those living in more disadvantaged areas. The objective of the present study was to determine the extent to which neighborhood disadvantage influences recovery following TBI among older adults. Setting and Participants: Community-dwelling Medicare beneficiaries aged ≥65 years hospitalized with TBI 2010-2018. DESIGN AND MAIN MEASURES In this retrospective cohort study, the Area Deprivation Index (ADI) was used to assess neighborhood deprivation by linking it to 9-digit beneficiary zip codes. We used national-level rankings to divide the cohort into the top 10% (highest neighborhood disadvantage), middle 11-90%, and bottom 10% (lowest neighborhood disadvantage). Recovery was operationalized as days at home, calculated by subtracting days spent in a care environment or deceased from monthly follow-up over the year post-TBI. RESULTS Among 13,747 Medicare beneficiaries with TBI, 1713 (12.7%) were in the lowest decile of ADI rankings and 1030 (7.6%) were in the highest decile of ADI rankings. Following covariate adjustment, beneficiaries in neighborhoods with greatest disadvantage [rate ratio (RtR) 0.96; 95% confidence interval (CI) 0.94, 0.98] and beneficiaries in middle ADI percentiles (RtR 0.98; 95% CI 0.97, 0.99) had fewer days at home per month compared to beneficiaries in neighborhoods with lowest disadvantage. CONCLUSION This study provides evidence that neighborhood is associated with recovery from TBI among older adults and highlights days at home as a recovery metric that is responsive to differences in neighborhood disadvantage.
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Affiliation(s)
- Jennifer S Albrecht
- Author Affiliations: Department of Epidemiology and Public Health (Drs Albrecht, Kirk, and Falvey), Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition (Ms Ryan), Department of Physical Therapy and Rehabilitation Science (Dr Falvey), University of Maryland School of Medicine, Baltimore, Maryland
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17
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Fujiki RB, Lien KM, Munday J, Thibeault SL. Socioeconomic Deprivation Detrimentally Influences Language Outcomes in Toddlers With Cleft Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3113-3132. [PMID: 39173117 PMCID: PMC11427525 DOI: 10.1044/2024_jslhr-24-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The purpose of this study was to examine the influence of socioeconomic deprivation on language and developmental outcomes in toddlers with cleft palate with or without cleft lip (CP ± L). Other factors known to influence language outcomes were also considered, including home language history, history of hearing problems, syndromic diagnoses, and sex. METHOD A multicenter, cross-sectional study design was conducted. Data for 566 16-month-old toddlers with CP ± L were collected from 17 outpatient cleft palate clinics located throughout the United States. Outcome measures included the MacArthur-Bates Communicative Development Inventories, LENA Developmental Snapshot, age at first word as reported by the caregiver, and the Ages and Stages Questionnaires-Third Edition (ASQ-3). Multivariable linear or logistic regression was used to determine the influence of socioeconomic deprivation, as measured by the Area Deprivation Index, on language and developmental outcomes. RESULTS Greater socioeconomic deprivation significantly predicted poorer language outcomes in toddlers with CP ± L, including receptive vocabulary words (p = .02), expressive vocabulary words (p = .02), and late-developing gestures (p = .02). Additionally, toddlers from less affluent neighborhoods produced their first words significantly later than their counterparts living in more affluent areas (p < .01). Lower maternal education levels predicted significantly increased risk for problem solving delays (p < .01), and patients with subsidized insurance were at significantly increased risk for personal-social delays on the ASQ-3 (p < .01). CONCLUSIONS Children with CP ± L are susceptible to developmental delays associated with socioeconomic deprivation. These findings have implications for identifying a child's individual risk factors for developmental language disorders when conducting speech-language assessments. Future study should examine how inequities in care can be mitigated and addressed.
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Affiliation(s)
| | - Kari M. Lien
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - John Munday
- Department of Surgery, University of Wisconsin–Madison
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Martinez M, Cai T, Yang B, Zhou Z, Shankman SA, Mittal VA, Haase CM, Qu Y. Depressive symptoms during the transition to adolescence: Left hippocampal volume as a marker of social context sensitivity. Proc Natl Acad Sci U S A 2024; 121:e2321965121. [PMID: 39226358 PMCID: PMC11406239 DOI: 10.1073/pnas.2321965121] [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: 12/19/2023] [Accepted: 06/17/2024] [Indexed: 09/05/2024] Open
Abstract
The transition to adolescence is a critical period for mental health development. Socio-experiential environments play an important role in the emergence of depressive symptoms with some adolescents showing more sensitivity to social contexts than others. Drawing on recent developmental neuroscience advances, we examined whether hippocampal volume amplifies social context effects in the transition to adolescence. We analyzed 2-y longitudinal data from the Adolescent Brain Cognitive Development (ABCD®) study in a diverse sample of 11,832 youth (mean age: 9.914 y; range: 8.917 to 11.083 y; 47.8% girls) from 21 sites across the United States. Socio-experiential environments (i.e., family conflict, primary caregiver's depressive symptoms, parental warmth, peer victimization, and prosocial school environment), hippocampal volume, and a wide range of demographic characteristics were measured at baseline. Youth's symptoms of major depressive disorder were assessed at both baseline and 2 y later. Multilevel mixed-effects linear regression analyses showed that negative social environments (i.e., family conflict, primary caregiver's depressive symptoms, and peer victimization) and the absence of positive social environments (i.e., parental warmth and prosocial school environment) predicted greater increases in youth's depressive symptoms over 2 y. Importantly, left hippocampal volume amplified social context effects such that youth with larger left hippocampal volume experienced greater increases in depressive symptoms in more negative and less positive social environments. Consistent with brain-environment interaction models of mental health, these findings underscore the importance of families, peers, and schools in the development of depression during the transition to adolescence and show how neural structure amplifies social context sensitivity.
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Affiliation(s)
- Matias Martinez
- School of Education and Social Policy, Northwestern University, Evanston, IL 60208
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL 60611
- Institute for Policy Research, Northwestern University, Evanston, IL 60208
| | - Tianying Cai
- School of Education and Social Policy, Northwestern University, Evanston, IL 60208
- Institute of Child Development, University of Minnesota, Twin Cities, Minneapolis, MN 55455
| | - Beiming Yang
- School of Education and Social Policy, Northwestern University, Evanston, IL 60208
| | - Zexi Zhou
- Department of Human Development and Family Sciences, University of Texas, Austin, TX 78712
| | - Stewart A Shankman
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL 60611
- Department of Psychology, Northwestern University, Evanston, IL 60208
- Department of Psychiatry, Northwestern University, Chicago, IL 60611
| | - Vijay A Mittal
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL 60611
- Institute for Policy Research, Northwestern University, Evanston, IL 60208
- Department of Psychology, Northwestern University, Evanston, IL 60208
- Department of Psychiatry, Northwestern University, Chicago, IL 60611
| | - Claudia M Haase
- School of Education and Social Policy, Northwestern University, Evanston, IL 60208
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL 60611
- Institute for Policy Research, Northwestern University, Evanston, IL 60208
- Department of Psychology, Northwestern University, Evanston, IL 60208
- Department of Psychiatry, Northwestern University, Chicago, IL 60611
- Interdepartmental Neuroscience, Northwestern University, Evanston, IL 60611
- Buffett Institute for Global Studies, Northwestern University, Evanston, IL 60201
| | - Yang Qu
- School of Education and Social Policy, Northwestern University, Evanston, IL 60208
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL 60611
- Institute for Policy Research, Northwestern University, Evanston, IL 60208
- Department of Psychology, Northwestern University, Evanston, IL 60208
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Kell PA, Huber FA, Lowe TS, Shadlow JO, Rhudy JL. The Relationship Between Neighborhood Disadvantage and Markers of Chronic Pain Risk: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP). THE JOURNAL OF PAIN 2024:104659. [PMID: 39182538 DOI: 10.1016/j.jpain.2024.104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/19/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
Socioeconomic disadvantage contributes to health inequities, including chronic pain. Yet, research examining socioeconomic disadvantage and pain risk in Native Americans (NAs) is scant. This exploratory analysis assessed relationships between socioeconomic position (SEP), ethnicity, and neighborhood disadvantage on pronociceptive processes in 272 healthy, chronic pain-free NAs (n = 139) and non-Hispanic Whites (NHWs, n = 133) from the Oklahoma Study of Native American Pain Risk (OK-SNAP). Neighborhood disadvantage was quantified using the Area Deprivation Index (ADI). Regression models tested whether ADI predicted pain-promoting outcomes (ie, peripheral fiber functionality, pain sensitivity, pain and nociceptive amplification, and endogenous pain inhibition) above-and-beyond SEP and ethnicity. The Ethnicity × ADI interaction was also tested. Of the 11 outcomes tested, 9 were not statistically significant. Of the significant findings, neighborhood disadvantage predicted impaired inhibition of the nociceptive flexion reflex above-and-beyond SEP and ethnicity. Additionally, ethnicity moderated the relationship between ADI and warm detection threshold; disadvantage was associated with higher thresholds for NAs, but not for NHWs. Together, the results suggest neighborhood disadvantage is associated with reduced C-fiber function and impaired spinal inhibition, thus pointing to a role of neighborhood disadvantage in the relationship between the environment and pain inequities. PERSPECTIVE: This study assessed neighborhood socioeconomic disadvantage and pronociceptive processes in chronic pain-free Native Americans (NAs) and non-Hispanic Whites (NHWs). Irrespective of ethnicity, greater neighborhood disadvantage predicted less descending inhibition of spinal nociception. Neighborhood disadvantage was associated with a marker of C-fiber impairment (higher warm detection threshold) in NAs only.
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Affiliation(s)
- Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Felicitas A Huber
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Department of Anesthesiology, Washington University, St. Louis, Missouri
| | - Travis S Lowe
- Department of Sociology, The University of Tulsa, Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Department of Psychology, Oklahoma State University, Tulsa, Oklahoma
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma; Department of Health Promotions Sciences, University of Oklahoma Health Sciences Center, Tulsa, Oklahoma.
