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Fahoum K, Ringel JB, Hirsch JA, Rundle A, Levitan EB, Reshetnyak E, Sterling MR, Ezeoma C, Goyal P, Safford MM. Development and validation of mortality prediction models based on the social determinants of health. J Epidemiol Community Health 2024:jech-2023-221287. [PMID: 38729661 DOI: 10.1136/jech-2023-221287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND There is no standardised approach to screening adults for social risk factors. The goal of this study was to develop mortality risk prediction models based on the social determinants of health (SDoH) for clinical risk stratification. METHODS Data were used from REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort of black and white Americans aged ≥45 recruited between 2003 and 2007. Analysis was limited to participants with available SDoH and mortality data (n=20 843). All-cause mortality, available through 31 December 2018, was modelled using Cox proportional hazards with baseline individual, area-level and business-level SDoH as predictors. The area-level Social Vulnerability Index (SVI) was included for comparison. All models were adjusted for age, sex and sampling region and underwent internal split-sample validation. RESULTS The baseline prediction model including only age, sex and REGARDS sampling region had a c-statistic of 0.699. An individual-level SDoH model (Model 1) had a higher c-statistic than the SVI (0.723 vs 0.708, p<0.001) in the testing set. Sequentially adding area-level SDoH (c-statistic 0.723) and business-level SDoH (c-statistics 0.723) to Model 1 had minimal improvement in model discrimination. Structural racism variables were associated with all-cause mortality for black participants but did not improve model discrimination compared with Model 1 (p=0.175). CONCLUSION In conclusion, SDoH can improve mortality prediction over 10 years relative to a baseline model and have the potential to identify high-risk patients for further evaluation or intervention if validated externally.
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Affiliation(s)
- Khalid Fahoum
- Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Jana A Hirsch
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | | | - Emily B Levitan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Chiomah Ezeoma
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Gusoff G, Ringel JB, Bensson-Ravunniarath M, Wiggins F, Lee A, Espinosa CG, Avgar AC, Sarkisian C, Sterling MR. Having a Say in Patient Care: Factors Associated with High and Low Voice among Home Care Workers. J Am Med Dir Assoc 2024; 25:737-743.e2. [PMID: 38432645 DOI: 10.1016/j.jamda.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To identify factors associated with high and low "voice"-or level of input in patient care decisions-among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions. DESIGN We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument. SETTING AND PARTICIPANTS The survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English- or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible. METHODS HCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice. RESULTS The 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P = .001), depersonalization-related burnout (OR 1.14, P = .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P = .04) and job satisfaction (OR 1.22, P = .001). CONCLUSIONS AND IMPLICATIONS Organizational factors such as team communication practices-including among non-English speakers-may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.
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Affiliation(s)
- Geoffrey Gusoff
- National Clinician Scholars Program, University of California, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | | | | | - Faith Wiggins
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Ann Lee
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Cisco G Espinosa
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Catherine Sarkisian
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA, USA
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Levitan EB, Goyal P, Ringel JB, Soroka O, Sterling MR, Durant RW, Brown TM, Bowling CB, Safford MM. Myocardial infarction and physical function: the REasons for Geographic And Racial Differences in Stroke prospective cohort study. BMJ Public Health 2023; 1:e000107. [PMID: 37920711 PMCID: PMC10618954 DOI: 10.1136/bmjph-2023-000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Objective To examine associations between myocardial infarction (MI) and multiple physical function metrics. Methods Among participants aged ≥45 years in the REasons for Geographic And Racial Differences in Stroke prospective cohort study, instrumental activities of daily living (IADL), activities of daily living (ADL), gait speed, chair stands, and Short Form-12 physical component summary (PCS) were assessed after approximately 10 years of follow-up. We examined associations between MI and physical function (no MI [n = 9,472], adjudicated MI during follow-up [n = 288, median 4.7 years prior to function assessment], history of MI at baseline [n = 745], history of MI at baseline and adjudicated MI during follow-up [n = 70, median of 6.7 years prior to function assessment]). Models were adjusted for sociodemographic characteristics, health behaviours, depressive symptoms, cognitive impairment, body mass index, diabetes, hypertension, and urinary albumin to creatinine ratio. We examined subgroups defined by age, gender, and race. Results The average age at baseline was 62 years old, 56% were women, and 35% Black. MI was significantly associated with worse IADL and ADL scores, IADL dependency, chair stands, and PCS, but not ADL dependency or gait speed. For example, compared to participants without MI, IADL scores (possible range 0-14, higher score represents worse function) were greater for participants with MI during follow-up (difference: 0.37 [95% CI 0.16, 0.59]), MI at baseline (0.26 [95% CI 0.12, 0.41]), and MI at baseline and follow-up (0.71 [95% CI 0.15, 1.26]), p < 0.001. Associations tended to be greater in magnitude among participants who were women and particularly Black women. Conclusion MI was associated with various measures of physical function. These decrements in function associated with MI may be preventable or treatable.
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Affiliation(s)
- Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Parag Goyal
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Orysya Soroka
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Madeline R. Sterling
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Raegan W. Durant
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Todd M. Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C. Barrett Bowling
- Department of Veterans Affairs, Durham Geriatrics Research Education and Clinical Center, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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Cummings DM, Adams A, Patil S, Cherrington A, Halladay JR, Oparil S, Soroka O, Ringel JB, Safford MM. Treatment Intensity, Prescribing Patterns, and Blood Pressure Control in Rural Black Patients with Uncontrolled Hypertension. J Racial Ethn Health Disparities 2023; 10:2505-2512. [PMID: 36271193 DOI: 10.1007/s40615-022-01431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE Because racial disparities in hypertension treatment persist, the objective of the present study was to examine patient vs. practice characteristics that influence antihypertensive selection and treatment intensity for non-Hispanic Black (hereafter "Black") patients with uncontrolled hypertension in the rural southeastern USA. METHODS We enrolled 25 Black patients from each of 69 rural practices in Alabama and North Carolina with uncontrolled hypertension (systolic blood pressure (BP) ≥ 140 mm Hg) in a 4-arm cluster randomized trial of BP control interventions. Patients' antihypertensive medications were abstracted from medical records and reconciled at the baseline visit. Treatment intensity was computed using the defined daily dose (DDD) method of the World Health Organization. Correlates of greater antihypertensive medication intensity were assessed by linear regression modeling, and antihypertensive medication classes were compared by baseline systolic BP (SBP) level. RESULTS A total of 1431 patients were enrolled and had complete baseline data. Antihypertensive treatment intensity averaged 3.7 ± 2.6 equivalent medications at usual dosages and was significantly related to higher baseline systolic BP, older age, male sex, insurance availability, higher BMI, and concurrent diabetes, but not to practice type or medication barriers in regression models. Renin-angiotensin system inhibitors were the most commonly used medications, followed by diuretics and calcium channel blockers. CONCLUSION/RELEVANCE Antihypertensive treatment intensity for Black patients in the rural southeastern USA with a history of uncontrolled hypertension averaged the equivalent of almost four medications at usual dosages and was significantly associated with baseline SBP levels and other patient characteristics, but not clinic type. TRIAL REGISTRATION ClinicalTrials.gov NCT02866669.
