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Juarez MC, Pulavarty A, Doudican N, Lee N, Stevenson ML, Carucci JA, Criscito MC. Tumor size associated with upstaged cutaneous squamous cell carcinoma in patients with skin of color. J Am Acad Dermatol 2024; 90:1048-1051. [PMID: 38215794 DOI: 10.1016/j.jaad.2023.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Michelle C Juarez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Akshay Pulavarty
- New York University Grossman School of Medicine, New York, New York
| | - Nicole Doudican
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Nayoung Lee
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - John A Carucci
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Maressa C Criscito
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
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Nguyen KH, Chen S, Bao Y, Lu Y, Bednarczyk RA, Vasudevan L. COVID-19 Diagnosis, Severity, and Long COVID Among U.S. Adolescents, National Health Interview Survey, 2022. Am J Health Promot 2024; 38:534-539. [PMID: 38311899 DOI: 10.1177/08901171241231642] [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] [Indexed: 02/06/2024]
Abstract
PURPOSE Understanding disparities in COVID-19 outcomes, overall and stratified by vaccination status, is important for developing targeted strategies to increase vaccination coverage and protect adolescents from COVID-19. DESIGN The 2022 National Health Interview Survey (NHIS) is a cross-sectional nationally representative household survey of U.S. adults. SETTING A probability sample of households in the U.S. SAMPLE One child aged 12-17 years is randomly selected from each family in the household. A knowledgeable adult (eg, parent or guardian), responds on behalf of the child through an in-person interview (response rate = 49.9%). MEASURES Input measures-sociodemographic characteristics and COVID-19 vaccination status; output measures-ever had COVID-19, moderate/severe COVID-19, long COVID. ANALYSIS Prevalence of COVID-19 outcomes was assessed for adolescents aged 12-17 years. Factors associated with each COVID-19 outcome were assessed with multivariable logistic regression analyses. RESULTS Among 2758 adolescents aged 12-17 years in 2022, 60.5% had received ≥1 dose of COVID-19 vaccine, 30.2% had ever been diagnosed by a doctor that they had COVID-19, 29.5% had moderate/severe COVID-19, and 6.2% had long COVID. Adolescents who were vaccinated with ≥1 dose were less likely to be diagnosed with COVID-19 (aOR = .79) and less likely to have long COVID (aOR = .30). CONCLUSION Targeted messaging to highlight the importance of early treatment, the harms of long COVID-19, and the benefits of vaccination in protecting against long-term effects may be necessary to ensure that all adolescents and their families are adequately protected.
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Affiliation(s)
- Kimberly H Nguyen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, George Washington University School of Public Health and Health Sciences, Washington, DC, USA
| | - Siyu Chen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Yingjun Bao
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Yang Lu
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Lavanya Vasudevan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Ofori-Darko A, Barzallo D, DiSano K. Response to: Trepanowski et al., "Implications of the Supreme Court's affirmative action decision on underrepresented populations and dermatology". J Am Acad Dermatol 2024; 90:e179-e180. [PMID: 38219803 DOI: 10.1016/j.jaad.2023.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Afua Ofori-Darko
- Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Devin Barzallo
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Katherine DiSano
- Case Western Reserve University School of Medicine, Cleveland, Ohio; MetroHealth Medical Center, Cleveland, Ohio
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Hutchings H, Chang D, Ruffin W, Mohan N, Hooper R, Brue K, Okereke I. Effect of cardiothoracic surgery mentorship on underrepresented high school students. J Thorac Cardiovasc Surg 2024; 167:1885-1890. [PMID: 37500055 DOI: 10.1016/j.jtcvs.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Affiliation(s)
| | - Donald Chang
- Department of Surgery, Henry Ford Health, Detroit, Mich
| | - Wilma Ruffin
- Department of Surgery, Henry Ford Health, Detroit, Mich
| | - Navyatha Mohan
- Division of Cardiothoracic Surgery, Baylor University School of Medicine, Houston, Tex
| | - Rachel Hooper
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Kellie Brue
- Department of Surgery, Henry Ford Health, Detroit, Mich
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health, Detroit, Mich.
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Amboree TL, Damgacioglu H, Sonawane K, Adsul P, Montealegre JR, Deshmukh AA. Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county-level income in the United States, 2000-2019. Int J Cancer 2024; 154:1549-1555. [PMID: 38270521 DOI: 10.1002/ijc.34860] [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: 08/14/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
Early evidence suggests that declining cervical cancer incidence reversed in low-income regions in the United States in recent years; however, it is unclear whether there are distinct patterns by race/ethnicity and stage at diagnosis and if the increase has translated into rising mortality. Using Surveillance, Epidemiology, and End Results data, we evaluated trends in hysterectomy-corrected cervical cancer incidence rates (2000-2019) and mortality rates (2005-2019) by county-level income and race/ethnicity, with further stratification of incidence by stage at diagnosis. Following a period of decline, hysterectomy-corrected cervical cancer incidence increased 1.0%/year (95% CI = 0.1% to 4.5%) among Non-Hispanic White women in low-income counties. Particularly, a statistically significant 4.4%/year (95% CI = 1.7% to 7.5%) increase in distant-stage cancer occurred in this group. Additionally, recent increases in cervical cancer mortality (1.1%/year [95% CI = -1.4% to 3.7%]) were observed among this group and Non-Hispanic Black women in low-income counties (2.9%/year [95% CI = -2.3% to 18.2%]), but trends were not statistically significant. Among Hispanic women in low-income counties, distant-stage cervical cancer incidence increased 1.5%/year (95% CI = -0.6% to 4.1%), albeit not statistically significant. The increasing incidence of distant-stage cervical cancer and mortality in specific racial/ethnic groups suggests that the recent introduction of higher sensitivity screening tests may not explain increasing trends in low-income counties. Our findings suggest that the observed rise in cervical cancer incidence may reflect disruptions along the screening and treatment continuum. Future research to further comprehend these trends and continued enhancements in prevention are crucial to combat rising cervical cancer incidence and mortality in low-income counties in the United States.