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Jevnikar BE, Huffman N, Roth A, Klika AK, Deren ME, Zhang C, Piuzzi NS. Impacts of neighborhood deprivation on septic and aseptic revision total knee arthroplasty outcomes: A comprehensive analysis using the area deprivation index. Knee 2024; 51:74-83. [PMID: 39241673 DOI: 10.1016/j.knee.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/26/2024] [Accepted: 08/09/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Community deprivation has been linked to poor health outcomes following primary total knee arthroplasty (pTKA), but few studies have explored revision TKA (rTKA). The present study analyzed implications of neighborhood deprivation on rTKA outcomes by characterizing relationships between Area Deprivation Index (ADI) and (1) non-home discharge disposition (DD), (2) hospital length of stay (LOS), (3) 90-day emergency department (ED) visits, (4) 90-day hospital readmissions, and (5) the effect of race on these healthcare outcomes. METHODS A total of 1,434 patients who underwent rTKA between January 2016 and June 2022 were analyzed. Associations between the ADI and postoperative healthcare resource utilization outcomes were evaluated using multivariate logistic regression. Mediation effect was estimated using a nonparametric bootstrap resampling method. RESULTS Greater ADI was associated with non-home DD (p < 0.001), LOS ≥ 3 days (p < 0.001), 90-day ED visits (p = 0.015), and 90-day hospital readmission (p = 0.002). Although there was no significant difference in ADI between septic and aseptic patients, septic patients undergoing rTKA were more likely to experience non-home discharge (p < 0.001), prolonged LOS (p < 0.001), and 90-day hospital readmission (p = 0.001). The effect of race on non-home DD was found to be mediated via ADI (p = 0.038). Similarly, results showed the effect of race on prolonged LOS was mediated via ADI (p = 0.01). CONCLUSION A higher ADI was associated with non-home discharge, prolonged LOS, 90-day ED visits, and 90-day hospital readmissions. The impacts of patient race on both non-home discharge and prolonged LOS were mediated by ADI. This index allows clinicians to better understand and address disparities in rTKA outcomes.
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Affiliation(s)
| | - Nickelas Huffman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Alexander Roth
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Matthew E Deren
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Chao Zhang
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
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21
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Tinglin J, McLeod MC, Williams CP, Tipre M, Rocque G, Crouse AB, Krontiras H, Gutnik L. Impact of Affordable Care Act Provisions on the Racial Makeup of Patients Enrolled at a Deep South, High-Risk Breast Cancer Clinic. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02104-y. [PMID: 39235712 DOI: 10.1007/s40615-024-02104-y] [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: 01/15/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE Black women are less likely to receive screening mammograms, are more likely to develop breast cancer at an earlier age, and more likely to die from breast cancer when compared to White women. Affordable Care Act (ACA) provisions decreased cost sharing for women's preventive screening, potentially mitigating screening disparities. We examined enrollment of a high-risk screening program before and after ACA implementation stratified by race. METHODS This retrospective, quasi-experimental study examined the ACA's impact on patient demographics at a high-risk breast cancer screening clinic from 02/28/2003 to 02/28/2019. Patient demographic data were abstracted from electronic medical records and descriptively compared in the pre- and post-ACA time periods. Interrupted time series (ITS) analysis using Poisson regression assessed yearly clinic enrollment rates by race using incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS Two thousand seven hundred and sixty-seven patients enrolled in the clinic. On average, patients were 46 years old (SD, ± 12), 82% were commercially insured, and 8% lived in a highly disadvantaged neighborhood. In ITS models accounting for trends over time, prior to ACA implementation, White patient enrollment was stable (IRR 1.01, 95% CI 1.00-1.02) while Black patient enrollment increased at 13% per year (IRR 1.13, 95% CI 1.05-1.22). Compared to the pre-ACA enrollment period, the post-ACA enrollment rate remained unchanged for White patients (IRR 0.99, 95% CI 0.97-1.01) but decreased by 17% per year for Black patients (IRR 0.83, 95% CI 0.74-0.92). CONCLUSION Black patient enrollment decreased at a high-risk breast cancer screening clinic post-ACA compared to the pre-ACA period, indicating a need to identify factors contributing to racial disparities in clinic enrollment.
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Affiliation(s)
- Jillian Tinglin
- University of Alabama (UAB) Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35233, USA.
| | | | | | - Meghan Tipre
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Gabrielle Rocque
- UAB Department of Medicine, Birmingham, AL, 35294, USA
- Division of Hematology and Oncology, UAB, Birmingham, AL, 35233, USA
| | - Andrew B Crouse
- UAB Hugh Kaul Precision Medicine Institute, Birmingham, AL, 35294, USA
| | | | - Lily Gutnik
- UAB Department of Surgery, Birmingham, AL, 35233, USA
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22
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Hogeveen J, Campbell EM, Mullins TS, Robertson-Benta CR, Quinn DK, Mayer AR, Cavanagh JF. Neural response to monetary incentives in acquired adolescent depression after mild traumatic brain injury: Stage 2 Registered Report. Brain Commun 2024; 6:fcae250. [PMID: 39234169 PMCID: PMC11371397 DOI: 10.1093/braincomms/fcae250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/03/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024] Open
Abstract
Depression is a common consequence of traumatic brain injury. Separately, spontaneous depression-arising without brain injury-has been linked to abnormal responses in motivational neural circuitry to the anticipation or receipt of rewards. It is unknown if post-injury and spontaneously occurring depression share similar phenotypic profiles. This issue is compounded by the fact that nearly all examinations of these psychiatric sequelae are post hoc: there are rarely any prospective assessments of mood and neural functioning before and after a brain injury. In this Stage 2 Registered Report, we used the Adolescent Brain Cognitive Development Consortium dataset to examine if a disruption in functional neural responses to rewards is present in patients with depression after a mild traumatic brain injury. Notably, this study provides an unparalleled opportunity to examine the trajectory of neuropsychiatric symptoms longitudinally within-subjects. This allowed us to isolate mild traumatic brain injury-specific variance independent from pre-existing functioning. Here, we focus on a case-control comparison between 43 youth who experienced a mild traumatic brain injury between MRI visits, and 43 well-matched controls. Contrary to pre-registered predictions (https://osf.io/h5uba/), there was no statistically credible increase in depression in mild traumatic brain injury cases relative to controls. Mild traumatic brain injury was associated with subtle changes in motivational neural circuit recruitment during the anticipation of incentives on the Monetary Incentive Delay paradigm. Specifically, changes in neural recruitment appeared to reflect a failure to deactivate 'task-negative' brain regions (ventromedial prefrontal cortex), alongside blunted recruitment of 'task-positive' regions (anterior cingulate, anterior insula and caudate), during the anticipation of reward and loss in adolescents following mild brain injuries. Critically, these changes in brain activity were not correlated with depressive symptoms at either visit or depression change scores before and after the brain injury. Increased time since injury was associated with a recovery of cognitive functioning-driven primarily by processing speed differences-but depression did not scale with time since injury. These cognitive changes were also uncorrelated with neural changes after mild traumatic brain injury. This report provides evidence that acquired depression may not be observed as commonly after a mild traumatic brain injury in late childhood and early adolescence, relative to findings in adult cases. Several reasons for these differing findings are considered, including sampling enrichment in retrospective cohort studies, under-reporting of depressive symptoms in parent-report data, and neuroprotective factors in childhood and adolescence.
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Affiliation(s)
- Jeremy Hogeveen
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
- Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Ethan M Campbell
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
- Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Teagan S Mullins
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
- Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Cidney R Robertson-Benta
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
- Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Davin K Quinn
- Department of Psychiatry & Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Andrew R Mayer
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
- Department of Psychiatry & Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA
| | - James F Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
- Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM 87131, USA
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23
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Freeman E, Paul R, Dorsey M, Nigaglioni Rivera A, Reeves JA, Madden T. Demographic differences between patients selecting video or telephone for contraceptive counseling via telehealth. Contraception 2024:110699. [PMID: 39233023 DOI: 10.1016/j.contraception.2024.110699] [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: 06/27/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To explore differences in demographic characteristics and telehealth usability between patients who chose video versus telephone for telehealth contraceptive counseling. STUDY DESIGN This was a secondary analysis of a prospective cohort comparing the interpersonal quality of contraceptive counseling between in-person and telehealth visits at a single Title X-funded clinic. Before the clinical visit, a non-clinician counselor provided structured contraceptive counseling based on patients' preferred modality. After counseling, respondents completed an electronic survey which included the Telehealth Usability Questionnaire (TUQ). Post-visit, the counselor evaluated perceived patient engagement. We calculated Area Deprivation Index (ADI) percentiles to characterize neighborhood environment. We compared characteristics between patients choosing video and telephone using Poisson regression and performed analyses stratified by ADI to test for effect modification. RESULTS Between March 2021 and June 2022, we enrolled 149 patients in the telehealth group: 146 (98%) were included in the analysis. Seventy percent of respondents chose telephone. Higher ADI, Black race, and lower educational level (<4 years college) were associated with choosing telephone in the unadjusted analysis. However, after stratifying by ADI, only lower educational level remained associated with choice of telephone among respondents from more deprived neighborhoods (aRR 1.46, 95% CI 1.01-2.11). We observed no differences in TUQ scores between respondents choosing telephone and video. CONCLUSION When given the option, more patients selected telephone than video for telehealth contraceptive counseling. No demographic characteristics were associated with choice of telephone among patients with a higher ADI. Offering telephone-based telehealth may improve access for people seeking contraceptive services. IMPLICATIONS We found that telephone-based telehealth is preferable for some patients, which may reflect differences in access to or comfort with video technology. We observed that higher ADI, Black race, and lower education level were associated with choice of telephone, although not after stratifying by ADI. Utilization of telephone-based telehealth may improve access for some patients and lead to more equitable-based health care.