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Affiliation(s)
- Doyle M Cummings
- Departments of Public Health and Family Medicine, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834-8982, USA.
| | - Alyssa Adams
- Departments of Public Health and Family Medicine, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834-8982, USA
| | - Shivajirao Patil
- Departments of Public Health and Family Medicine, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834-8982, USA
| | - Andrea Cherrington
- Divisions of Preventive Medicine and Cardiovascular Disease, University of Alabama-Birmingham, Birmingham, AL, USA
| | | | - Suzanne Oparil
- Divisions of Preventive Medicine and Cardiovascular Disease, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Orysya Soroka
- Division of General Internal Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medical Center, New York, NY, USA
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Bensson-Ravunniarath M, Bryan Ringel J, Avgar A, Wiggins F, Lee A, McDonald MV, Guerrero LR, Kallas J, Gusoff G, Shen M, Tseng E, Dell N, Czaja S, Lindquist LA, Sterling MR. Having a Say Matters: The Association Between Home Health Aides' Voice and Job Satisfaction. Risk Manag Healthc Policy 2023; 16:1791-1800. [PMID: 37705993 PMCID: PMC10497062 DOI: 10.2147/rmhp.s420207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Despite a rapidly growing need for home health aides (HHAs), turnover rates are high. While this is driven in large part by the demanding nature of their work and low wages, another factor may be that HHAs are often not considered part of the medical team which can leave them feeling unheard by other healthcare professionals. We sought to determine whether this concept, or HHAs' perceived voice, was associated with job satisfaction. Methods and Design This cross-sectional survey of English- and Spanish-speaking HHAs caring for adults with heart failure (HF) was conducted from June 2020 to July 2021 in New York, NY in partnership with a labor management fund of a large healthcare union that provides benefits and training to HHAs. Voice was assessed with a validated 5-item scale (total score range 5 to 25). Job Satisfaction was assessed with the 5-item Work Domain Satisfaction Scale (total score range 5 to 35). Multivariable linear regression analysis was used to examine the association between voice and job satisfaction. Results A total of 413 HHAs employed by 56 unique home care agencies completed the survey; they had a mean age of 48 years, 97.6% were female, 60.2% were Hispanic, and they worked as HHAs for a median of 10 years (IQR, 5, 17). They had a median Voice score of 18 (IQR 15-20) and mean job satisfaction score of 26.4 (SD 5.6). Higher levels of voice (1.75 [0.46-3.04]) were associated with greater job satisfaction (p=0.008). When adjusting for Race/Ethnicity, HF training, and HF knowledge, the association between Voice and job satisfaction remained significant ((1.77 [0.40-3.13]). Conclusion HHAs with a voice in the care of their patients experienced greater job satisfaction. Voice may be an important target for interventions aiming to improve HHAs' retention in the field.
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Affiliation(s)
| | | | - Ariel Avgar
- Cornell University, School of Industrial Labor Relations, Ithaca, NY, USA
| | - Faith Wiggins
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Ann Lee
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | | | | | - John Kallas
- Cornell University, School of Industrial Labor Relations, Ithaca, NY, USA
| | | | - Megan Shen
- Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Emily Tseng
- Cornell Tech, Cornell University, New York, NY, USA
| | - Nicola Dell
- Cornell Tech, Cornell University, New York, NY, USA
| | - Sara Czaja
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lee A Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Sterling MR, Ringel JB, Riegel B, Goyal P, Arbaje AI, Bowles KH, McDonald MV, Kern LM. Home Health Care Workers' Interactions with Medical Providers, Home Care Agencies, and Family Members for Patients with Heart Failure. J Am Board Fam Med 2023; 36:369-375. [PMID: 36948539 PMCID: PMC10329236 DOI: 10.3122/jabfm.2022.220204r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Despite providing frequent care to heart failure (HF) patients, home health care workers (HHWs) are generally considered neither part of the health care team nor the family, and their clinical observations are often overlooked. To better understand this workforce's involvement in care, we quantified HHWs' scope of interactions with clinicians, health systems, and family caregivers. METHODS Community-partnered cross-sectional survey of English- and Spanish-speaking HHWs who cared for a HF patient in the last year. The survey included 6 open-ended questions about aspects of care coordination, alongside demographic and employment characteristics. Descriptive statistics were performed. RESULTS Three hundred ninety-one HHWs employed by 56 unique home care agencies completed the survey. HHWs took HF patients to a median of 3 doctor appointments in the last year with 21.9% of them taking patients to ≥ 7 doctor appointments. Nearly a quarter of HHWs reported that these appointments were in ≥ 3 different health systems. A third of HHWs organized care for their HF patient with ≥ 2 family caregivers. CONCLUSIONS HHWs' scope of health-related interactions is large, indicating that there may be novel opportunities to leverage HHWs' experiences to improve health care delivery and patient care in HF.