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Affiliation(s)
- Trisha L Amboree
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Haluk Damgacioglu
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kalyani Sonawane
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Cancer Control and Population Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
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Basourakos SP, An A, Davuluri M, Pinheiro LC, Al Awamlh BAH, Borregales LD, Luan D, Tamimi RM, Hu JC, Kensler KH. Racial and Ethnic Variation in Receipt and Intensity of Active Surveillance for Older Patients With Localized Prostate Cancer. Urol Pract 2024; 11:538-546. [PMID: 38640417 DOI: 10.1097/upj.0000000000000529] [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: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The use of active surveillance (AS) for prostate cancer is increasing, and racial disparities have been identified in its implementation. We investigated differences by race and ethnicity in the utilization and intensity of AS by race and ethnicity among older men with low- and favorable intermediate-risk prostate cancer, with particular focus on the integration of multiparametric MRI (mpMRI) into AS protocols. METHODS Using the Surveillance, Epidemiology, and End Results and Medicare fee-for-service linked database, we identified a cohort of men diagnosed between 2010 and 2017 with low- or favorable intermediate-risk prostate cancer. The odds of receiving AS were compared by patient race and ethnicity using multivariable logistic regression models, while the rates of usage of PSA tests, biopsy, and mpMRI within 2 years of diagnosis among men on AS were assessed using multivariable Poisson regression models. RESULTS Our cohort included 33,542 men. The proportion of men with low-risk disease who underwent AS increased from 29.5% in 2010 to 51.7% in 2017, while the proportion among men with favorable intermediate disease grew from 11.4% to 17.2%. Hispanic (odds ratio [OR] = 0.68, 95% CI 0.58-0.79) and non-Hispanic Black men (OR = 0.78, 95% CI 0.68-0.89) were less likely to receive AS than non-Hispanic White men for low-risk disease, while non-Hispanic Black men were more likely to receive AS for favorable intermediate disease (OR = 1.21, 95% CI 1.04-1.39). Non-Hispanic Black men receiving AS underwent prostate MRI at a lower rate compared to non-Hispanic White men, regardless of whether they had low-risk (incidence rate ratio = 0.77, 95% CI 0.61-0.97) or favorable intermediate-risk (incidence rate ratio = 0.61, 95% CI 0.44-0.83) disease, respectively. CONCLUSIONS The overall adoption of AS for low-risk prostate cancer increased among Medicare fee-for-service beneficiaries. However, a significant disparity exists for non-Hispanic Black men, as they exhibit lower rates of AS utilization. Moreover, non-Hispanic Black men are less likely to have access to novel technologies, such as mpMRI, as part of their AS protocols.
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Affiliation(s)
- Spyridon P Basourakos
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Anjile An
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Meenakshi Davuluri
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Laura C Pinheiro
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Leonardo D Borregales
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Danny Luan
- Department of Hematology and Oncology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Jim C Hu
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Kevin H Kensler
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Eisenberg MA, Deboever N, Mills AC, Egyud MR, Hofstetter WL, Mehran RJ, Rice DC, Rajaram R, Sepesi B, Swisher SG, Walsh GL, Vaporciyan AA, Antonoff MB. Impact of travel distance on receipt of indicated adjuvant therapy in resected non-small cell lung cancer. J Thorac Cardiovasc Surg 2024; 167:1617-1627. [PMID: 37696428 DOI: 10.1016/j.jtcvs.2023.08.049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE We have previously demonstrated the negative impact of travel distance on adherence to surveillance imaging guidelines for resected non-small cell lung cancer (NSCLC). The influence of patient residential location on adherence to recommended postoperative treatment plans remains unclear. We sought to characterize the impact of travel distance on receipt of indicated adjuvant therapy in resected NSCLC. METHODS We performed a single-institution, retrospective review of patients with stage II-III NSCLC who underwent upfront pulmonary resection, 2012-2016. Clinicopathologic and operative/perioperative details of treatment were collected. Travel distance was measured from patients' homes to the operative hospital. Our primary outcome was receipt of adjuvant systemic or radiotherapy. Travel distance was stratified as <100 or >100 miles. Multivariable logistic regression was performed. RESULTS In total, 391 patients met inclusion criteria, with mean age of 65.9 years and fairly even sex distribution (182 women, 49.2%). Most patients were Non-Hispanic White (n = 309, 83.5%), and most frequent clinical stage was II (n = 254, 64.9%). Indicated adjuvant therapy was received by 266 (71.9%), and median distance traveled was 209 miles (interquartile range, 50.7-617). Multivariate analysis revealed that longer travel distance was inversely associated with receipt of indicated adjuvant therapy (odds ratio, 0.13; 95% confidence interval, 0.06-0.26; P < .001). In addition, Black patients were less likely to receive appropriate treatment (odds ratio, 0.05; 95% confidence interval, 0.02-0.15; P < .001). CONCLUSIONS Travel distance >100 miles negatively impacts the likelihood of receiving indicated adjuvant therapy in NSCLC. Indications for systemic therapy in earlier staged disease are rapidly expanding, and these findings bear heightened relevance as we aim to provide equitable access to all patients.