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Affiliation(s)
- Emily Freeman
- Divisions of Clinical Research and Complex Family Planning, Contraception, and Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States; Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Rachel Paul
- Divisions of Clinical Research and Complex Family Planning, Contraception, and Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Megan Dorsey
- Divisions of Clinical Research and Complex Family Planning, Contraception, and Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Adriana Nigaglioni Rivera
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jennifer A Reeves
- Divisions of Clinical Research and Complex Family Planning, Contraception, and Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tessa Madden
- Divisions of Clinical Research and Complex Family Planning, Contraception, and Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States; Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
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24
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Chandrashekar AS, Hymel AM, Baker CE, Martin JR, Wilson JM. Socioeconomic Indices Are Associated With Increased Resource Utilizations, but Not 90-Day Complications Following Total Hip and Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00887-8. [PMID: 39233103 DOI: 10.1016/j.arth.2024.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Socioeconomic disadvantage has been associated with negative outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The area deprivation index (ADI) and distressed communities index (DCI) are composite rankings that score socioeconomic status (SES) using patients' home addresses. The purpose of this study was to examine the association of ADI and DCI with outcomes following THA and TKA while controlling for potential confounding covariates. METHODS A series of 4,146 consecutive patients undergoing primary THA and TKA between January 2018 and May 2023 were queried from our institutional total joint registry. The 90-day medical and surgical complications and resource utilization were collected. The ADI and DCI scores were obtained for each patient, and the association between these scores and postoperative outcomes was analyzed. RESULTS The ADI and DCI were both associated with patient age, sex, race, comorbidity burden, and smoking status. After controlling for these variables, higher ADI and DCI scores were associated with increased length of stay (P = 0.003 and P = 0.008, respectively), but were not associated with the occurrence of any 90-day complication, reoperation, or revision. CONCLUSIONS The SES, as quantified by ADI and DCI, was associated with multiple known risk factors for complications following THA and TKA, but was not independently associated with complications, reoperations, or revision surgeries at 90 days postoperatively. While convenient metrics for the quantification of SES, in some populations, ADI and DCI may not be independently associated with detrimental outcomes following THA and TKA.
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Affiliation(s)
| | - Alicia M Hymel
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Courtney E Baker
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob M Wilson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Jung D, Jarrín OF, Choi JHS, Knox S, Emerson KG, Chen Z. The Role of Neighborhood Socioeconomic Status in Institutionalization of Home Health Care Patients With and Without Alzheimer's Disease and Related Dementias. J Am Med Dir Assoc 2024; 25:105170. [PMID: 39067862 DOI: 10.1016/j.jamda.2024.105170] [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: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES To assess whether neighborhood socioeconomic status (SES) moderates the association between Alzheimer's disease and related dementias (ADRD) and successful discharge to the community. In addition, to explore whether the role of neighborhood SES on successful discharge for patients with ADRD varies by the severity of ADRD. DESIGN This is a retrospective cohort study. SETTING AND PARTICIPANTS Medicare Fee-for-service beneficiaries, aged 65 or older, who received home health care in 2019. METHODS We used linear probability regression models with successful discharge to the community as the main outcome, and neighborhood SES and ADRD as independent variables. Also, we modified the Functional Assessment Staging Tool (FAST) to measure ADRD severity. RESULTS Our study results show ADRD and residing in neighborhoods with lower socioeconomic conditions were independently associated with lower probabilities of successful discharge to the community. We also found that the differences in probabilities of remaining at home between patients with and without ADRD were larger among those in neighborhoods with lower SES (ADRD∗less disadvantaged neighborhood, coeff: -0.01, P < .001; ADRD∗more disadvantaged neighborhood, coeff: -0.02, P < .001; ADRD∗most disadvantaged neighborhood, coeff: 0.032, P < .001). Among patients with ADRD, patients with the most advanced ADRD were less likely to remain in their homes and community when living in neighborhoods with lower SES. CONCLUSIONS AND IMPLICATIONS Our study results show that when patients with ADRD receiving home health care live in neighborhoods with lower SES, they face further challenges to remaining in their homes and community. Public health officials and community planners should consider using area-level interventions to improve care and health outcomes for patients with ADRD. Also, further research aimed at identifying the specific factors and resources influencing lower care quality and poorer health outcomes in socioeconomically disadvantaged neighborhoods, particularly for patients with ADRD, can provide valuable insights for the development and implementation of targeted interventions.
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Affiliation(s)
- Daniel Jung
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA.
| | - Olga F Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA; Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jeong Ha Steph Choi
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, GA, USA
| | - Sara Knox
- Department of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Kerstin Gerst Emerson
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA; Institute of Gerontology, University of Georgia, Athens, GA, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
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26
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Johnson EI, Planalp EM, Williams DT, Poehlmann J. Parental incarceration and health risks in a population-based study of U.S. early adolescents: Results among racialized groups. SSM Popul Health 2024; 27:101702. [PMID: 39184526 PMCID: PMC11342108 DOI: 10.1016/j.ssmph.2024.101702] [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: 05/03/2024] [Revised: 06/25/2024] [Accepted: 07/25/2024] [Indexed: 08/27/2024] Open
Abstract
Parental incarceration is an adverse childhood experience that inequitably burdens families of color and affects millions of U.S. children and adolescents. Although racialized disparities in exposure to parental incarceration are often acknowledged, researchers have yet to examine whether manifestations of racism may affect the link between parental incarceration and youth outcomes. This study provides a first look at how parental incarceration relates to health vulnerabilities in the Adolescent Brain Cognitive Development (ABCD) study, an ongoing, population-based study of U.S. children born between 2006 and 2008. We start by describing exposure to parental incarceration and then examine how parental incarceration, state-level racial prejudice, and discrimination relate to health risks among 9191 White (66%), Black (19%), or Hispanic (15%) youth. Consistent with what we know about pervasive racialized disparities in the U.S. criminal legal system, we find that 19.3% of Black children in our sample have experienced parental incarceration, followed by 7.8% of Hispanic children, and 4.8% of White children. Results of multilevel mixed models further indicate that parental incarceration was associated with increased health risks among White children whereas family economic hardship and discrimination experiences were more robustly associated with health vulnerabilities among Black and Hispanic children. Additional analyses explored whether parental incarceration was associated with other outcomes among Black and Hispanic children, revealing increased risk for behavior problems contingent upon parental incarceration and discrimination for Black children and Hispanic boys. Among Hispanic girls, parental incarceration was associated with increased risk of behavior problems in states with higher levels of racism. Results suggest that parental incarceration contributes to risk among early adolescents across racialized groups, but that the specific toll it takes depends on outcomes assessed and the context in which it occurs.
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Price MD, McDermott KM, An D, Aslam U, Slidell MB, Nasr IW. Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC). J Pediatr Surg 2024; 59:1865-1874. [PMID: 38705831 PMCID: PMC11309908 DOI: 10.1016/j.jpedsurg.2024.04.002] [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] [Received: 12/04/2023] [Revised: 03/20/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND National estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and identify risk factors for re-injury. METHODS The Maryland Health Services Cost Review Commission Dataset was queried for 0-19-year-old patients with emergency department or inpatient encounters for traumatic injuries between 2013 and 2019. We measured trauma recidivism by identifying patients with any subsequent presentation for a new traumatic injury. Univariate and multivariable regressions were used to estimate associations of patient and injury characteristics with any recidivism and inpatient recidivism. RESULTS Of 574,472 patients with at least one injury encounter, 29.6% experienced trauma recidivism. Age ≤2 years, public insurance, and self-inflicted injuries were associated with recidivism regardless of index treatment setting. Of those with index emergency department presentations 0.06% represented with an injury requiring inpatient admission; unique risk factors for ED-to-inpatient recidivism were age >10 years (aOR 1.61), cyclist (aOR 1.31) or burn (aOR 1.39) mechanisms, child abuse (aOR 1.27), and assault (aOR 1.43). Among patients with at least one inpatient encounter, 6.3% experienced another inpatient trauma admission, 3.4% of which were fatal. Unique risk factors for inpatient-to-inpatient recidivism were firearm (aOR 2.48) and motor vehicle/transportation (aOR 1.62) mechanisms of injury (all p < 0.05). CONCLUSIONS Pediatric trauma recidivism is more common and morbid than previously estimated, and risk factors for repeat injury differ by treatment setting. Demographic and injury characteristics may help develop and target setting-specific interventions. LEVEL OF EVIDENCE III (Retrospective Comparative Study).
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Affiliation(s)
- Matthew D Price
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Katherine M McDermott
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel An
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Usman Aslam
- Division of Trauma and Acute Care Surgery, Honorhealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Mark B Slidell
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Isam W Nasr
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Reyes A, Prabhakaran D, Banegas MP, Shih JJ, Iragui-Madoz VJ, Almane DN, Ferguson L, Jones JE, Busch RM, Hermann BP, McDonald CR. Individual- and community-level social determinants of health are associated with cognition in older adults with focal epilepsy. Epilepsy Behav 2024; 158:109927. [PMID: 38970893 DOI: 10.1016/j.yebeh.2024.109927] [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] [Received: 05/15/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Epilepsy is associated with significant health disparities, including access to specialized care and adverse outcomes that have been associated with several social determinants of health (SDOH). We sought to examine the relationship between individual- and community-level SDOH and cognitive outcomes in older adults with epilepsy. MATERIALS AND METHODS We collected clinical, SDOH, and neuropsychological data in 57 older adults with epilepsy. Individual-level SDOH included patient factors (quality of education, income, insurance, marital status) and early-life environmental factors (parental education and occupation, childhood employment). Neighborhood deprivation was measured with the Area Deprivation Index (ADI). Stepwise regressions were conducted to examine the independent contribution of individual-level SDOH to cognitive performance, and Spearman rho correlations were conducted to examine the relationship between ADI and cognitive performance. The SDOH profiles of patients who met the criteria for cognitive impairment were examined. RESULTS After controlling for clinical variables, patient factors (public health insurance, poorer quality of education) and early-life environmental factors (lower mother's education, lower father's and mother's occupational complexity, history of childhood employment) were significant predictors of lower performance on measures of global cognition, verbal learning and memory, processing speed, and executive function. Higher ADI values (greater disadvantage) were associated with lower scores on global cognitive measures, verbal learning and memory, and executive function. Patients who met criteria for cognitive impairment had, on average, a greater number of adverse SDOH, including lower household incomes and father's education, and higher ADI values compared to those who were cognitively intact. CONCLUSION We provide new evidence of the role of individual- and community-level SDOH on cognitive outcomes in older adults with epilepsy. This emerging literature highlights the need to examine SDOH beyond epilepsy-related clinical factors. These data could inform the development of interventions focused on increasing access to epilepsy care, education, and resources and promoting brain and cognitive health within the most at-risk communities.