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Affiliation(s)
- Madeline R Sterling
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM).
| | - Joanna Bryan Ringel
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Barbara Riegel
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Parag Goyal
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Alicia I Arbaje
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Kathryn H Bowles
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Margaret V McDonald
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Lisa M Kern
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
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Stawnychy MA, Ringel JB, Riegel B, Sterling MR. Better Preparation and Training Determine Home Care Workers' Self-Efficacy in Contributing to Heart Failure Self-Care. J Appl Gerontol 2023; 42:651-659. [PMID: 35801567 PMCID: PMC9825674 DOI: 10.1177/07334648221113322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Identify determinants of home care workers' (HCW) self-efficacy in contributing to heart failure (HF) self-care. METHODS Secondary analysis of a survey (n = 328) examining characteristics of HCWs caring for adults with HF in New York. Self-efficacy assessed using Caregiver Self-Efficacy in Contributing to Self-Care Scale. Standardized scores range 0-100; ≥ 70 points indicate adequate self-efficacy. Characteristics determined by self-efficacy (low vs. adequate). Prevalence ratios with 95% confidence intervals (PR [95% CI]) were estimated using multivariable Poisson regression with robust standard errors. RESULTS Home care workers with adequate self-efficacy had at least some prior HF training (55% vs. 17%, p < .001) and greater job satisfaction (90% vs. 77%, p = .003). Significant determinants for adequate self-efficacy were employment length (1.02 [1.00-1.03], p = .027), preparation for caregiving (3.10 [2.42-3.96], p < .001), and HF training (1.48 [1.20-1.84], p < .001). CONCLUSION Home care agencies and policy-makers can target caregiving preparation and HF training to improve HCWs' confidence in caring for adult HF patients.
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Affiliation(s)
- Michael A. Stawnychy
- Robert Wood Johnson Foundation Future of Nursing Scholar
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Vargas F, Ringel JB, Yum B, Levitan EB, Mangal S, Steinman MA, Safford MM, Goyal P. Implications of Under-Reporting Medication Side Effects: Beta-Blockers in Heart Failure as a Case Example. Drugs Aging 2023; 40:285-291. [PMID: 36800060 PMCID: PMC10900534 DOI: 10.1007/s40266-023-01007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Perceiving medication side effects but not reporting them to a clinician is common. Patterns of "under-reporting" and their implications are not well described. We aimed to address this gap by examining patterns of under-reporting perceived side effects of beta-blockers among patients with heart failure. METHODS In 2016, a survey that evaluated medication-taking behavior was administered to 1114 participants (46.5% response rate) from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort with prior adjudicated heart failure hospitalization or a heart failure Medicare claim. We examined the results of survey respondents who reported taking a beta-blocker to understand patterns of under-reporting perceived beta-blocker side effects. We defined an under-reporter as a participant who perceived experiencing a side effect from their beta-blocker but did not share it with their clinician (according to survey responses). We conducted a multivariable logistic regression analysis to identify determinants of being an under-reporter. Co-variates included age, sex, race, income, level of education, geographical location, and pill burden. We also examined whether under-reporters differed in self-reported medication adherence and willingness to take additional medication to prevent a future healthcare encounter compared to participants who reported perceived side effects to their clinicians and those who did not experience side effects. RESULTS Among 310 respondents, 28% (n = 87) were under-reporters. Black race (odds ratio 2.11, confidence interval 1.21-3.67) and education less than college (odds ratio 2.00, confidence interval 1.09-3.67) were associated with being an under-reporter. Self-reported medication adherence was similar between groups (under-reporters: 46.3%; those who reported perceived side effects: 49.4%; those who did not experience side effects: 45.0%); under-reporters were more frequently unwilling to take additional medication to prevent a doctor's visit (18.9% vs 12.1% vs 10.8%), emergency room visit (21.6% vs 13.3% vs 9.9%), and hospitalization (17.6% vs 10.8% vs 9.0%) compared with the other groups. CONCLUSION We conclude that under-reporting perceived side effects of beta-blockers among adults with heart failure is common, is associated with Black race and low education, and may contribute to patient willingness to take additional medication to prevent future medical encounters.
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Affiliation(s)
- Fabian Vargas
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Joanna Bryan Ringel
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Brian Yum
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina Mangal
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Michael A Steinman
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Monika M Safford
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Parag Goyal
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA.
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Sterling MR, Cené CW, Ringel JB, Avgar AC, Kent EE. Rural-urban differences in family and paid caregiving utilization in the United States: Findings from the Cornell National Social Survey. J Rural Health 2022; 38:689-695. [PMID: 35355330 PMCID: PMC9492623 DOI: 10.1111/jrh.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE While rates of family caregiving and paid caregiving are increasing, how often they occur together ("shared care") and whether utilization varies geographically are unknown. We examined differences in family and paid caregiving utilization by rurality and region in the United States. METHODS The 2020 Cornell National Social Survey is an annual cross-sectional telephone-based survey of a random sample of 1,000 US adults. Participants were asked if they have been a family caregiver, including if they provided care alongside a paid caregiver. Rural-Urban Commuting Area Codes and Census areas classified rurality and region. The association between residence and the prevalence of caregiving was determined with multivariable Poisson regression. FINDINGS Among 857 participants with geographic and caregiving data, 11.8% (n = 101) were rural dwellers and 34.2% were family caregivers. Rural residence (vs urban) was associated with a higher prevalence of family caregiving (PR: 1.59 [1.22, 2.06]), and Western residence (vs Northeast) was associated with a lower prevalence of family caregiving (PR: 0.63 [0.46, 0.87], P = .01). Forty percent of family caregivers shared care with a paid caregiver. There was no significant difference in shared care by rural residence in unadjusted (31.8% rural vs 43.1% urban, P = .22) or adjusted models (PR: 0.85 [0.51, 1.41], P = .53). CONCLUSIONS Although family caregiving was more prevalent in rural areas and certain regions, shared care did not differ by rurality or region. Studies are needed to understand why rural residents do more family caregiving without additional support from paid caregivers, and what the implications are for caregivers and care recipients.