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Affiliation(s)
- Michael A Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Alexander C Mills
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, Houston, Tex
| | - Matthew R Egyud
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, Tex
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
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Potter AL, Rosenstein AL, Kandala K, Venkateswaran S, Kiang MV, Okusanya OT, Auchincloss HG, Martin LW, Colson YL, Jeffrey Yang CF. Shortage of thoracic surgeons in the United States: Implications for treatment and survival for stage I lung cancer patients. J Thorac Cardiovasc Surg 2024; 167:1603-1614.e9. [PMID: 37716651 DOI: 10.1016/j.jtcvs.2023.08.059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/10/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVES To evaluate whether there is a shortage of thoracic surgeons in the United States and whether any potential shortage is impacting lung cancer treatment and outcomes. DESIGN Using the US Area Health Resources File and Surveillance Epidemiology End Results database, we assessed the number of cardiothoracic surgeons per 100,000 people and the number of stage I non-small cell lung cancer (NSCLC) diagnoses in the US in 2010 versus 2018. Changes in the percentage of patients diagnosed with stage I NSCLC who underwent surgery and stereotactic body radiotherapy and changes in overall survival of patients with stage I NSCLC from 2010 to 2018 in the National Cancer Database were evaluated using multivariable logistic regression and Cox proportional hazards modeling. RESULTS From 2010 to 2018, the number of cardiothoracic surgeons per 100,000 people in the US decreased by 12% (P < .001), while the number of patients diagnosed with stage I NSCLC increased by 40% (P < .001). Over the same period, the percentage of patients who underwent surgery for stage I NSCLC decreased from 81.0% to 72.3% (adjusted odds ratio, 0.59; 95% confidence interval, 0.55-0.63); this decrease was similarly seen in a subgroup of young and otherwise healthy patients. Greater decreases in the percentage of patients who underwent surgery in nonmetropolitan and underserved regions corresponded with worse improvements in survival among patients in these regions from 2010 to 2018. CONCLUSIONS Recent declines in the US cardiothoracic surgery workforce may have led to significantly fewer patients undergoing surgery for stage I NSCLC and worsening disparities in survival between different patient populations.
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Affiliation(s)
- Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Allison L Rosenstein
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Keervani Kandala
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Shivaek Venkateswaran
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, Calif
| | - Olugbenga T Okusanya
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Hugh G Auchincloss
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Linda W Martin
- Department of Surgery, University of Virginia, Charlottesville, Va
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
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Reese PP, Powe NR, Lo B. Engineering Equity Into the Promise of Xenotransplantation. Am J Kidney Dis 2024; 83:677-683. [PMID: 37992981 DOI: 10.1053/j.ajkd.2023.09.019] [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: 03/29/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/24/2023]
Abstract
Two of the greatest challenges facing kidney transplantation are the lack of donated organs and inequities in who receives a transplant. Xenotransplantation holds promise as a treatment approach that could solve the supply problem. Major advances in gene-editing procedures have enabled several companies to raise genetically engineered pigs for organ donation. These porcine organs lack antigens and have other modifications that should reduce the probability of immunological rejection when transplanted into humans. The US Food and Drug Administration and transplantation leaders are starting to chart a path to test xenotransplants in clinical trials and later integrate them into routine clinical care. Here we provide a framework that industry, regulatory authorities, payers, transplantation professionals, and patient groups can implement to promote equity during every stage in this process. We also call for immediate action. Companies developing xenotransplant technology should assemble patient advocacy boards to bring the concerns of individuals with end-stage kidney disease to the forefront. For trials, xenotransplantation companies should partner with transplant programs with substantial patient populations of racial and ethnic minority groups and that have reciprocal relationships with those communities. Those companies and transplant programs should reach out now to those communities to inform them about xenotransplantation and try to address their concerns. These actions have the potential to make these communities full partners in the promise of xenotransplantation.
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Affiliation(s)
- Peter P Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Neil R Powe
- Department of Medicine, University of California San Francisco at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Bernard Lo
- Department of Medicine, University of California San Francisco, San Francisco, CA
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Canaday FT, Georas SN, Croft DP. Examining the impact of air pollution, climate change, and social determinants of health on asthma and environmental justice. Curr Opin Pulm Med 2024; 30:276-280. [PMID: 38411188 PMCID: PMC10959677 DOI: 10.1097/mcp.0000000000001065] [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: 02/28/2024]
Abstract
PURPOSE OF REVIEW In this review, we discuss the current literature examining the impact air pollution and climate change has on asthma onset, control, and exacerbation. This review also addresses the risk of exposure to specific disproportionately affected communities, highlighting health disparities in exposure and asthma outcomes. RECENT FINDINGS Recent studies have shifted from highlighting the associations between asthma exacerbations and indoor and outdoor air pollution. Studies are now focused on confirming the association of asthma incidence from these same exposures. Many studies have linked particulate matter to adverse asthma outcomes, however, the pollutant exposures that pose the greatest risk and the effect of natural disasters fueled by climate change are under current study. Some studies have observed that the true burden that pollutant exposures have on asthma outcomes occurs at the intersection of exposure and vulnerability. Future studies in this area will address social determinants of health, societal factors such as redlining and other systemic racism practices. SUMMARY Although decades of research support the causal link between gaseous and particulate air pollution and the exacerbation of preexisting asthma, recent studies suggest air pollution can cause incident (new onset) asthma. Studies have started to focus on the underlying drivers of poor outcomes in asthma. Many of the structural impediments to high quality asthma care at the society level (e.g. poverty, redlining, systemic racism) also are risk factors for worsened climate events and air pollution exposure. The individuals in these disproportionately affected groups are doubly affected by worsened exposure and worsened access to care for the resultant asthma exacerbations or incident asthma. More research is needed to understand the specific climate and air pollution mitigation efforts where disproportionately affected communities would derive the most benefit.
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Affiliation(s)
- Felicia T Canaday
- Department of Medicine, Division of Pulmonary and Critical Care, University of Rochester Medical Center, Rochester, New York, USA
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Varanasi AP, Burhansstipanov L, Dorn C, Gentry S, Capossela MA, Fox K, Wilson D, Tanjasiri S, Odumosu O, Saavedra Ferrer EL. Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable. Cancer 2024; 130:1549-1567. [PMID: 38306297 DOI: 10.1002/cncr.35147] [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] [Indexed: 02/04/2024]
Abstract
PLAIN LANGUAGE SUMMARY Cancer patient navigators work in diverse settings ranging from community-based programs to comprehensive cancer centers to improve outcomes in underserved populations by eliminating barriers to timely cancer prevention, early detection, diagnosis, treatment, and survivorship in a culturally appropriate and competent manner. This article clarifies the roles and responsibilities of Entry, Intermediate, and Advanced level cancer patient navigators. The competencies described in this article apply to patient navigators, nurse navigators, and social work navigators. This article provides a resource for administrators to create job descriptions for navigators with specific levels of expertise and for patient navigators to advance their oncology careers and attain a higher level of expertise.