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Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA.
| | - Divya Prabhakaran
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA
| | - Jerry J Shih
- Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
| | | | - Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Carrie R McDonald
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Jeong S, Linder BA, Barnett AM, Tharpe MA, Hutchison ZJ, Culver MN, Sanchez SO, Nichols OI, Grosicki GJ, Bunsawat K, Nasci VL, Gohar EY, Fuller-Rowell TE, Robinson AT. Interplay of race and neighborhood deprivation on resting and ambulatory blood pressure in young adults. Am J Physiol Heart Circ Physiol 2024; 327:H601-H613. [PMID: 38995211 PMCID: PMC11442101 DOI: 10.1152/ajpheart.00726.2023] [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] [Received: 11/17/2023] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
Nighttime blood pressure (BP) and BP dipping (daytime-nighttime BP) are prognostic for cardiovascular disease. When compared with other racial/ethnic groups, Black Americans exhibit elevated nighttime BP and attenuated BP dipping. Neighborhood deprivation may contribute to disparities in cardiovascular health, but its effects on resting and ambulatory BP patterns in young adults are unclear. Therefore, we examined associations between neighborhood deprivation with resting and nighttime BP and BP dipping in young Black and White adults. We recruited 19 Black and 28 White participants (23 males/24 females, 21 ± 1 yr, body mass index: 26 ± 4 kg/m2) for 24-h ambulatory BP monitoring. We assessed resting BP, nighttime BP, and BP dipping (absolute dip and nighttime:daytime BP ratio). We used the area deprivation index (ADI) to assess average neighborhood deprivation during early and mid-childhood and adolescence. When compared with White participants, Black participants exhibited higher resting systolic and diastolic BP (Ps ≤ 0.029), nighttime systolic BP (114 ± 9 vs. 108 ± 9 mmHg, P = 0.049), diastolic BP (63 ± 8 vs. 57 ± 7 mmHg, P = 0.010), and attenuated absolute systolic BP dipping (12 ± 5 vs. 9 ± 7 mmHg, P = 0.050). Black participants experienced greater average ADI scores compared with White participants [110 (10) vs. 97 (22), P = 0.002], and select ADI scores correlated with resting BP and some ambulatory BP measures. Within each race, select ADI scores correlated with some BP measures for Black participants, but there were no ADI and BP correlations for White participants. In conclusion, our findings suggest that neighborhood deprivation may contribute to higher resting BP and impaired ambulatory BP patterns in young adults warranting further investigation in larger cohorts.NEW & NOTEWORTHY We demonstrate that young Black adults exhibit higher resting blood pressure, nighttime blood pressure, and attenuated systolic blood pressure dipping compared with young White adults. Black adults were exposed to greater neighborhood deprivation, which demonstrated some associations with resting and ambulatory blood pressure. Our findings add to a growing body of literature indicating that neighborhood deprivation may contribute to increased blood pressure.
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Affiliation(s)
- Soolim Jeong
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Braxton A Linder
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Alex M Barnett
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - McKenna A Tharpe
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Zach J Hutchison
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Meral N Culver
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Sofia O Sanchez
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Olivia I Nichols
- Department of Human Development and Family Studies, Auburn University, Auburn, Alabama, United States
| | - Gregory J Grosicki
- Department of Health Sciences and Kinesiology, Biodynamics and Human Performance Center, Georgia Southern University (Armstrong Campus), Savannah, Georgia, United States
| | - Kanokwan Bunsawat
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
- George E. Wahlen Department of Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, United States
| | - Victoria L Nasci
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Eman Y Gohar
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Studies, Auburn University, Auburn, Alabama, United States
| | - Austin T Robinson
- School of Kinesiology, Auburn University, Auburn, Alabama, United States
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana, United States
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Gordon AM, Ng MK, Elali F, Piuzzi NS, Mont MA. A Nationwide Analysis of the Impact of Socioeconomic Status on Complications and Health Care Utilizations After Total Knee Arthroplasty Using the Area Deprivation Index: Consideration of the Disadvantaged Patient. J Arthroplasty 2024; 39:2166-2172. [PMID: 38615971 DOI: 10.1016/j.arth.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Socioeconomic status has been demonstrated to be an important prognostic risk factor among patients undergoing total joint arthroplasty. We evaluated patients living near neighborhoods with higher socioeconomic risk undergoing total knee arthroplasty (TKA) and if they were associated with differences in the following: (1) medical complications; (2) emergency department (ED) utilizations; (3) readmissions; and (4) costs of care. METHODS A query of a national database from 2010 to 2020 was performed for primary TKAs. The Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. Higher numbers indicate a greater disadvantage. Patients undergoing TKA in zip codes associated with high ADI (90%+) were 1:1 propensity-matched to a comparison group by age, sex, and Elixhauser Comorbidity Index. This yielded 225,038 total patients, evenly matched between cohorts. Outcomes studied included complications, ED utilizations, readmission rates, and 90-day costs. Logistic regression models computed the odds ratios (OR) of ADI on the dependent variables. P values less than .003 were significant. RESULTS High ADI led to higher rates and odds of any medical complications (11.7 versus 11.0%; OR: 1.05, P = .0006), respiratory failures (0.4 versus 0.3%; OR: 1.28, P = .001), and acute kidney injuries (1.7 versus 1.5%; OR: 1.15, P < .0001). Despite lower readmission rates (2.9 versus 3.5%), high ADI patients had greater 90-day ED visits (4.2 versus 4.0%; OR: 1.07, P = .0008). The 90-day expenditures ($15,066 versus $12,459; P < .0001) were higher in patients who have a high ADI. CONCLUSIONS Socioeconomically disadvantaged patients have increased complications and ED utilizations. Neighborhood disadvantage may inform health care policy and improve postdischarge care. The socioeconomic status metrics, including ADI (which captures community effects), should be used to adequately risk-adjust or risk-stratify patients so that access to care for deprived regions and patients is not lost. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adam M Gordon
- Questrom School of Business, Boston University, Boston, Massachusetts; Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Faisal Elali
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Mont
- Rubin Institute of Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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31
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Garg S, Sweet N, Boderman B, Montes D, Walunas T, Ramsey-Goldman R, Khosroshahi A, Astor BC, Sam Lim S, Bartels CM. Multiplicative Impact of Adverse Social Determinants of Health on Outcomes in Lupus Nephritis: A Meta-analysis and Systematic Review. Arthritis Care Res (Hoboken) 2024; 76:1232-1245. [PMID: 38693617 PMCID: PMC11349475 DOI: 10.1002/acr.25359] [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: 02/02/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Social determinants of health (SDoH) likely contribute to outcome disparities in lupus nephritis (LN). Understanding the overall burden and contribution of each domain could guide future health equity-focused interventions to improve outcomes and reduce disparities in LN. Objectives of this meta-analysis were to 1) determine the association of overall SDoH and specific SDoH domains on LN outcomes and 2) develop a framework for the multidimensional impact of SDoH on LN outcomes. METHODS We performed a comprehensive search of studies measuring associations between SDoH and LN outcomes. We examined pooled odds of poor LN outcomes including death, end-stage kidney disease, or cardiovascular disease in patients with and without adverse SDoH. Additionally, we calculated the pooled odds ratios of outcomes by four SDoH domains: individual (eg, insurance), health care (eg, fragmented care), community (eg, neighborhood socioeconomic status), and health behaviors (eg, smoking). RESULTS Among 531 screened studies, 31 meeting inclusion criteria and 13 with raw data were included in meta-analysis. Pooled odds of poor outcomes were 1.47-fold higher in patients with any adverse SDoH. Patients with adverse SDoH in individual and health care domains had 1.64-fold and 1.77-fold higher odds of poor outcomes. We found a multiplicative impact of having two or more adverse SDoH on LN outcomes. Black patients with public insurance and fragmented care had 12-fold higher odds of poor LN outcomes. CONCLUSION Adverse SDoH is associated with poor LN outcomes. Having two or more adverse SDoH, specifically in different SDoH domains, had a multiplicative impact leading to worse LN outcomes, widening disparities.
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Affiliation(s)
- Shivani Garg
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nadia Sweet
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, USA
| | - Brianna Boderman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, USA
| | | | | | | | | | - Brad C. Astor
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Christie M. Bartels
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Michael C, Taxali A, Angstadt M, Kardan O, Weigard A, Molloy MF, McCurry KL, Hyde LW, Heitzeg MM, Sripada C. Socioeconomic resources in youth are linked to divergent patterns of network integration/segregation across the brain's transmodal axis. PNAS NEXUS 2024; 3:pgae412. [PMID: 39323982 PMCID: PMC11423146 DOI: 10.1093/pnasnexus/pgae412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 08/07/2024] [Indexed: 09/27/2024]
Abstract
Socioeconomic resources (SER) calibrate the developing brain to the current context, which can confer or attenuate risk for psychopathology across the lifespan. Recent multivariate work indicates that SER levels powerfully relate to intrinsic functional connectivity patterns across the entire brain. Nevertheless, the neuroscientific meaning of these widespread neural differences remains poorly understood, despite its translational promise for early risk identification, targeted intervention, and policy reform. In the present study, we leverage graph theory to precisely characterize multivariate and univariate associations between SER across household and neighborhood contexts and the intrinsic functional architecture of brain regions in 5,821 youth (9-10 years) from the Adolescent Brain Cognitive Development Study. First, we establish that decomposing the brain into profiles of integration and segregation captures more than half of the multivariate association between SER and functional connectivity with greater parsimony (100-fold reduction in number of features) and interpretability. Second, we show that the topological effects of SER are not uniform across the brain; rather, higher SER levels are associated with greater integration of somatomotor and subcortical systems, but greater segregation of default mode, orbitofrontal, and cerebellar systems. Finally, we demonstrate that topological associations with SER are spatially patterned along the unimodal-transmodal gradient of brain organization. These findings provide critical interpretive context for the established and widespread associations between SER and brain organization. This study highlights both higher-order and somatomotor networks that are differentially implicated in environmental stress, disadvantage, and opportunity in youth.