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Affiliation(s)
| | - Crystal W. Cené
- University of North Caroline at Chapel Hill, Chapel Hill, NC
| | | | | | - Erin E. Kent
- University of North Caroline at Chapel Hill, Chapel Hill, NC
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Khodneva Y, Ringel JB, Rajan M, Goyal P, Jackson EA, Sterling MR, Cherrington A, Oparil S, Durant R, Safford MM, Levitan EB. Depressive symptoms, cognitive impairment, and all-cause mortality among REGARDS participants with heart failure. European Heart Journal Open 2022; 2:oeac064. [PMID: 36330357 PMCID: PMC9617474 DOI: 10.1093/ehjopen/oeac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Aims To ascertain whether depressive symptoms and cognitive impairment (CI) are associated with mortality among patients with heart failure (HF), adjusting for sociodemographic, comorbidities, and biomarkers. Methods and results We utilized Medicare-linked data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a biracial prospective ongoing cohort of 30 239 US community-dwelling adults, recruited in 2003-07. HF diagnosis was ascertained in claims analysis. Depressive symptoms were defined as a score ≥4 on the four-item Center for Epidemiological Studies-Depression scale. Cognitive impairment was defined as a score of ≤4 on the six-item screener that assessed three-item recall and orientation to year, month, and day of the week. Sequentially adjusted Cox proportional hazard models were used to estimate the risk of death. We analyzed 1059 REGARDS participants (mean age 73, 48%-African American) with HF; of those 146 (14%) reported depressive symptoms, 136 (13%) had CI and 31 (3%) had both. Over the median follow-up of 6.8 years (interquartile range, 3.4-10.3), 785 (74%) died. In the socio-demographics-adjusted model, CI was significantly associated with increased mortality, hazard ratio 1.24 (95% confidence interval 1.01-1.52), compared with persons with neither depressive symptoms nor CI, but this association was attenuated after further adjustment. Neither depressive symptoms alone nor their comorbidity with CI was associated with mortality. Risk factors of all-cause mortality included: low income, comorbidities, smoking, physical inactivity, and severity of HF. Conclusion Depressive symptoms, CI, or their comorbidity was not associated with mortality in HF in this study. Treatment of HF in elderly needs to be tailored to cognitive status and includes focus on medical comorbidities.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Joanna Bryan Ringel
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Mangala Rajan
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Parag Goyal
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
- Division of Cardiology, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Elizabeth A Jackson
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Madeline R Sterling
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Andrea Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Suzanne Oparil
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Raegan Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Monika M Safford
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Al 35294, USA
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Gaglioti AH, Rivers D, Ringel JB, Judd S, Safford MM. Individual and Neighborhood Influences on the Relationship Between Waist Circumference and Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke Study. Prev Chronic Dis 2022; 19:E20. [PMID: 35446759 PMCID: PMC9044900 DOI: 10.5888/pcd19.210195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective of this study was to describe how the relationship between waist circumference and incident coronary heart disease (CHD) is influenced by individual and neighborhood factors in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. METHODS REGARDS is a cohort study of 30,239 US adults. The primary exposure was sex-specific quartiles of waist circumference. Individual covariates included sociodemographic characteristics, health status, health behavior, and usual source of care. Neighborhood (ie, zip code-level) covariates included access to primary care, poverty, rurality, and racial segregation. The main outcome was incident CHD from baseline (2003) through 2017. We used descriptive statistics, Kaplan-Meier curves, and Cox proportional hazard models to analyze the overall sample and race-sex subgroups. RESULTS During the study period, 23,042 study participants had 1,499 CHD events. We found a higher risk of incident CHD in the upper quartile of waist circumference compared with the first quartile in all 4 race-sex subgroups except African American men, among whom we found no relationship between waist circumference and incident CHD. Covariates did not attenuate these relationships. CONCLUSION In all groups except African American men, waist circumference in the highest quartile was associated with increased risk of incident CHD. Individual and neighborhood factors did not influence the relationship between waist circumference and development of CHD but differentially influenced incident CHD among race-sex subgroups.
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Affiliation(s)
- Anne H Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, 720 Westview Dr SW; Atlanta, GA 30310.
| | - Desiree Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Joanna Bryan Ringel
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika M Safford
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
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12
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Finch AJ, Ringel JB, Dargar S, Halladay J, Cene C, Cherrington A, Cummings D, Safford MM. Greater Social Functioning Associated With Lower Depressive Symptomatology Among Black Belt African Americans Enrolled in the Southeastern Collaboration to Improve Blood Pressure Control Study. Prim Care Companion CNS Disord 2022; 24:21m02988. [PMID: 35114739 PMCID: PMC10038214 DOI: 10.4088/pcc.21m02988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objective: In many populations, higher social functioning is associated with lower depressive symptomatology, which in turn is associated with improved cardiovascular health. This study aimed to establish an association between social functioning and depressive symptomatology, which has not yet been demonstrated in the African American Black Belt. This would be an important finding in a region with high cardiovascular morbidity. Methods: This observational study used baseline data from 1,225 African American Black Belt residents with uncontrolled hypertension in the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial. Three Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires-the emotional support, instrumental support, and social isolation questionnaires-and marital status assessed social functioning. The 8-item Patient Health Questionnaire assessed depressive symptomatology. Multivariable logistic regression models examined associations between social functioning and depressive symptomatology separately and then simultaneously. Data were collected from May 2017 to April 2021. Results: Social functioning was higher than US-reported averages, and the prevalence of moderate to severe depressive symptomatology was low (20.8%) among primary care populations. In a separate model, lower emotional support, lower instrumental support, and increased social isolation were significantly associated with greater depressive symptomatology (odds ratio [OR] = 1.56, 95% CI, 1.20-2.02; OR = 1.33, 95% CI, 1.01-1.77; and OR = 2.39, 95% CI, 1.81-3.16, respectively). In a simultaneous model, only increased perceived social isolation remained significantly associated with greater depressive symptomatology (OR = 2.24, 95% CI, 1.67-3.00). Conclusions: Greater social functioning is associated with lower depressive symptom burden in the Black Belt region. Future research into the directionality of this association could assist in the development of interventions to improve regional mental and cardiovascular health. Trial Registration: ClinicalTrials.gov identifier: NCT02866669.