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Affiliation(s)
| | | | - Carrie Dorn
- National Association of Social Workers, Washington, DC, USA
| | - Sharon Gentry
- Academy of Oncology Nurse and Patient Navigators (AONN+), Lewisville, North Carolina, USA
| | | | - Kyandra Fox
- Patient Navigation, Education and Training, Susan G. Komen Foundation, Allen, Texas, USA
| | - Donna Wilson
- HCA Henrico Doctors' Hospital/Virginia Cancer Patient Navigator Network (VaCPNN), Midlothian, Virginia, USA
| | - Sora Tanjasiri
- Department of Health, Society and Behavior, University of Irvine, Irvine, California, USA
| | | | - Elba L Saavedra Ferrer
- College of Education and Human Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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Pan S, Li S, Jiang S, Shin JI, Liu GG, Wu H, Lyu B. Trends in Number and Appropriateness of Prescription Medication Utilization among Community-Dwelling Older Adults in the US: 2011-2020. J Gerontol A Biol Sci Med Sci 2024:glae108. [PMID: 38644631 DOI: 10.1093/gerona/glae108] [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: 11/23/2023] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Contemporary data on the quantity and quality of medication use among older adults are lacking. This study examined recent trends in number and appropriateness of prescription medication use among older adults in the US. METHOD Data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020 were used and 6336 adult participants aged 65 and older were included. We examined the number of prescription medication, prevalence of polypharmacy (≥5 prescription drugs), use of potentially inappropriate medication (PIM), and use of recommended medications (ACEI/ARBs plus beta-blockers among patients with heart failure and ACEI/ARBs among patients with albuminuria). RESULTS There has been a slight increase in the prevalence of polypharmacy (39.3% in 2011-2012 to 43.8% in 2017-2020, p for trend= 0.32). Antihypertensive, antihyperlipidemic, antidiabetic medications, and antidepressants are the most commonly used medications. There was no substantial change in the use of PIM (17.0% to 14.7%). Less than 50% of older adults with heart failure received ACEI/ARBs plus beta-blockers (44.3% in 2017-2020) and approximately 50% patients with albuminuria received ACEI/ARBs (54.0 in 2017-2020), with no improvement over the study period. Polypharmacy, older age, female, and lower socioeconomic status generally were associated with greater use of PIM but lower use of recommended medications. CONCLUSIONS The medication burden remained high among older adults in the US and the appropriate utilization of medications did not improve in the recent decade. Our results underscore the need for greater attentions and interventions to the quality of medication use among older adults.
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Affiliation(s)
- Shaoxi Pan
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China
- China Center for Health Economic Research, Peking university
| | - Shanshan Li
- China Center for Health Economic Research, Peking university
- Institute for Global Health and Development, Peking university
| | - Shaoxiang Jiang
- Institute for Global Health and Development, Peking university
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gordon G Liu
- Institute for Global Health and Development, Peking university
- National School of Development, Peking University
| | - Hongyan Wu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China
| | - Beini Lyu
- Institute for Global Health and Development, Peking university
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Kyriakos CN, Driezen P, Fong G, Chung-Hall J, Hyland A, Geboers C, Quah ACK, Willemsen MC, Filippidis FT. Impact of the European Union's menthol cigarette ban on smoking cessation outcomes: longitudinal findings from the 2020-2021 ITC Netherlands Surveys. Tob Control 2024; 33:302-309. [PMID: 36163172 DOI: 10.1136/tc-2022-057428] [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: 03/30/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION To reduce the appeal of tobacco, the European Union (EU) banned menthol as a characterising flavour in cigarettes in May 2020. This pre/post-study evaluated the impact of the menthol ban on smoking cessation outcomes among a representative cohort of Dutch smokers. METHODS Adult (18+ years) smokers were recruited at wave 1 (pre-ban) of the International Tobacco Control Netherlands Surveys (February-March 2020) and followed post-ban at wave 2 (September-November 2020) and wave 3 (June-July 2021) (N=1326 participated in all three waves). Weighted bivariate, logistic regression and generalised estimating equation model analyses were conducted. RESULTS Usual menthol use decreased from pre-ban (7.8%) to post-ban (4.0% at wave 2 and 4.4% at wave 3) (p<0.001). Pre-ban menthol smokers had greater odds of making a post-ban quit attempt than non-menthol smokers (66.9% vs 49.6%, adjusted OR (aOR)=1.89, 95% CI: 1.13 to 3.16). Compared with pre-ban non-menthol smokers, a higher proportion of menthol smokers quit by wave 2 (17.8% vs 10.2%, p=0.025) and by wave 3 (26.1% vs 14.1%, p=0.002), although this was not significant after adjusting for other factors. Female pre-ban menthol smokers had greater odds of quitting by wave 3 than female non-menthol smokers (aOR=2.23, 95% CI: 1.10 to 4.51). Most pre-ban menthol smokers (n=99) switched to non-menthol cigarettes (40.0%) or reported that they continued to smoke menthol cigarettes (33.0%) at wave 3. CONCLUSIONS The EU menthol ban was effective in reducing menthol use and in increasing quit attempts and quitting among pre-ban menthol smokers. Impact could be maximised by closing gaps that allow post-ban menthol cigarette use.