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Affiliation(s)
- Cleanthis Michael
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Aman Taxali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mike Angstadt
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Omid Kardan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alexander Weigard
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - M Fiona Molloy
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Luke W Hyde
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
- Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chandra Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
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Mormer ER, Berkeley SBJ, Johnson AM, Ressel K, Zhang S, Pastva AM, Bushnell CD, Duncan P, Freburger JK. Social Determinants of Health and the Use of Community-Based Rehabilitation Following Stroke: Methodologic Considerations. Arch Rehabil Res Clin Transl 2024; 6:100358. [PMID: 39372247 PMCID: PMC11447761 DOI: 10.1016/j.arrct.2024.100358] [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] [Indexed: 10/08/2024] Open
Abstract
Social determinants are nonmedical factors frequently used to study disparities in health outcomes but have not been widely explored in regard to rehabilitation service utilization. In our National Institutes of Child Health and Human Development-funded study, Access to and Effectiveness of Community-Based Rehabilitation After Stroke, we reviewed several conceptual models and frameworks for the study of social determinants to inform our work. The overall objective of this special communication is to describe our approach to identifying, selecting, and using area-level measures of social determinants to explore the relationship between social determinants and rehabilitation use. We present our methods for developing a conceptual model and a methodologic framework for the selection of social determinant measures relevant to rehabilitation use, as well as an overview of publicly available data on social determinants. We then discuss the methodologic challenges encountered and future directions for this work.
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Affiliation(s)
- Elizabeth R. Mormer
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara B. Jones Berkeley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M. Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristin Ressel
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shuqi Zhang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy M. Pastva
- Department of Orthopaedic Surgery, Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Abbatemarco JR, Aboseif A, Swetlik C, Widmar J, Harvey T, Kunchok A, O'Mahony J, Miller DM, Conway DS. Neighborhood disadvantage, race, and clinical outcomes in neuromyelitis optica spectrum disorder. Mult Scler 2024; 30:1322-1330. [PMID: 39105475 DOI: 10.1177/13524585241267231] [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] [Indexed: 08/07/2024]
Abstract
BACKGROUND Little is known about the relationship between neighborhood disadvantage and neuromyelitis optica spectrum disorder (NMOSD) outcomes. OBJECTIVE The objective is to determine the impact of neighborhood disadvantage on time from symptom onset to diagnosis and annualized relapse rate (ARR). METHODS Neighborhood disadvantage were captured with the Area Deprivation Index (ADI), a validated measure of neighborhood-level disadvantage. Negative binomial regression models assessed the impact of ADI on diagnostic delay (⩾3 months between symptom onset and diagnosis) and ARR. RESULTS A total of 158 NMOSD patients were identified, a majority of whom were White (56.3%) and female (89.9%) with a mean age of 46 years at diagnosis. The ADI did not significantly affect odds of diagnostic delay (odds ratio (OR) = 0.99, p = 0.26). In univariable models, the ADI was not significantly associated with ARR (OR = 1.004, p = 0.29), but non-White race (OR = 1.541, p = 0.02) and time on immunosuppressive therapies (ISTs; OR = 0.994, p = 0.03) were. White patients used IST for an average of 81% of the follow-up period, compared to an average of 65% for non-White patients (p < 0.01). CONCLUSION No significant relationship between neighborhood-level disadvantage and diagnostic delay or ARR in NMOSD patients was observed. Non-White patients had a higher ARR, which may be related to less IST use.
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Affiliation(s)
- J R Abbatemarco
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A Aboseif
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - C Swetlik
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - J Widmar
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - T Harvey
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A Kunchok
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - J O'Mahony
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Miller
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D S Conway
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
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Gill TM, Becher RD, Leo-Summers L, Gahbauer EA. Changes in neighborhood disadvantage over the course of 22 years among community-living older persons. J Am Geriatr Soc 2024. [PMID: 39206716 DOI: 10.1111/jgs.19172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Among older persons, neighborhood disadvantage is a granular and increasingly used social determinant of health and functional well-being. The frequency of transitions into or out of a disadvantaged neighborhood over time is not known. These transitions may occur when a person moves from one location to another or when the Neighborhood Atlas, the data source for the area deprivation index (ADI) that is used to identify disadvantaged neighborhoods at the census-block level, is updated. METHODS From a prospective longitudinal study of community-living persons, aged 70 years or older in South Central Connecticut, neighborhood disadvantage was ascertained every 18 months for 22 years (from March 1998 to March 2020). ADI scores higher than the 80th state percentile were used to distinguish neighborhoods that were disadvantaged (81-100) from those that were not (1-80). RESULTS At baseline, 205 (29.3%) of the 699 participants were living in a disadvantaged neighborhood. Changes in neighborhood disadvantage during 14 consecutive 18-month intervals were relatively uncommon, ranging from 1.5% to 11.8%. Nearly 80% of participants had no change in neighborhood disadvantage and less than 4% had more than one change over a median follow-up of more than 9 years. Overall, the rate of transitions into or out of neighborhood disadvantage was only 2.7 per 100 person-years. These transitions were most common when the Neighborhood Atlas was updated (2013, 2015, 2018, and 2020). Comparable results were observed when decile changes in ADI scores during the 18-month intervals were evaluated. CONCLUSIONS In longitudinal studies of older persons with extended follow-up, it may not be necessary to update information on disadvantaged neighborhoods in circumstances when it is possible, and the degree of misclassification of neighborhood disadvantage should be relatively low in circumstances when updated information cannot be obtained.
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Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert D Becher
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Linda Leo-Summers
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Evelyne A Gahbauer
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Ku B, Yuan Q, Christensen GM, Dimitrov L, Risk B, Huels A. Exposure profiles of social-environmental neighborhood factors and psychotic-like experiences. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.21.24312315. [PMID: 39228699 PMCID: PMC11370530 DOI: 10.1101/2024.08.21.24312315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Importance Recent research has demonstrated that domains of social determinants of health (SDOH) (e.g., air pollution and social context) are associated with psychosis. However, SDOHs have often been studied in isolation. Objective To identify distinct exposure profiles, estimate their associations with persistent distressing psychotic-like experiences (PLE), and evaluate whether involvement with physical activities partially explains this association. Design Setting and Participants This population-based study used data from the Adolescent Brain and Cognitive Development (ABCD) Study. Participants were recruited from 22 US sites between September 2016 and January 2022. Data from baseline and three follow-ups were included. Exposures Area-level geocoded variables spanning various domains of SDOH, including socioeconomic status (SES), education, crime, built environment, social context, and crime, were clustered using a self-organizing map method to identify exposure profiles. Main Outcomes and Measures Persistent distressing PLE was derived from the Prodromal Questionnaire-Brief Child Version across four years. Generalized linear mixed modeling tested the association between exposure profiles and persistent distressing PLE as well as physical activities (i.e., team and individual sports), adjusting for individual-level covariates including age, sex, race/ethnicity, highest level of parent education, family-relatedness, and study sites. Results Among 8,145 participants (baseline mean [SD] age, 9.92 [0.63] years; 3,868 (47.5%) females; 5,566 (68.3%) White, 956 (11.7%) Black, 159 (2.0%) Asian, and 1,480 (18.4%) Hispanic participants), five exposure profiles were identified. Compared to the reference Profile 1 (suburban affluent areas, 2521 children, 30.9%), Profile 3 (rural areas with low walkability and high ozone; 1459 children, 17.9%; adjusted OR: 1.34, 95% CI: 1.09-1.64) and Profile 4 (urban areas with high SES deprivation, high crime, and high pollution; 715 children, 8.8%; adjusted OR: 1.40, 95% CI: 1.08-1.81), were associated with persistent distressing PLE. Team sports mediated 6.14% of the association for Profile 3. Conclusion and Relevance This study found that neighborhoods characterized by rural areas with low walkability and urban areas with high socioeconomic deprivation, air pollutants, and crime were associated with persistent distressing PLE. Further research is needed to explore the pathways through which different environmental factors may impact the development of psychosis.
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Goldberg ZN, Jain A, Wu R, Cognetti DM, Goldman RA. Social Determinants of Health Impact Complications Following Free-Flap Reconstruction for Head and Neck Cancer. Otolaryngol Head Neck Surg 2024. [PMID: 39189141 DOI: 10.1002/ohn.953] [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: 11/25/2023] [Revised: 08/01/2024] [Accepted: 08/10/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE Head and neck cancers (HNCs) have increased in prevalence and often require free-flap reconstruction (FFR) after tumor ablation. Postoperative complications following FFR can be high, occurring in as many as 48% and 71% of cases. HNC patients also have many disparities in Social Determinants of Health (SDOH), but the potential impact of SDOH disparities on postoperative complications following FFR has not been formally assessed. STUDY DESIGN Retrospective cohort review. SETTING Academic Tertiary Care Institution in Northeast United States. METHODS Patients that underwent head and neck FFR between January 2018 and December 2021 were analyzed to determine associations between quartiles of the national Area Deprivation Index (ADI), a proxy for SDOH disparity, and various medical and surgical postoperative complications. Associations were assessed using χ2 analysis. RESULTS Two hundred four patients were included in the study, and 61 patients had 97 complications. Significant associations between higher national ADI quartile and incidence of several postoperative complications were identified, including any surgical complication (P = .0419), wound dehiscence (P = .0494), myocardial infarction (MI) (P = .0215), and sepsis (P = .0464). CONCLUSION There are significant associations between SDOH disparities and postoperative surgical complications, wound dehiscence, MI, and sepsis following head and neck FFR. Addressing SDOH disparities in HNC is pivotal to enhance postoperative outcomes and promote holistic patient care.