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Affiliation(s)
- Anthony J Finch
- Department of General Internal Medicine, Weill Cornell Medicine, New York, New York
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
- Corresponding author: Anthony J. Finch, MD, 525 East 68th St, New York, NY 10065
| | - Joanna Bryan Ringel
- Department of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Savira Dargar
- Department of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | | | - Crystal Cene
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Monika M Safford
- Department of General Internal Medicine, Weill Cornell Medicine, New York, New York
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13
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Sterling MR, Ringel JB, Cho J, Riffin CA, Avgar AC. Utilization, Contributions, and Perceptions of Paid Home Care Workers among Households in New York State. Innov Aging 2022; 6:igac001. [PMID: 35237732 PMCID: PMC8883505 DOI: 10.1093/geroni/igac001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives While family caregivers have traditionally provided care for older adults with chronic conditions and disabilities, the demand for paid home care workers has increased in the last decade. Although typically thought to assist with personal care, emerging data suggest that paid home care workers assist with a wider scope of care. However, the extent and quality of the care they deliver remains poorly understood. Research Design and Methods Using the Empire State Poll, a telephone-based cross-sectional survey of 800 adults in New York State, we characterized the types of care that paid home care workers provided and the perceived value of that care. Results Of 800 participants surveyed, 274 reported that they or an immediate family member received care from a paid home care worker (34.3%). Of these, the majority (73.9%) reported that paid home care workers provided emotional and/or medical care, in addition to personal care. In adjusted models, providing emotional and medical care (compared to personal care alone) was associated with nearly a twofold greater perception of importance and experience by the care recipients. Discussion and Implications Our findings provide additional data on how paid home care workers contribute to patient care, from the perspective of the care recipient(s). The type of care provided is associated with varying magnitudes of perceived quality. Although limited to New York, these findings have implications for paid home care workers’ training and compensation. Future studies are warranted to investigate the specific factors that mediate the association between types of care provided and their perceived value.
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Affiliation(s)
- Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jacklyn Cho
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Catherine A Riffin
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ariel C Avgar
- College of Industrial Labor Relations, Cornell University, Ithaca, New York, USA
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14
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Sterling MR, Ringel JB, Pinheiro LC, Safford MM, Levitan EB, Phillips E, Brown TM, Nguyen OK, Goyal P. Social Determinants of Health and 30-Day Readmissions Among Adults Hospitalized for Heart Failure in the REGARDS Study. Circ Heart Fail 2022; 15:e008409. [PMID: 34865525 PMCID: PMC8849604 DOI: 10.1161/circheartfailure.121.008409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND It is not known which social determinants of health (SDOH) impact 30-day readmission after a heart failure (HF) hospitalization among older adults. We examined the association of 9 individual SDOH with 30-day readmission after an HF hospitalization. METHODS AND RESULTS Using the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), we included Medicare beneficiaries who were discharged alive after an HF hospitalization between 2003 and 2014. We assessed 9 SDOH based on the Healthy People 2030 Framework: race, education, income, social isolation, social network, residential poverty, Health Professional Shortage Area, rural residence, and state public health infrastructure. The primary outcome was 30-day all-cause readmission. For each SDOH, we calculated incidence per 1000 person-years and multivariable-adjusted hazard ratios of readmission. Among 690 participants, the median age was 76 years at hospitalization (interquartile range, 71-82), 44.3% were women, 35.5% were Black, 23.5% had low educational attainment, 63.0% had low income, 21.0% had zip code-level poverty, 43.5% resided in Health Professional Shortage Areas, 39.3% lived in states with poor public health infrastructure, 13.1% were socially isolated, 13.3% had poor social networks, and 10.2% lived in rural areas. The 30-day readmission rate was 22.4%. In an unadjusted analysis, only Health Professional Shortage Area was significantly associated with 30-day readmission; in a fully adjusted analysis, none of the 9 SDOH were individually associated with 30-day readmission. CONCLUSIONS In this modestly sized national cohort, although prevalent, none of the SDOH were associated with 30-day readmission after an HF hospitalization. Policies or interventions that only target individual SDOH to reduce readmissions after HF hospitalizations may not be sufficient to prevent readmission among older adults.
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Affiliation(s)
- Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, A.L
| | - Erica Phillips
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Todd M. Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, A.L
| | - Oanh K. Nguyen
- Division of Hospital Medicine, University of California at San Francisco, San Francisco, CA
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY., Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY
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15
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King JB, Pinheiro LC, Ringel JB, Bress AP, Shimbo D, Muntner P, Reynolds K, Cushman M, Howard G, Manly JJ, Safford MM. Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the REGARDS Study. Hypertension 2022; 79:196-206. [PMID: 34784734 PMCID: PMC8665033 DOI: 10.1161/hypertensionaha.120.15196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Social vulnerabilities increase the risk of developing hypertension and lower life expectancy, but the effect of an individual's overall vulnerability burden is unknown. Our objective was to determine the association of social vulnerability count and the risk of developing hypertension or dying over 10 years and whether these associations vary by race. We used the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and included participants without baseline hypertension. The primary exposure was the count of social vulnerabilities defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. Among 5425 participants of mean age 64±10 SD years of which 24% were Black participants, 1468 (31%) had 1 vulnerability and 717 (15%) had ≥2 vulnerabilities. Compared with participants without vulnerabilities, the adjusted relative risk ratio for developing hypertension was 1.16 (95% CI, 0.99-1.36) and 1.49 (95% CI, 1.20-1.85) for individuals with 1 and ≥2 vulnerabilities, respectively. The adjusted relative risk ratio for death was 1.55 (95% CI, 1.24-1.93) and 2.30 (95% CI, 1.75-3.04) for individuals with 1 and ≥2 vulnerabilities, respectively. A greater proportion of Black participants developed hypertension and died than did White participants (hypertension, 38% versus 31%; death, 25% versus 20%). The vulnerability count association was strongest in White participants (P value for vulnerability count×race interaction: hypertension=0.046, death=0.015). Overall, a greater number of socially determined vulnerabilities was associated with progressively higher risk of developing hypertension, and an even higher risk of dying over 10 years.