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Affiliation(s)
- Christina N Kyriakos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew Hyland
- Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Cloé Geboers
- Department of Health Promotion (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Netherlands Expertise Centre for Tobacco Control, Trimbos-institute, Utrecht, The Netherlands
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Marc C Willemsen
- Department of Health Promotion (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Netherlands Expertise Centre for Tobacco Control, Trimbos-institute, Utrecht, The Netherlands
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Nguyen MTH, Sakamoto Y, Maeda T, Woodward M, Anderson CS, Catiwa J, Yazidjoglou A, Carcel C, Yang M, Wang X. Influence of Socioeconomic Status on Functional Outcomes After Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024:e033078. [PMID: 38639361 DOI: 10.1161/jaha.123.033078] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This review aimed to quantify the impact of socioeconomic status on functional outcomes from stroke and identify the socioeconomic status indicators that exhibit the highest magnitude of association. METHODS AND RESULTS We performed a systematic literature search across Medline and Embase from inception to May 2022, to identify observational studies (n≥100, and in English). Risk of bias was assessed using the modified Newcastle Ottawa Scale. Random effects meta-analysis was used to pool data. We included 19 studies (157 715 patients, 47.7% women) reporting functional outcomes measured with modified Rankin Scale or Barthel index, with 10 assessed as low risk of bias. Measures of socioeconomic status reported were education (11 studies), income (8), occupation (4), health insurance status (3), and neighborhood socioeconomic deprivation (3). Pooled data suggested that low socioeconomic status was significantly associated with poor functional outcomes, including incomplete education or below high school level versus high school attainment and above (odds ratio [OR], 1.66 [95% CI, 1.40-1.95]), lowest income versus highest income (OR, 1.36 [95% CI, 1.02-1.83]), a manual job/being unemployed versus a nonmanual job/working (OR, 1.62 [95% CI, 1.29-2.02]), and living in the most disadvantaged socioeconomic neighborhood versus the least disadvantaged (OR, 1.55 [95% CI, 1.25-1.92]). Low health insurance status was also associated with an increased risk of poor functional outcomes (OR, 1.32 [95% CI, 0.95-1.84]), although this was association was not statistically significant. CONCLUSIONS Despite great strides in stroke treatment in the past decades, social disadvantage remains a risk factor for poor functional outcome after an acute stroke. Further research is needed to better understand causal mechanisms and disparities.
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Affiliation(s)
- Mai T H Nguyen
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Centre of Epidemiology for Policy and Practice, National Centre for Epidemiology and Population Health Australian National University Canberra Australian Capital Territory Australia
| | - Yuki Sakamoto
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Department of Neurology Graduate School of Medicine, Nippon Medical School Tokyo Japan
| | - Toshiki Maeda
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Department of Preventive Medicine and Public Health, Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Mark Woodward
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- The George Institute for Global Health, School of Public Health, Imperial College London London United Kingdom
| | - Craig S Anderson
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
- The George Institute China Registered Office of The George Institute for Global Health Australia Beijing China
| | - Jayson Catiwa
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
| | - Amelia Yazidjoglou
- Centre of Epidemiology for Policy and Practice, National Centre for Epidemiology and Population Health Australian National University Canberra Australian Capital Territory Australia
| | - Cheryl Carcel
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
| | - Min Yang
- Department of Neurology First Affiliated Hospital of Chengdu Medical College Chengdu China
| | - Xia Wang
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
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McGing M, Ashbrook M, Cheng V, Matsuo K, Schellenberg M, Martin M, Inaba K, Matsushima K. Identifying Pregnant Patients With Suspected Intimate Partner Violence. Am Surg 2024:31348241248799. [PMID: 38634425 DOI: 10.1177/00031348241248799] [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] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Intimate partner violence (IPV) is the leading cause of death in pregnant women. Although it can be difficult to identify patients experiencing IPV, injuries to the head, neck, or face due to an assault are known to correlate with intentional injury. The objective of this study is to assess the contemporary burden of IPV in pregnancy and describe the patient characteristics. METHODS The National Inpatient Sample was queried for all pregnant women between January 2016 and December 2019. Patients were divided into two groups: suspected IPV (SIPV) and no-SIPV groups. We defined SIPV as any pregnant patient with an identified head, neck, or face injuries categorized as intentional assault. Multivariable logistic regression analysis was performed to assess the association between SIPV and variables of interest. RESULTS A total of 28,540 pregnant patients presented with traumatic injuries with 530 (.02%) identified as SIPV. Suspected IPV patients were younger (25 vs 27 years, P = .012), more likely to be of Black race (46% vs 28%, P = .002), more likely to be in the lowest income quartile (51% vs 38%, P = .031), less likely to have private insurance (12% vs 34%, P < .001), and have higher rates of substance use disorder (35% vs 18%, P < .001). Black race and history of substance use disorder were associated with increased odds of SIPV-related injuries (odds ratio [OR]: 2.01, interquartile range [IQR]: 1.27-3.16, P = .003 and OR: 2.30, IQR 1.54-3.43, P < .001, respectively). CONCLUSIONS Our results suggest that there are significant racial and socioeconomic disparities in potential risk for IPV during pregnancy.
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Affiliation(s)
- Maggie McGing
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Matthew Ashbrook
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Vincent Cheng
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Matthew Martin
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
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16
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Schletzbaum M, Powell WR, Garg S, Kramer J, Astor BC, Gilmore-Bykovskyi A, Kind AJ, Bartels CM. Receipt of rheumatology care and lupus-specific labs among young adults with systemic lupus erythematosus: A US Medicare retention in care cohort study. Lupus 2024:9612033241247905. [PMID: 38631342 DOI: 10.1177/09612033241247905] [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] [Indexed: 04/19/2024]
Abstract
OBJECTIVE In systemic lupus erythematosus, poor disease outcomes occur in young adults, patients identifying as Black or Hispanic, and socioeconomically disadvantaged patients. These identities and social factors differentially shape care access and quality that contribute to lupus health disparities in the US. Thus, our objective was to measure markers of care access and quality, including rheumatology visits (longitudinal care retention) and lupus-specific serology testing, by race and ethnicity, neighborhood disadvantage, and geographic context. METHODS This cohort study used a geo-linked 20% national sample of young adult Medicare beneficiaries (ages 18-35) with lupus-coded encounters and a 1-year assessment period. Retention in lupus care required a rheumatology visit in each 6-month period, and serology testing required ≥1 complement or dsDNA antibody test within the year. Multivariable logistic regression models were fit for visit-based retention and serology testing to determine associations with race and ethnicity, neighborhood disadvantage, and geography. RESULTS Among 1,036 young adults with lupus, 39% saw a rheumatologist every 6 months and 28% had serology testing. White beneficiaries from the least disadvantaged quintile of neighborhoods had higher visit-based retention than other beneficiaries (64% vs 30%-60%). Serology testing decreased with increasing neighborhood disadvantage quintile (aOR 0.80; 95% CI 0.71, 0.90) and in the Midwest (aOR 0.46; 0.30, 0.71). CONCLUSION Disparities in care, measured by rheumatology visits and serology testing, exist by neighborhood disadvantage, race and ethnicity, and region among young adults with lupus, despite uniform Medicare coverage. Findings support evaluating lupus care quality measures and their impact on US lupus outcomes.