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Affiliation(s)
- Zachary N Goldberg
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amiti Jain
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richard Wu
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Richard A Goldman
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Lipska KJ, Oladele C, Zawack K, Gulanski B, Mutalik P, Reaven P, Lynch JA, Lee KM, Shih MC, Lee JS, Aslan M. Association of Race and Ethnicity with Prescriptions for Continuous Glucose Monitoring Systems Among a National Sample of Veterans with Diabetes on Insulin Therapy. Diabetes Technol Ther 2024. [PMID: 39177775 DOI: 10.1089/dia.2024.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Introduction and Objective: Continuous glucose monitoring (CGM) can improve glycemic control in people with diabetes on insulin therapy. We assessed rates of prescriptions for CGM in a national sample of Veterans across subgroups defined by race and ethnicity. Methods: This cross-sectional analysis of data from the U.S. Veterans Health Administration included adults with type 1 or type 2 diabetes on insulin therapy. Main exposures included self-reported race and ethnicity, and primary outcome was the percentage of patients with at least one CGM prescription between January 1, 2020, and December 31, 2021. Association of race and ethnicity categories with CGM prescription was examined using multilevel, multivariable mixed-effects models. Results: Among 368,794 patients on insulin (mean age, 68.5 years; 96% male; 96.8% type 2 diabetes; 0.8% American Indian or Alaska Native, 0.7% Asian, 18.9% Black or African American, 0.9% Native Hawaiian or other Pacific Islander, 70.2% White, 2.8% multiracial, 5.7% with unknown race, and 7.0% Hispanic or Latino ethnicity), 11.2% were prescribed CGM. CGM was prescribed for 10.4% American Indian or Alaska Native, 9.7% Asian, 9.2% Black or African American, 9.3% Native Hawaiian or other Pacific Islander, 11.8% White, 11.8% multiracial, and 10.1% patients with unknown race. CGM was prescribed for 8.3% Hispanic or Latino, 11.4% non-Hispanic, and 11.5% of patients with unknown ethnicity. After accounting for patient-, clinical-, and system-level factors, Black or African American patients had significantly lower odds of CGM prescription compared with White patients (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.59-0.64), whereas Hispanic or Latino patients had significantly lower odds compared with non-Hispanic patients (aOR 0.79, 95% CI 0.74-0.84). Findings were consistent across subgroups with clinical indications for CGM use. Conclusions: Among Veterans with diabetes on insulin therapy, there were significant disparities in prescribing of CGM technology by race and ethnicity, which require further study and intervention.
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Affiliation(s)
- Kasia J Lipska
- Department of Medicine, Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Carol Oladele
- Equity Research and Innovation Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kelson Zawack
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Barbara Gulanski
- Department of Medicine, Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Pradeep Mutalik
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peter Reaven
- Phoenix VA Healthcare System, Phoenix, Arizona, USA
| | - Julie A Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kyung Min Lee
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Mei-Chiung Shih
- VA Palo Alto Heath Care System, VA Palo Alto Cooperative Studies Program Coordinating Center, California, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer S Lee
- VA Palo Alto Heath Care System, VA Palo Alto Cooperative Studies Program Coordinating Center, California, USA
- Division of Endocrinology, Gerontology, and Metabolism, Endocrinology Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mihaela Aslan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Lusk JB, Blass B, Mahoney H, Hoffman MN, Clark AG, Bae J, Mentz RJ, Wang TY, Patel M, Hammill BG. Neighborhood Socioeconomic Disadvantage and 30-Day Outcomes for Common Cardiovascular Conditions. J Am Heart Assoc 2024; 13:e036265. [PMID: 39119993 DOI: 10.1161/jaha.124.036265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/14/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Understanding the relationship between neighborhood environment and cardiovascular outcomes is important to achieve health equity and implement effective quality strategies. We conducted a population-based cohort study to determine the association of neighborhood socioeconomic deprivation and 30-day mortality and readmission rate for patients admitted with common cardiovascular conditions. METHODS AND RESULTS We examined claims data from fee-for-service Medicare beneficiaries aged ≥65 years between 2017 and 2019 admitted for heart failure, valvular heart disease, ischemic heart disease, or cardiac arrhythmias. The primary exposure was the Area Deprivation Index; outcomes were 30-day all-cause death and unplanned readmission. More than 2 million admissions were included. After sequential adjustment for patient characteristics (demographics, dual eligibility, comorbidities), area health care resources (primary care clinicians, specialists, and hospital beds per capita), and admitting hospital characteristics (ownership, size, teaching status), there was a dose-dependent association between neighborhood socioeconomic deprivation and 30-day mortality rate for all conditions. In the fully adjusted model for death, estimated effect sizes of residence in the most disadvantaged versus least disadvantaged neighborhoods ranged from adjusted odds ratio 1.29 (95% CI, 1.22-1.36) for the heart failure group to adjusted odds ratio 1.63 (95% CI, 1.36-1.95) for the valvular heart disease group. Neighborhood deprivation was associated with increased adjusted 30-day readmission rates, with estimated effect sizes from adjusted odds ratio 1.09 (95% CI, 1.05-1.14) for heart failure to adjusted odds ratio 1.19 (95% CI, 1.13-1.26) for arrhythmia. CONCLUSIONS Neighborhood socioeconomic disadvantage was associated with 30-day mortality rate and readmission for patients admitted with common cardiovascular conditions independent of individual demographics, socioeconomic status, medical risk, care access, or admitting hospital characteristics.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine Durham NC USA
- Duke University Fuqua School of Business Durham NC USA
| | - Beau Blass
- Duke University School of Medicine Durham NC USA
| | - Hannah Mahoney
- Duke University Department of Population Health Sciences Durham NC USA
| | - Molly N Hoffman
- Duke University Department of Population Health Sciences Durham NC USA
| | - Amy G Clark
- Duke University Department of Population Health Sciences Durham NC USA
| | - Jonathan Bae
- Duke University Health System Durham NC USA
- Division of Cardiology Duke University Department of Medicine Durham NC USA
| | - Robert J Mentz
- Division of Cardiology Duke University Department of Medicine Durham NC USA
| | - Tracy Y Wang
- Patient Centered Outcomes Research Institute Durham NC USA
| | - Manesh Patel
- Division of Cardiology Duke University Department of Medicine Durham NC USA
| | - Bradley G Hammill
- Duke University School of Medicine Durham NC USA
- Duke University Department of Population Health Sciences Durham NC USA
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Yanez B, Perry LM, Peipert JD, Kuharic M, Taub C, Garcia SF, Diaz A, Buitrago D, Mai Q, Gharzai LA, Cella D, Kircher SM. Exploring the Relationship Among Financial Hardship, Anxiety, and Depression in Patients With Cancer: A Longitudinal Study. JCO Oncol Pract 2024:OP2400025. [PMID: 39146505 DOI: 10.1200/op.24.00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/04/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024] Open
Abstract
PURPOSE Financial hardship (FH) is a complex issue in cancer care, affecting material conditions, well-being, and coping behaviors. This study aimed to longitudinally examine FH, anxiety, depressive symptoms, and their associations while incorporating social determinants of health and health care cost covariates in a sample of patients diagnosed with cancer. METHODS This prospective, longitudinal cohort study analyzed data from 2,305 participants from the Northwestern University Improving the Management of Symptoms during and following Cancer Treatment trial. Outcomes assessed at baseline and at 3, 6, 9, and 12 months postbaseline included depressive symptoms, anxiety, and FH. Analysis involved random intercept cross-lagged panel models to explore between- and within-person effects, incorporating factors such as age, sex, insurance status, neighborhood area deprivation, health care charges, out-of-pocket costs, and health literacy. RESULTS The cohort had a mean age of 60.7 (standard deviation [SD] = 12.7) years and was mostly female (64.9%) and White (86.2%). Correlations were found between FH and depressive symptoms (r = 0.310) and anxiety (r = 0.289). A predictive relationship was observed between FH and depressive symptoms, with baseline and 6-month depressive symptom levels predicting later FH (baseline β = .079, P = .070; 6-month β = .072, P = .081) and 9-month FH significantly predicting 12-month depressive symptoms (β = .083, P = .025), even after accounting for health care charges and out-of-pocket costs. Baseline and 9-month anxiety showed a predictive relationship with subsequent FH (baseline β = .097, P = .023; 9-month β = .071, P = .068). CONCLUSION FH emerged as a prominent issue, with nearly half of participants experiencing some level of FH. Depressive symptoms and anxiety were related to FH. These findings underscore the need for a comprehensive approach in cancer care that concurrently addresses anxiety, depressive symptoms, and FH, recognizing their interconnected impact.
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Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Laura M Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Health Outcomes, Implementation, and Community-Engaged Science, Tulane University School of Medicine, New Orleans, LA
- Louisiana Cancer Research Center, New Orleans, LA
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maja Kuharic
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL
| | - Chloe Taub
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alma Diaz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Quan Mai
- The Enterprise Data Warehouse (EDW), Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Laila A Gharzai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sheetal M Kircher
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Botticello AL, Murphy L, Charlifue S, Chen Y, Corrigan J, Driver S, Eagye CB, Wilroy J, Lequerica A. Development of Composite Measures of Neighborhood Economic Factors for Use in Spinal Cord Injury Outcomes Studies: A Spinal Cord Injury Model Systems Database Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01115-8. [PMID: 39151747 DOI: 10.1016/j.apmr.2024.06.018] [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: 04/04/2024] [Revised: 06/02/2024] [Accepted: 06/18/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To develop composite measures of neighborhood economic factors for use with the national Spinal Cord Injury Model Systems (SCIMSs) database in cross-sectional and longitudinal investigations of the social determinants of health. DESIGN Secondary data analysis of administrative data from the 2009, 2014, and 2019 American Community Survey (ACS) 5-year estimates and survey data collected for the SCIMS database. SETTING Community. PARTICIPANTS The validity of the neighborhood economic measures developed from the ACS data was tested with a sample of SCIMS participants who completed a follow-up interview between 2017 and 2021 (N=8,130). The predictive validity of the neighborhood measures was assessed with a subsample of cases with complete data on the outcome and covariate measures (N=6,457). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A binary measure of self-rated health status (1=poor/fair health; 0=good/very good/excellent). RESULTS A combination of panel review and data reduction techniques yielded 2 distinct measuring neighborhood socioeconomic status (SES) and neighborhood socioeconomic disadvantage that were validated using 3 waves of ACS data and the SCIMS data. The odds of reporting poor health were lower among people living in moderate- and high-SES neighborhoods and highest among people living in moderately and highly disadvantaged neighborhoods. The negative association between neighborhood SES and poor health was fully attenuated by differences in participants' individual demographic and economic characteristics whereas the positive association between neighborhood disadvantage and poor health persisted after adjusting for individual differences. CONCLUSIONS The two composite measures of neighborhood economic factors developed by this study are robust in samples from different periods of time and valid for use with the SCIMS database. Future investigations conducting surveillance of the needs of the SCI population using this resource may consider using these measures to assess the effect of the social determinants of health in outcomes after SCI.