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Affiliation(s)
- Jordan B. King
- Department of Population Health Sciences, School of Medicine, University of Utah,Institute for Health Research, Kaiser Permanente Colorado
| | | | | | - Adam P. Bress
- Department of Population Health Sciences, School of Medicine, University of Utah
| | - Daichi Shimbo
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons
| | - Paul Muntner
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California,Department of Health Systems Science, Kaiser Permanente School of Medicine
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, University of Vermont
| | - George Howard
- Department of Biostatistics, Ryals School of Public Health, University of Alabama at Birmingham
| | - Jennifer J. Manly
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons
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16
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Sterling MR, Li J, Cho J, Ringel JB, Silver SR. Prevalence and Predictors of Home Health Care Workers' General, Physical, and Mental Health: Findings From the 2014‒2018 Behavioral Risk Factor Surveillance System. Am J Public Health 2021; 111:2239-2250. [PMID: 34878879 PMCID: PMC8667821 DOI: 10.2105/ajph.2021.306512] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 12/27/2022]
Abstract
Objectives. To determine the prevalence and predictors of US home health care workers' (HHWs') self-reported general, physical, and mental health. Methods. Using the 2014-2018 Behavioral Risk Factor Surveillance System, we analyzed the characteristics and health of 2987 HHWs (weighted n = 659 000) compared with 2 similar low-wage worker groups (health care aides and health care support workers, not working in the home). We conducted multivariable logistic regression to determine which characteristics predicted HHWs' health. Results. Overall, 26.6% of HHWs had fair or poor general health, 14.1% had poor physical health, and 20.9% had poor mental health; the prevalence of each outcome was significantly higher than that of the comparison groups. Among HHWs, certain factors, such as low household income, an inability to see a doctor because of cost, and a history of depression, were associated with all 3 aspects of suboptimal health. Conclusions. HHWs had worse general, physical, and mental health compared with low-wage workers not in home health. Public Health Implications. Increased attention to the health of HHWs by public health experts and policymakers is warranted. In addition, targeted interventions appropriate to their specific health needs may be required. (Am J Public Health. 2021;111(12):2239-2250. https://doi.org/10.2105/AJPH.2021.306512).
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Affiliation(s)
- Madeline R Sterling
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Jia Li
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Jacklyn Cho
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Joanna Bryan Ringel
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Sharon R Silver
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
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17
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Kern LM, Ringel JB, Rajan M, Colantonio LD, Casalino LP, Pinheiro LC, Reshetnyak E, Safford MM. Ambulatory Care Fragmentation and Subsequent Hospitalization: Evidence From the REGARDS Study. Med Care 2021; 59:334-340. [PMID: 33273294 PMCID: PMC7954814 DOI: 10.1097/mlr.0000000000001470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have suggested that highly fragmented ambulatory care increases the risk of subsequent hospitalization, but those studies used claims only and were not able to adjust for many clinical potential confounders. OBJECTIVE The objective of this study was to determine the association between fragmented ambulatory care and subsequent hospitalization, adjusting for demographics, medical conditions, medications, health behaviors, psychosocial variables, and physiological variables. DESIGN Longitudinal analysis of data (2003-2016) from the nationwide REasons for Geographic And Racial Differences in Stroke (REGARDS) study, linked to Medicare fee-for-service claims. SUBJECTS A total of 12,693 Medicare beneficiaries 65 years and older from the REGARDS study who had at least 4 ambulatory visits in the first year of observation and did not have a hospitalization in the prior year. MEASURES We defined high fragmentation as a reversed Bice-Boxerman score above the 75th percentile. We used Cox proportional hazards models to determine the association between fragmentation as a time-varying exposure and incident hospitalization in the 3 months following each exposure period. RESULTS The mean age was 70.4 years; 54% were women, and 33% were African American. During the first year of observation, participants with high fragmentation had a median of 8 ambulatory visits with 6 providers, whereas participants with low fragmentation had a median of 7 visits with 3 providers. Over 11.8 years of follow-up, 6947 participants (55%) had a hospitalization. High fragmentation was associated with an increased hazard of hospitalization (adjusted hazard ratio=1.18; 95% confidence interval: 1.12, 1.24). CONCLUSION Highly fragmented ambulatory care is an independent risk factor for hospitalization.
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18
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Kern LM, Rajan M, Colantonio LD, Reshetnyak E, Ringel JB, Muntner PM, Casalino LP, Pinheiro LC, Safford MM. Differences in ambulatory care fragmentation by race. BMC Health Serv Res 2021; 21:154. [PMID: 33596897 PMCID: PMC7890852 DOI: 10.1186/s12913-021-06133-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with more subsequent healthcare utilization (such as more tests, procedures, emergency department visits, and hospitalizations) than less fragmented ambulatory care. It is not known if race and socioeconomic status are associated with fragmented ambulatory care. METHODS We conducted a longitudinal analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, using the REGARDS baseline visit plus the first year of follow-up. We included participants ≥65 years old, who had linked fee-for-service Medicare claims, and ≥ 4 ambulatory visits in the first year of follow-up. We used Tobit regression to determine the associations between race, annual household income, and educational attainment at baseline and fragmentation score in the subsequent year (as measured with the reversed Bice-Boxerman Index). Covariates included other demographic characteristics, medical conditions, medication use, health behaviors, and psychosocial variables. Additional analyses categorized visits by the type of provider (primary care vs. specialist). RESULTS The study participants (N = 6799) had an average age of 73.0 years, 53% were female, and 30% were black. Nearly half had low annual household income (<$35,000) and 41% had a high school education or less. Overall, participants had a median of 10 ambulatory visits to 4 providers in the 12 months following their baseline study visit. Participants in the highest quintile of fragmentation scores had a median of 11 visits to 7 providers. Black race was associated with an absolute adjusted 3% lower fragmentation score compared to white race (95% confidence interval (2% lower to 4% lower; p < 0.001). This difference was explained by blacks seeing fewer specialists than whites. Income and education were not independent predictors of fragmentation scores. CONCLUSIONS Among Medicare beneficiaries, blacks had less fragmented ambulatory care than whites, due to lower utilization of specialty care. Future research is needed to determine the effect of fragmented care on health outcomes for blacks and whites.