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Affiliation(s)
- Maria Schletzbaum
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - W Ryan Powell
- 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
| | - Shivani Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joseph Kramer
- 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
| | - Brad C Astor
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrea Gilmore-Bykovskyi
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amy J Kind
- 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
| | - Christie M Bartels
- 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
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17
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Forrester SN, Baek J, Hou L, Roger V, Kiefe CI. A Comparison of 5 Measures of Accelerated Biological Aging and Their Association With Incident Cardiovascular Disease: The CARDIA Study. J Am Heart Assoc 2024; 13:e032847. [PMID: 38606769 DOI: 10.1161/jaha.123.032847] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Accelerated biological aging is an increasingly popular way to track the acceleration of biology over time that may not be captured by calendar time. Biological aging has been linked to external and internal chronic stressors and has the potential to be used clinically to understand a person's personalized functioning and predict future disease. We compared the association of different measures of biological aging and incident cardiovascular disease (CVD) overall and by race. METHODS AND RESULTS We used multiple informants models to compare the strength of clinical marker-derived age acceleration, 5 measures of epigenetic age acceleration (intrinsic and extrinsic epigenetic age acceleration, GrimAge acceleration, and PhenoAge acceleration), and 1 established clinical predictor of future CVD, Framingham 10-year risk score, with incident CVD over an 11-year period (2007-2018). Participants were 913 self-identified Black or White (41% and 59%, respectively) female or male (51% and 49%, respectively) individuals enrolled in the US-based CARDIA (Coronary Artery Risk Development in Young Adults) cohort study. The analytic baseline for this study was the 20-year follow-up examination (2005-2006; median age 45 years). We also included race-specific analysis. We found that all measures were modestly correlated with one another. However, clinical marker-derived age acceleration and Framingham 10-year risk score were more strongly associated with incident CVD than all the epigenetic measures. Clinical marker-derived age acceleration and Framingham 10-year risk score were not significantly different than one another in their association with incident CVD. CONCLUSIONS The type of accelerated aging measure should be taken into consideration when comparing their association with clinical outcomes. A multisystem clinical composite shows associations with incident CVD equally to a well-known clinical predictor.
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Affiliation(s)
- Sarah N Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services, Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL
| | - Veronique Roger
- Laboratory of Heart Disease Phenomics National Heart, Lung, and Blood Institute Bethesda MD
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
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Ta A, Kaur S, Mader M, Franklin K, Williams M, Williams R, Blaize JP, Naqvi A, Ananth S, Song M, Warnecke BO, Pandya A, Djoumessi LRD, Nazarewicz P, Espinoza-Gutarra M, Lucero KT, Whitehead J, Al-Abayechi A, Boyle L, Lee S, Roman Souza G, Toro Velez E, Mines I, Nooruddin Z. The impact of race and ethnicity on diffuse large B-cell lymphoma outcomes within the veterans health administration (VHA). Leuk Lymphoma 2024:1-10. [PMID: 38619488 DOI: 10.1080/10428194.2024.2338856] [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: 01/22/2024] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
We performed a retrospective chart review of 6266 randomly selected DLBCL patients treated in the VHA nationwide between 1/1/2011 and 12/31/2021. The 3178 patients who met inclusion criteria were predominantly male (97%) and white (75%). Median age of diagnosis for Black patients was 63 years vs 69 years for the entire cohort (p < 0.001). However, patients in each race/ethnicity subgroup presented with similar rates of stage I/II and III/IV disease, IPI score, cell of origin and HIT status. Outcomes analysis revealed similar treatment, response rates, median overall survival, and 1-, 3-, and 5-year survival across all subgroups. Hispanic patients had a 21% lower risk of death (HR = 0.79) than white patients, and Black patients had no significant difference in survival (HR = 0.98). This large retrospective study shows that when standard of care therapy is given within an equal access system, short-term treatment and survival outcomes are the same for all races.
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Affiliation(s)
- Andrew Ta
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Supreet Kaur
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael Mader
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | | | - Ryan Williams
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Amna Naqvi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Snegha Ananth
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Brian Oliver Warnecke
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Abhishek Pandya
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lakene Raissa Djoufack Djoumessi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Manuel Espinoza-Gutarra
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kana Tai Lucero
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Alaq Al-Abayechi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lauren Boyle
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Sophia Lee
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Gabriel Roman Souza
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Esteban Toro Velez
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Ian Mines
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zohra Nooruddin
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
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Ranganathan S, Dee EC, Debnath N, Patel TA, Jain B, Murthy V. Access and barriers to genomic classifiers for breast cancer and prostate cancer in India. Int J Cancer 2024; 154:1335-1339. [PMID: 37962056 DOI: 10.1002/ijc.34784] [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: 05/16/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
The incidence of cancer in general, including breast and prostate cancer specifically, is increasing in India. Breast and prostate cancers have genomic classifiers developed to guide therapy decisions. However, these genomic classifiers are often inaccessible in India due to high cost. These classifiers may also be less suitable to the Indian population, as data primarily from patients in wealthy Western countries were used in developing these genomic classifiers. In addition to the limitations in using these existing genomic classifiers, developing and validating new genomic classifiers for breast and prostate cancer in India is challenging due to the heterogeneity in the Indian population. However, there are steps that can be taken to address the various barriers that currently exist for accurate, accessible genomic classifiers for cancer in India.