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Affiliation(s)
- Amanda L Botticello
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, NJ.
| | - Lauren Murphy
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, NJ
| | | | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, AL
| | - John Corrigan
- Department of Physical Medicine and Rehabilitation, College of Medicine, The Ohio State University, Columbus, OH
| | - Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, TX
| | - C B Eagye
- Research Department, Craig Hospital, Englewood, CO
| | - Jereme Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, AL
| | - Anthony Lequerica
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, NJ; Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ
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Hendele JB, Nichols JT, Vutien P, Perkins JD, Reyes J, Dick AAS. A retrospective cohort study of socioeconomic deprivation and post-liver transplant survival in adults. Liver Transpl 2024; 30:816-825. [PMID: 38289266 DOI: 10.1097/lvt.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/12/2024] [Indexed: 05/08/2024]
Abstract
The Area Deprivation Index is a granular measure of neighborhood socioeconomic deprivation. The relationship between neighborhood socioeconomic deprivation and recipient survival following liver transplantation (LT) is unclear. To investigate this, the authors performed a retrospective cohort study of adults who underwent LT at the University of Washington Medical Center from January 1, 2004, to December 31, 2020. The primary exposure was a degree of neighborhood socioeconomic deprivation as determined by the Area Deprivation Index score. The primary outcome was posttransplant recipient mortality. In a multivariable Cox proportional analysis, LT recipients from high-deprivation areas had a higher risk of mortality than those from low-deprivation areas (HR: 1.81; 95% CI: 1.03-3.18, p =0.04). Notably, the difference in mortality between area deprivation groups did not become statistically significant until 6 years after transplantation. In summary, LT recipients experiencing high socioeconomic deprivation tended to have worse posttransplant survival. Further research is needed to elucidate the extent to which neighborhood socioeconomic deprivation contributes to mortality risk and identify effective measures to improve survival in more socioeconomically disadvantaged LT recipients.
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Affiliation(s)
- James B Hendele
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Jordan T Nichols
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Philip Vutien
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - James D Perkins
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Jorge Reyes
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - André A S Dick
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
- Department of Surgery, Division of Transplant Surgery, University of Washington, Section of Pediatric Transplant Surgery, Seattle Children's Hospital, Seattle, Washington, USA
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Moura SP, McLaughlin MT, Gowda M, Shaffrey EC, Edalatpour A, Chu DY, Michelotti BF. The Impact of Neighborhood and Socioeconomic Disparities on Distal Radius Fracture Follow-Up Adherence. Plast Reconstr Surg 2024; 154:306e-316e. [PMID: 37566490 DOI: 10.1097/prs.0000000000010984] [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] [Indexed: 08/13/2023]
Abstract
BACKGROUND The aims of this retrospective cohort study were (1) to assess whether the Area Deprivation Index (ADI), a novel neighborhood-level socioeconomic disparities metric, is associated with follow-up nonadherence, and (2) to determine the individual-level socioeconomic factors associated with follow-up nonadherence after treatment of distal radius fractures (DRFs). METHODS The authors included all patients who underwent nonoperative or operative management of DRFs at an academic level I trauma center between 2019 and 2021. A manual chart review was performed to collect data on ADI, sociodemographic factors, injury characteristics, conservative and surgical interventions, and health care utilization. RESULTS There was a significant weak negative Spearman-ranked correlation between ADI state deciles and clinic attendance rates ( rs [220] = -0.144 [95% CI, -0.274 to -0.009]; P = 0.032). Socioeconomic factors associated with significant differences in clinic attendance rates were having a spouse or partner (protective) ( P = 0.007), Medicaid insurance ( P = 0.013), male sex ( P = 0.023), and current smoking ( P = 0.026). Factors associated with differences in no-show rates were having a spouse or partner (odds ratio [OR], 0.326 [95% CI, 0.123 to 0.867]; P = 0.025), Medicaid insurance (OR, 7.78 [95% CI, 2.15 to 28.2]; P = 0.002), male sex (OR, 4.09 [95% CI, 1.72 to 9.74]; P = 0.001), and cigarette use (OR, 5.07 [95% CI, 1.65 to 15.6]; P = 0.005). CONCLUSIONS ADI has a weak, negative correlation with clinic attendance rates after DRF treatment. Significant disparities in clinic follow-up adherence exist between patients on the basis of marital status, insurance, sex, and cigarette use. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Steven P Moura
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
- Boston University School of Medicine
| | - Matthew T McLaughlin
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Madhu Gowda
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Ellen C Shaffrey
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Armin Edalatpour
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Daniel Y Chu
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Brett F Michelotti
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
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Bartels CM, Chen Y, Powell WR, Rosenkranz MA, Bendlin BB, Kramer J, Busse WW, Kind A. Alzheimer incidence and prevalence with and without asthma: A Medicare cohort study. J Allergy Clin Immunol 2024; 154:498-502.e1. [PMID: 38670235 PMCID: PMC11305945 DOI: 10.1016/j.jaci.2024.04.008] [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: 09/26/2023] [Revised: 03/22/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND International data suggest that asthma, like other inflammatory diseases, might increase Alzheimer disease (AD) risk. OBJECTIVE We sought to explore risk pathways and future mitigation strategies by comparing diagnostic claims-based AD incidence and prevalence among US patients with asthma with those without asthma. METHODS This cohort study included a national Medicare 20% random sample (2013-2015). Adult patients with asthma with more than 12 months continuous Medicare were compared with subjects without asthma overall and as matched. Asthma was defined by 1 inpatient or 2 outpatient codes for asthma. The main outcomes were 2-year incident or prevalent AD defined by International Classification of Diseases, Ninth Revision code 331.0 or Tenth Revision code G30.0, G30.1, G30.8, or G30.9. RESULTS Among 5,460,732 total beneficiaries, 678,730 patients were identified with baseline asthma and more often identified as Black or Hispanic, were Medicaid eligible, or resided in a highly disadvantaged neighborhood than those without asthma. Two-year incidence of AD was 1.4% with asthma versus 1.1% without asthma; prevalence was 7.8% versus 5.4% (both P ≤ .001). Per 100,000 patients over 2 years, 303 more incident AD diagnoses occurred in those with asthma, with 2,425 more prevalent cases (P < .001). Multivariable models showed that asthma had greater odds of 2-year AD incidence (adjusted odds ratio, 1.33 [95% CI, 1.29-1.36]; matched 1.2 [95% CI, 1.17-1.24]) and prevalence (adjusted odds ratio, 1.48 [95% CI, 1.47-1.50]; matched 1.25 [95% CI, 1.22-1.27]). CONCLUSIONS Asthma was associated with 20% to 33% increased 2-year incidence and 25% to 48% increased prevalence of claims-based AD in this nationally representative US sample. Future research should investigate risk pathways of underlying comorbidities and social determinants as well as whether there are potential asthma treatments that may preserve brain health.
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Affiliation(s)
- Christie M Bartels
- Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Yi Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - W Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Melissa A Rosenkranz
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Center for Healthy Minds, University of Wisconsin-Madison, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Barbara B Bendlin
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Joseph Kramer
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - William W Busse
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Amy Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Connery AK, Lee AH, Peterson RL, Dichiaro M, Chiesa A. Caregiver report of social-emotional functioning in infants and young children after inflicted traumatic brain injury. Child Neuropsychol 2024; 30:954-966. [PMID: 38214531 DOI: 10.1080/09297049.2024.2302684] [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: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
Social-emotional difficulties are common sequelae of traumatic brain injury (TBI). Children who have experienced inflicted TBI (iTBI) may be at increased risk for social-emotional problems due to the risk factors associated with both early neurologic injury and with child maltreatment. We characterized the associations among injury severity, caregiver type (i.e., biological parents, non-kinship, kinship), and child social-emotional functioning in 41 infants and young children who had sustained iTBI and were seen in a large, regional children's hospital. This study was a retrospective analysis, utilizing data collected from the medical record as part of routine clinical care. Social-emotional functioning was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition. Children with more severe injuries were rated as having worse social-emotional functioning. Caregiver type was associated with child social-emotional scores, above and beyond injury and demographic predictors. Biological parents were more likely to report better social-emotional skills than non-kinship caregivers, with the pattern of results suggesting that rater bias plays a role in this difference. In order to ensure that children are accurately identified for supports, these relationships should be considered when interpreting caregiver report of social-emotional skills.
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Affiliation(s)
- Amy K Connery
- Department of Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela H Lee
- Department of Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Robin L Peterson
- Department of Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mike Dichiaro
- Department of Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Antonia Chiesa
- Department of Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Aijaz A, Hao Z, Tran TGN, Anderson D, Shah J, Sadigh G. Sociodemographic Factors Associated with Outpatient Radiology No-shows Versus Cancellations. Acad Radiol 2024; 31:3406-3414. [PMID: 38705764 DOI: 10.1016/j.acra.2024.04.020] [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: 03/02/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024]
Abstract
RATIONALE AND OBJECTIVES To assess prevalence of missed outpatient radiology appointments and sociodemographic factors associated with no-shows vs. cancellations. METHODS Adults with outpatient radiology appointments in 2022 and January 2023 at a single tertiary academic health center were included. Generalized estimating equation regression was used to evaluate sociodemographic factors associated with missed vs. completed appointments, no-shows vs. cancellations and time interval between cancellations and appointments. RESULTS 19,262 (24.3%) examinations were either a cancellation (22.3%) or no-show (2.0%) among 9713 patients (mean age 60.8 ± 15.5; 67.1% female, 63.9% White, 20.0% Asian, 22.0% Hispanics). Among cancellations, 70.19% were patient-initiated. Age ≥ 65 significantly decreased the probability of missed appointments by 5.4% point (pp) (95% CI: 3.7-7.2) or no-shows (4.2 pp; 95% CI, 1.4-6.9), while being single increased probability of missed appointments (2.2 pp; 95% CI, 1.2-3.1) or no-shows (2.6 pp; 95% CI, 1.2-4.1). Those uninsured or with public insurance were 1.3-4.9 pp more likely to miss appointments than commercial insurance, and 2.2-7.6 pp more likely to have no-shows than cancellations. Living in disadvantaged neighborhoods 4.9 pp (95% CI, 3.9-6.0) increased likelihood of missing appointment and was associated with shorter time interval between cancellation and appointment. English speakers were 2.2 pp (95% CI, 1.1-3.3) more likely to miss their exam, while 2.7 pp (95% CI, 1.1-0.4.3) less likely to be a no-show than cancellation. CONCLUSION Cancellations represented a significant portion of missed appointments. Specific sociodemographic subgroups exhibited higher tendencies for having missed appointments and no-shows.