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Affiliation(s)
- Lisa M Kern
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA.
| | - Mangala Rajan
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | | | - Evgeniya Reshetnyak
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Joanna Bryan Ringel
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Paul M Muntner
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence P Casalino
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Laura C Pinheiro
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Monika M Safford
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
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Abstract
IMPORTANCE Caregiver strain has been shown to be associated with adverse effects on caregivers' health, particularly among those with cardiovascular disease. Less is known about the association of caregiver strain with health behaviors among caregivers with diabetes, a disease that requires a high degree of self-care. OBJECTIVE To examine the association between caregiver strain and diabetes self-care among caregivers with diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted between July 13, 2018, and June 25, 2020, using data on 795 US caregivers aged 45 years or older with self-reported diabetes from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which comprised 30 239 Black and White adults 45 years or older throughout the US enrolled from January 2003 to October 2007. EXPOSURES Caregiver strain, assessed by self-report in response to the question, "How much of a mental or emotional strain is it to provide this care?" Response options were no strain, some strain, or a lot of (high) strain. MAIN OUTCOMES AND MEASURES Diabetes self-care, which was assessed across 4 domains (Mediterranean diet adherence, physical activity, smoking status, and medication adherence), and a composite self-care score summing performance across these domains. The association between caregiver strain and diabetes self-care was examined with multivariable Poisson regression adjusting for demographic, clinical, physical and mental functioning, and caregiving covariates. RESULTS Among the 795 caregivers with diabetes included in the study, the mean (SD) age was 63.7 (8.6) years, 469 (59.0%) were women, and 452 (56.9%) were Black individuals. Overall, 146 caregivers (18.4%) reported high caregiver strain. In unadjusted models, high caregiver strain was associated with less physical activity (prevalence ratio [PR], 0.66; 95% CI, 0.45-0.97), low medication adherence (PR, 0.80; 95% CI, 0.68-0.94), and worse self-care (PR, 0.65; 95% CI, 0.44-0.98). In adjusted models, the association between some and high caregiving strain with low medication adherence remained significant (adjusted PR: some strain, 0.88 [95% CI, 0.78-0.99]; high strain, 0.83 [95% CI, 0.69-0.99]). CONCLUSIONS AND RELEVANCE In this cohort study of US adult caregivers with diabetes, a high level of strain was associated with low medication adherence. Increased awareness of the prevalence of caregiver strain and potential ramifications on caregivers' self-care appears to be warranted among health care professionals and caregivers.
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Affiliation(s)
- Alexandra King
- New York Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - Ronald Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - David L. Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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20
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Kern LM, Rajan M, Ringel JB, Colantonio LD, Muntner PM, Casalino LP, Pesko M, Reshetnyak E, Pinheiro LC, Safford MM. Healthcare Fragmentation and Incident Acute Coronary Heart Disease Events: a Cohort Study. J Gen Intern Med 2021; 36:422-429. [PMID: 33140281 PMCID: PMC7878592 DOI: 10.1007/s11606-020-06305-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Highly fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with excess tests, procedures, emergency department visits, and hospitalizations. Whether fragmented care is associated with worse health outcomes, or whether any association varies with health status, is unclear. OBJECTIVE To determine whether fragmented care is associated with the risk of incident coronary heart disease (CHD) events, overall and stratified by self-rated general health. DESIGN AND PARTICIPANTS We conducted a secondary analysis of the nationwide prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study (2003-2016). We included participants who were ≥ 65 years old, had linked Medicare fee-for-service claims, and had no history of CHD (N = 10,556). MAIN MEASURES We measured fragmentation with the reversed Bice-Boxerman Index. We used Cox proportional hazards models to determine the association between fragmentation as a time-varying exposure and adjudicated incident CHD events in the 3 months following each exposure period. KEY RESULTS The mean age was 70 years; 57% were women, and 34% were African-American. Over 11.8 years of follow-up, 569 participants had CHD events. Overall, the adjusted hazard ratio (HR) for the association between high fragmentation and incident CHD events was 1.14 (95% confidence interval (CI) 0.92, 1.39). Among those with very good or good self-rated health, high fragmentation was associated with an increased hazard of CHD events (adjusted HR 1.35; 95% CI 1.06, 1.73; p = 0.01). Among those with fair or poor self-rated health, high fragmentation was associated with a trend toward a decreased hazard of CHD events (adjusted HR 0.54; 95% CI 0.29, 1.01; p = 0.052). There was no association among those with excellent self-rated health. CONCLUSION High fragmentation was associated with an increased independent risk of incident CHD events among those with very good or good self-rated health.
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Affiliation(s)
| | | | | | | | - Paul M Muntner
- University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Goyal P, Ringel JB, Rajan M, Choi JJ, Pinheiro LC, Li HA, Wehmeyer GT, Alshak MN, Jabri A, Schenck EJ, Chen R, Satlin MJ, Campion TR, Nahid M, Plataki M, Hoffman KL, Reshetnyak E, Hupert N, Horn EM, Martinez FJ, Gulick RM, Safford MM. Obesity and COVID-19 in New York City: A Retrospective Cohort Study. Ann Intern Med 2020; 173:855-858. [PMID: 32628537 PMCID: PMC7384267 DOI: 10.7326/m20-2730] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Parag Goyal
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Joanna Bryan Ringel
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Mangala Rajan
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Justin J Choi
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Laura C Pinheiro
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Han A Li
- Weill Cornell Medical College, New York, New York (H.A.L., G.T.W., M.N.A.)
| | - Graham T Wehmeyer
- Weill Cornell Medical College, New York, New York (H.A.L., G.T.W., M.N.A.)
| | - Mark N Alshak
- Weill Cornell Medical College, New York, New York (H.A.L., G.T.W., M.N.A.)
| | - Assem Jabri
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Edward J Schenck
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Ruijun Chen
- Weill Cornell Medicine and Columbia University, New York, New York (R.C.)
| | - Michael J Satlin
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Thomas R Campion
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Musarrat Nahid
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Maria Plataki
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Katherine L Hoffman
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Evgeniya Reshetnyak
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Nathaniel Hupert
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Evelyn M Horn
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Fernando J Martinez
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Roy M Gulick
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
| | - Monika M Safford
- Weill Cornell Medicine, New York, New York (P.G., J.B.R., M.R., J.J.C., L.C.P., A.J., E.J.S., M.J.S., T.R.C., M.N., M.P., K.L.H., E.R., N.H., E.M.H., F.J.M., R.M.G., M.M.S.)