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Affiliation(s)
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Debnath
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Morningside/West), New York, New York, USA
| | - Tej A Patel
- Department of Healthcare Management & Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Vedang Murthy
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Abdus S, Selden TM. Racial and Ethnic Disparities in Attendance to Well-Child Visit Recommendations during COVID-19. Acad Pediatr 2024:S1876-2859(24)00146-3. [PMID: 38614214 DOI: 10.1016/j.acap.2024.04.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/25/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVES To measure the impact of the COVID-19 pandemic on racial and ethnic disparities in attendance to well-child visit recommendations. METHODS We used the nationally representative Medical Expenditure Panel Survey (MEPS) to compare pre-pandemic (2018-2019) and pandemic (2020 and 2021) ratios of well-child visits to age-based recommendations, presenting both unadjusted and adjusted attendance disparities over time. We also used the 1996-2021 MEPS to place the pandemic changes in an historical context. RESULTS Average attendance decreased from 66.6% in 2018-2019 (95% confidence interval [CI]: 64.1, 69.1) to 58.6% in 2020 (95% CI: 55.5, 61.6), rebounding to 65.1% in 2021 (95% CI: 61.5, 68.7). The unadjusted disparity in attendance between White non-Hispanic and Black non-Hispanic children widened from 9.6 percentage points in 2018-2019 (95% CI: 2.8, 16.4) to 24.8 percentage points in 2020 (95% CI: 17.5, 32.2) and 21.4 percentage points in 2021 (95% CI: 11.2, 31.5). The unadjusted disparity in attendance between White non-Hispanic and Hispanic children widened from 14.8 percentage points in 2018-2019 (95% CI: 9.7, 19.8) to 26.3 percentage points in 2020 (95% CI: 19.9, 32.7) and 24.9 percentage points in 2021 (95% CI: 17.5, 32.3). Changes in disparities were large even when we controlled for health status, demographic and socioeconomic characteristics, health insurance, and state of residence. Magnitudes of the racial and ethnic attendance disparities during the pandemic's first two years were unprecedented since before 1996. CONCLUSIONS Widening attendance disparities during the pandemic highlight the need to build a more equitable healthcare system for all children. WHAT'S NEW Using nationally representative household data we show that racial and ethnic disparities in attendance to well-child visit recommendations widened to unprecedented levels during the first two years of the COVID-19 pandemic.
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Affiliation(s)
- Salam Abdus
- Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Department of Health and Human Services.
| | - Thomas M Selden
- Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Department of Health and Human Services.
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Choy MA, O'Brien K, Barnes K, Sturgiss EA, Rieger E, Douglas K. Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study. J Med Internet Res 2024; 26:e50410. [PMID: 38602768 DOI: 10.2196/50410] [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: 07/03/2023] [Revised: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. OBJECTIVE This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. METHODS We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. RESULTS In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. CONCLUSIONS While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.
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Affiliation(s)
- Melinda Ada Choy
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
| | - Kathleen O'Brien
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Katelyn Barnes
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
| | | | - Elizabeth Rieger
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Kirsty Douglas
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
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Yamaguchi K, Newhall K, Edman NI, Zettervall SL, Sweet MP. Living in High-Poverty Areas is Associated with Reduced Survival in Patients with Thoracoabdominal Aortic Aneurysm. J Vasc Surg 2024:S0741-5214(24)00953-4. [PMID: 38608968 DOI: 10.1016/j.jvs.2024.03.452] [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: 01/14/2024] [Revised: 03/01/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Studies have demonstrated socioeconomic status, insurance, race, and distance impact clinical outcomes in patients with abdominal aortic aneurysms (AAA). The purpose of this study was to assess if these factors also impact clinical outcomes in patients with thoracoabdominal aortic aneurysms (TAAA). METHODS We conducted a retrospective review of patients with TAAAs confirmed by CT imaging between 2009 to 2019 at a single institution. Patients' zip codes were mapped to American Community Survey Data to obtain geographic poverty rates. We used the standard US Census definition of high-poverty concentration, as >20% of the population living at 100% of the poverty rate. Our primary outcome was overall survival, stratified by whether the patient underwent repair. RESULTS Of 578 patients, 575 had zip code data and were analyzed. In both the non-operative (N=268) and operative (N=307) groups there were no significant differences in age, race, co-morbidities, clinical urgency, surgery utilization, or surgery modality between patients living in high-poverty areas (N=95, 16.4%) versus not. In the non-operative group, patients from high-poverty areas were more likely to have aneurysm due to dissection (37.5 vs. 17.6%, P=0.03). In multivariate analyses, patients from high-poverty zip codes had significantly worse non-operative survival (HR 1.9, 95% 1.1-3.3, P=0.03). In the repair group, high-poverty was also a significant predictor of reduced post-operative survival (HR 1.65, 95% 1-2.63, P=0.04). Adding the Gagne Index, these differences persisted in both groups (non-operative: HR 1.93, 95% 1.01-3.70, P = 0.05; operative: HR 1.62, 95% 1.03-2.56, p = 0.04). In Kaplan-Meier analysis the difference in post-operative survival began approximately 1.5 years after repair. Private insurance was predictive of improved post-operative survival (HR 0.42, 95% 0.18- 0.95, P=0.04) but reduced non-operative survival (HR 2.05, 95% 1.01-4.14, P=0.04). Data were insufficient to determine if race impacted survival discretely from poverty status. These results were found after adjusting for age, race, sex, maximum aortic diameter, coronary artery disease, distance from the hospital, insurance, and active smoking. Interestingly, in multivariate regression, traveling greater than 100 miles was correlated with increased surgery utilization (OR 1.58, 95% 1.08-2.33, P=0.02) and long-term survival (HR 0.61, 95% 0.41-0.92, P=0.02). CONCLUSIONS Patients with TAAA living in high-poverty areas had significantly more dissections and suffered a nearly doubled risk of mortality compared to patients living outside such areas. These data suggest that these disparities are attributed to the overall impacts of poverty and highlight the pressing need for research into TAAA disparities.