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Affiliation(s)
- Arham Aijaz
- Department of Radiological Sciences, University of California, Irvine, California, 92677, USA
| | - Zuxian Hao
- Department of Radiological Sciences, University of California, Irvine, California, 92677, USA
| | - Thuan Gia-Nhat Tran
- Department of Radiological Sciences, University of California, Irvine, California, 92677, USA
| | - Desiree Anderson
- Department of Radiological Sciences, University of California, Irvine, California, 92677, USA
| | - Jarvish Shah
- Department of Radiological Sciences, University of California, Irvine, California, 92677, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California, Irvine, California, 92677, USA.
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Webb EK, Stevens JS, Ely TD, Lebois LAM, van Rooij SJH, Bruce SE, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Murty VP, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Sanchez LD, Joormann J, Pizzagalli DA, Harte SE, Kessler RC, Koenen KC, Ressler KJ, McLean SA, Harnett NG. Neighborhood Resources Associated With Psychological Trajectories and Neural Reactivity to Reward After Trauma. JAMA Psychiatry 2024:2821946. [PMID: 39083325 PMCID: PMC11292566 DOI: 10.1001/jamapsychiatry.2024.2148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/15/2024] [Indexed: 08/03/2024]
Abstract
Importance Research on resilience after trauma has often focused on individual-level factors (eg, ability to cope with adversity) and overlooked influential neighborhood-level factors that may help mitigate the development of posttraumatic stress disorder (PTSD). Objective To investigate whether an interaction between residential greenspace and self-reported individual resources was associated with a resilient PTSD trajectory (ie, low/no symptoms) and to test if the association between greenspace and PTSD trajectory was mediated by neural reactivity to reward. Design, Setting, and Participants As part of a longitudinal cohort study, trauma survivors were recruited from emergency departments across the US. Two weeks after trauma, a subset of participants underwent functional magnetic resonance imaging during a monetary reward task. Study data were analyzed from January to November 2023. Exposures Residential greenspace within a 100-m buffer of each participant's home address was derived from satellite imagery and quantified using the Normalized Difference Vegetation Index and perceived individual resources measured by the Connor-Davidson Resilience Scale (CD-RISC). Main Outcome and Measures PTSD symptom severity measured at 2 weeks, 8 weeks, 3 months, and 6 months after trauma. Neural responses to monetary reward in reward-related regions (ie, amygdala, nucleus accumbens, orbitofrontal cortex) was a secondary outcome. Covariates included both geocoded (eg, area deprivation index) and self-reported characteristics (eg, childhood maltreatment, income). Results In 2597 trauma survivors (mean [SD] age, 36.5 [13.4] years; 1637 female [63%]; 1304 non-Hispanic Black [50.2%], 289 Hispanic [11.1%], 901 non-Hispanic White [34.7%], 93 non-Hispanic other race [3.6%], and 10 missing/unreported [0.4%]), 6 PTSD trajectories (resilient, nonremitting high, nonremitting moderate, slow recovery, rapid recovery, delayed) were identified through latent-class mixed-effect modeling. Multinominal logistic regressions revealed that for individuals with higher CD-RISC scores, greenspace was associated with a greater likelihood of assignment in a resilient trajectory compared with nonremitting high (Wald z test = -3.92; P < .001), nonremitting moderate (Wald z test = -2.24; P = .03), or slow recovery (Wald z test = -2.27; P = .02) classes. Greenspace was also associated with greater neural reactivity to reward in the amygdala (n = 288; t277 = 2.83; adjusted P value = 0.02); however, reward reactivity did not differ by PTSD trajectory. Conclusions and Relevance In this cohort study, greenspace and self-reported individual resources were significantly associated with PTSD trajectories. These findings suggest that factors at multiple ecological levels may contribute to the likelihood of resiliency to PTSD after trauma.
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Affiliation(s)
- E. Kate Webb
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D. Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren A. M. Lebois
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Sanne J H. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri-St Louis, St Louis
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Francesca L. Beaudoin
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Laura T. Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- The Many Brains Project, Belmont, Massachusetts
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Scott L. Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E. Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus
- Ohio State University College of Nursing, Columbus
| | - Robert A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Vishnu P. Murty
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia
| | - Elizabeth M. Datner
- Department of Emergency Medicine, Jefferson Einstein Hospital, Jefferson Health, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St John Hospital, Detroit, Michigan
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Robert M. Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, Michigan
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, Michigan
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Nathaniel G. Harnett
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
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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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Setia K, Otoya D, Boyd S, Fong K, Amendola MF, Lavingia KS. Socioeconomic Status Based on Area Deprivation Index Does Not Affect Postoperative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Health-Care System. Ann Vasc Surg 2024; 109:245-255. [PMID: 39067846 DOI: 10.1016/j.avsg.2024.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/09/2024] [Accepted: 06/02/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Living conditions and socioeconomic status are known to impact individual health and access to medical care. Prior research has validated the Area Deprivation Index (ADI) tool as a measure of socioeconomic disadvantage for a given locality. Living in a neighborhood with a higher ADI score has been associated with increased rates of hospital readmission due to complications following surgery. We set forth to identify the possible associations between a patient's ADI score and postoperative endovascular aneurysm repair (EVAR) outcomes in the Veterans Health Care Administration (VHA). METHODS We retrospectively analyzed the outcomes of patients who underwent EVAR from January 2010 to December 2021 at a level 1A VHA Hospital. Patient demographics and intraoperative variables were obtained. ADI score was calculated based on home addresses and resulted in a local score on a scale of 1-10 and a national percentile on a scale of 1-100. We then further stratified these patients into local and national quintile groups. Local ADI 1 included scores of 1-2, and local ADI 5 included scores of 9-10. National ADI 1 comprised scores 1-20, and national ADI 5 scored 81-100. The other scores were equally divided into ADI 2, 3, and 4. Higher ADI scores were associated with lower socioeconomic status. We identified clinical outcomes, including wound infection, respiratory failure, urinary tract infection, acute kidney injury, limb stenosis, readmission, length of stay, and subsequent reintervention rates. RESULTS 241 patients underwent EVAR over the time period examined. 57.3% (n = 138) of patients were in quintiles 4 and 5 for local ADI; when national ADI percentiles organized these same patients, 47.3% (n = 114) were in quintiles 4 and 5. Patient demographics did not vary between the local and national groups. We saw no statistically significant difference in intraoperative variables, postoperative complications, readmission, loss to follow-up, or 1-year mortality rates across ADI quintiles at the local or national level. Binary Logistic Regression showed no statistical significance for local and national ADI quintiles for hospital readmission and overall postoperative complications. CONCLUSIONS We found that there was no statistical significance between hospital readmission rates or worse surgical outcomes across local and national ADI quintiles. This suggests that the VHA resources and multidisciplinary support may improve care across neighborhoods. This comprehensive care provided at VHA may mitigate postoperative complications in patients undergoing EVARs. Further research is warranted to investigate the role of area deprivation in health care and EVAR outcomes in a veteran population.
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Affiliation(s)
- Karishma Setia
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Diana Otoya
- Virginia Commonwealth University Healthcare System, Richmond, VA
| | - Sally Boyd
- Virginia Commonwealth University Healthcare System, Richmond, VA
| | - Kathryn Fong
- Virginia Commonwealth University School of Medicine, Richmond, VA; Central Virginia VA Healthcare System, Richmond, VA
| | - Michael F Amendola
- Virginia Commonwealth University School of Medicine, Richmond, VA; Central Virginia VA Healthcare System, Richmond, VA
| | - Kedar S Lavingia
- Virginia Commonwealth University School of Medicine, Richmond, VA; Central Virginia VA Healthcare System, Richmond, VA.
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50
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Snyder RA, Hillman SL, Marcotte V, Paskett ED, George S, Hahn O, Mandrekar SJ. Impact of the COVID-19 Pandemic on Cancer Clinical Trials: Alliance for Clinical Trials in Oncology Experience (Alliance A152022). JOURNAL OF CLINICAL TRIALS 2024; 14:570. [PMID: 39296880 PMCID: PMC11410363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
Objective The COVID-19 pandemic led to immediate changes in cancer clinical trial conduct. The primary aims of this study were to summarize the impact of the pandemic on Alliance for Clinical Trials in Oncology (Alliance) enrollment, protocol deviations, COVID-19 events (positive or presumptive-positive COVID test), and premature study discontinuation rates. Methods Enrollment trends were examined from January 2019 (pre COVID-19 pandemic) through 2022. Data were captured for protocol deviations and premature treatment and study discontinuation events across all Alliance protocols using a centralized Medidata Rave database, and summarized from January 1, 2020, through June 30, 2022. Descriptive statistics and graphical techniques are used to summarize observed trends. Results Overall enrollment across Alliance trials decreased during the COVID-19 pandemic and remained below pre-pandemic levels in 2022. Racial and ethnic demographics of enrolled patients did not change substantially. 4805 protocol deviations were reported on 2745 unique patients, with at least one protocol deviation reported by 618 sites and 77 unique trials. Commonly reported deviations were telemedicine visits (n=2167, 45%) and late/missed study procedures (n=2150, 45%). A total of 826 COVID-19 events were reported in 659 unique patients. Of an estimated 18,000 enrolled patients, only 68 withdrew from treatment and 45 withdrew from study due to COVID-19. Conclusion A centralized COVID-19 database enabled a comprehensive assessment of the impact of the pandemic across Alliance trials. COVID-19 led to an immediate decline in enrollment across all patient populations. While the number of trials open to patient accrual remained stable, several large, adjuvant studies completed accrual during this period, which contributed to accrual decline. Telemedicine usage was notable, and both COVID-19 events and study discontinuation due to COVID-19 were rare.
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Affiliation(s)
- Rebecca A Snyder
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shauna L Hillman
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Veronique Marcotte
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Suzanne George
- Dana-Farber/Partners Cancer Care, Boston, Massachusetts, USA
| | - Olwen Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, Illinois, USA
| | - Sumithra J Mandrekar
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
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