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22
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Sterling MR, Cho J, Ringel JB, Avgar AC. Heart Failure Training and Job Satisfaction: A Survey of Home Care Workers Caring for Adults with Heart Failure in New York City. Ethn Dis 2020; 30:575-582. [PMID: 32989357 PMCID: PMC7518527 DOI: 10.18865/ed.30.4.575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Home care workers (HCWs), who include home health aides and personal care attendants, frequently care for adults with heart failure (HF). Despite substantial involvement in HF care, prior qualitative studies have found that HCWs lack training and confidence, which creates challenges for this workforce and potentially for patient care. Herein, we quantified the prevalence of HF training among HCWs and determined its association with job satisfaction. Methods We conducted a cross-sectional survey of agency-employed HCWs caring for HF patients across New York, NY from 2018-2019. HF training was assessed with, "Have you received prior HF training?" Job satisfaction was assessed with, "How satisfied are you with your job?" The association between HF training and job satisfaction was determined with robust poisson regression. Results 323 HCWs from 23 agencies participated; their median age was 50 years (IQR: 37,58), 94% were women, 44% were non-Hispanic Black, 23% were Hispanic, 78% completed ≥ high school education, and 72% were foreign-born. They had been caregiving for a median of 8.5 years (IQR: 4,15) and 73% had cared for 1-5 HF patients. Two-thirds received none/a little HF training and 82% felt satisfied with their job. In a fully adjusted model, HCWs with some/a lot of HF training had 14% higher job satisfaction than those with none/a little HF training (aPR 1.14; 95% CI 1.03-1.27). Conclusions The majority of HCWs have not received HF training. HF training was associated with higher job satisfaction, suggesting that HF training programs may improve HCWs' experience caring for this patient population.
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Affiliation(s)
- Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Jacklyn Cho
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ariel C. Avgar
- College of Industrial Labor Relations, Cornell University, Ithaca, NY
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23
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Sterling MR, Ringel JB, Pinheiro LC, Safford MM, Levitan EB, Phillips E, Brown TM, Goyal P. Social Determinants of Health and 90-Day Mortality After Hospitalization for Heart Failure in the REGARDS Study. J Am Heart Assoc 2020; 9:e014836. [PMID: 32316807 PMCID: PMC7428585 DOI: 10.1161/jaha.119.014836] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Outcomes following heart failure (HF) hospitalizations are poor, with 90‐day mortality rates of 15% to 20%. Although prior studies found associations between individual social determinants of health (SDOH) and post‐discharge mortality, less is known about how an individuals’ total burden of SDOH affects 90‐day mortality. Methods and Results We included participants of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study who were Medicare beneficiaries aged ≥65 years discharged alive after an adjudicated HF hospitalization. Guided by the Healthy People 2020 Framework, we examined 9 SDOH. First, we examined age‐adjusted associations between each SDOH and 90‐day mortality; those associated with 90‐day mortality were used to create an SDOH count. Next, we determined the hazard of 90‐day mortality by the SDOH count, adjusting for confounders. Over 10 years, 690 participants were hospitalized for HF at 440 unique hospitals in the United States; there were a total of 79 deaths within 90 days. Overall, 28% of participants had 0 SDOH, 39% had 1, and 32% had ≥2. Compared with those with 0, the age‐adjusted hazard ratio for 90‐day mortality among those with 1 SDOH was 2.89 (95% CI, 1.46–5.72) and was 3.06 (1.51–6.19) among those with ≥2 SDOH. The adjusted hazard ratio was 2.78 (1.37–5.62) and 2.57 (1.19–5.54) for participants with 1 SDOH and ≥2, respectively. Conclusions While having any of the SDOH studied here markedly increased risk of 90‐day mortality after an HF hospitalization, a greater burden of SDOH was not associated with significantly greater risk in our population.
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Affiliation(s)
- Madeline R Sterling
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Joanna Bryan Ringel
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Laura C Pinheiro
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Monika M Safford
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Emily B Levitan
- Department of Epidemiology University of Alabama at Birmingham AL
| | - Erica Phillips
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Todd M Brown
- Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham AL
| | - Parag Goyal
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY.,Division of Cardiology Department of Medicine Weill Cornell Medicine New York NY
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24
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Ringel JB, Jannat-Khah D, Chambers R, Russo E, Merriman L, Gupta R. Impact of gaps in care for malnourished patients on length of stay and hospital readmission. BMC Health Serv Res 2019; 19:87. [PMID: 30709377 PMCID: PMC6359768 DOI: 10.1186/s12913-019-3918-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 01/21/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Few published articles have focused on identifying the gaps in care that follow a malnutrition diagnosis and their effects on length of stay (LOS) and 90-day readmission. We hypothesized that length of stay and readmission were associated with these gaps in care. METHODS Two registered dietitians retrospectively reviewed charts of 229 adult malnourished patients admitted to a medicine unit to determine their system level gap in care: communication, test delay, or discharge planning. In this secondary analysis, both readmission and length of stay were regressed on each gap in care. RESULTS Any system level gap was associated with a greater length of stay (β: 1.48, 95% CI: 1.15-1.91) and specifically the gap related to procedure/testing (β: 2.01, 95% CI: 1.62-2.47) resulted in a two-fold increase in length of stay. There was no association between 90-day readmission and any of the gaps in care. CONCLUSIONS There was a strong association between those who had any gap in their care and increased length of stay. Mitigating gaps in care may decrease length of stay and, in turn, result in less risk of infection and could potentially lead to reduced healthcare costs.
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Affiliation(s)
- Joanna Bryan Ringel
- Division of General Internal Medicine, Weill Cornell Medical College, 525 East 68th street, Box 331, New York, NY 10065 USA
| | - Deanna Jannat-Khah
- Division of General Internal Medicine, Weill Cornell Medical College, 525 East 68th street, Box 331, New York, NY 10065 USA
| | - Rachel Chambers
- Food and Nutrition, New York-Presbyterian Hospital, 525 East 68th street, New York, NY 10065 USA
| | - Emily Russo
- Food and Nutrition, New York-Presbyterian Hospital, 525 East 68th street, New York, NY 10065 USA
| | - Louise Merriman
- Food and Nutrition, New York-Presbyterian Hospital, 525 East 68th street, New York, NY 10065 USA
| | - Renuka Gupta
- Division of General Internal Medicine, Weill Cornell Medical College, 525 East 68th street, Box 331, New York, NY 10065 USA
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