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Affiliation(s)
| | - Karina Newhall
- University of Rochester School of Medicine and Dentistry Division of Vascular Surgery
| | - Natasha I Edman
- University of Washington School of Medicine and University of Washington Medical Scientist Training Program
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Yesantharao LV, Sriram S, Litvack JR, Chandrasekhar SS, Galaiya DJ. Is a Simple Checklist Associated With Improvement in Gender Representation at the AAO-HNSF Annual Meeting? Otolaryngol Head Neck Surg 2024. [PMID: 38591747 DOI: 10.1002/ohn.743] [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: 09/24/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE In September 2017, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) added 2 questions querying panel organizers if gender/racial diversity was considered in selecting panel presenters, beginning with the 2018 Annual Meeting (AM). This study examines how this checklist impacted the gender diversity of panel presenters at the AAO-HNS AM. STUDY DESIGN This was a cross-sectional investigation comparing female representation before and after the addition of questions inquiring about diversity in 2018. SETTING A review of abstract submissions for the AMs from 2015 to 2021. METHODS AM Official Program Abstracts were used to obtain presenter names and specialty area for each panel. The percentage of female presenters, in total and stratified by specialty area, were compared before and after 2018 to quantify changes following the addition of the checklist. RESULTS There was a significant increase in the proportion of female panel presenters from 22.3% (total n = 1199) in 2015 to 2017 to 33.0% (total n = 1868) in 2018 to 2021 (P < .001) and in all panel specialties. The number of female moderated panels also significantly increased after checklist implementation from 22% to 38% (P < .001). Correspondingly, the number of panels with no female representation decreased from 42% in 2015 to 2017 to 23% in 2018 to 2021 (P < .001). CONCLUSION The addition of a checklist asking panel organizers to consider diversity in selecting panelists was associated with an increased proportion of female presenters at the AM. This simple strategy can be implemented by all medical conferences to help close the gender gap.
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Affiliation(s)
- Lekha V Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shreya Sriram
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jamie R Litvack
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | | | - Deepa J Galaiya
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Gilmore N, Grant SJ, Bethea TN, Schiaffino MK, Klepin HD, Dale W, Hardi A, Mandelblatt J, Mohile S. A scoping review of racial, ethnic, socioeconomic, and geographic disparities in the outcomes of older adults with cancer. J Am Geriatr Soc 2024. [PMID: 38593225 DOI: 10.1111/jgs.18881] [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: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Cancer health disparities are widespread. Nevertheless, the disparities in outcomes among diverse survivors of cancer ages 65 years and older ("older") have not been systematically evaluated. METHODS We conducted a scoping review of original research articles published between January 2016 and September 2023 and indexed in Medline (Ovid), Embase, Scopus, and CINAHL databases. We included studies evaluating racial, ethnic, socioeconomic disadvantaged, geographic, sexual and gender, and/or persons with disabilities disparities in treatment, survivorship, and mortality among older survivors of cancer. We excluded studies with no a priori aims related to a health disparity, review articles, conference proceedings, meeting abstracts, studies with unclear methodologies, and articles in which the disparity group was examined only as an analytic covariate. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. RESULTS After searching and removing duplicates, 2573 unique citations remained and after screening 59 articles met the inclusion criteria. Many investigated more than one health disparity, and most focused on racial and ethnic (n = 44) or socioeconomic (n = 25) disparities; only 10 studies described geographic disparities, and none evaluated disparities in persons with disabilities or due to sexual and gender identity. Research investigating disparities in outcomes among diverse older survivors of cancer is increasing gradually-68% of eligible articles were published between 2020 and 2023. Most studies focused on the treatment phase of care (n = 28) and mortality (n = 26), with 16 examined disparities in survivorship, symptoms, or quality of life. Most research was descriptive and lacked analyses of potential underlying mechanisms contributing to the reported disparities. CONCLUSION Little research has evaluated the effect of strategies to reduce health disparities among older patients with cancer. This lack of evidence perpetuates cancer inequities and leaves the cancer care system ill equipped to address the unique needs of the rapidly growing and increasingly diverse older adult cancer population.
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Affiliation(s)
- Nikesha Gilmore
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, New York, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research and the Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Melody K Schiaffino
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, USA
| | - Heidi D Klepin
- Department of Hematology and Oncology, Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanne Mandelblatt
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Supriya Mohile
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
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Dobbs E, Tobin EC, Deslich S, Richmond BK. Race/Ethnicity and Social Determinants of Health and Their Impact on Receiving Appropriate Chemotherapy for Colon Cancer. Am Surg 2024:31348241244646. [PMID: 38587435 DOI: 10.1177/00031348241244646] [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] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Despite the heightened understanding and improved treatment for colorectal cancer in the United States, social determinants of health (SDH) play a significant role in the colorectal cancer outcomes. We sought to investigate the relationship between SDH and appropriate utilization of adjuvant chemotherapy in stage III colon cancer. METHODS For this retrospective study, we utilized data from the National Cancer Data Base (NCDB). Descriptive statistics are reported, including means and 95% confidence intervals for continuous variables and frequency and proportions for categorical variables. Univariate hypothesis testing to identify categorical level factors associated with treatment used Wilcoxon rank sum or Kruskal-Wallis tests, with multivariate analyses performed using regression analysis. RESULTS Significant differences were as follows: Metro-non-Hispanic White patients received treatment less frequently (69.7%) when compared to Metro-non-Hispanic Black patients (73.4%) (P < .001). Increasing age was a negative predictor of likelihood to receive with those over 65 years old having an 83% decrease in likelihood to receive chemotherapy when compared to those under 65 (P < .001). Medicaid patients were 47% less likely and Medicare patients were 40% less likely to receive chemotherapy when compared to those with private insurance (P < .001). Rural patients were statistically more likely to receive chemotherapy (OR 1.42, 1.32-2.52, P < .001) as were urban patients, (OR 1.26, 1.20-1.31, P < .001) when compared to patients residing in metro areas. CONCLUSION Age, living in a Metro area, and government insurance status at diagnosis are negatively correlated with the likelihood of receiving chemotherapy. Race was not associated with differences in receiving chemotherapy.
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Affiliation(s)
- Erica Dobbs
- Department of Surgery, Charleston Area Medical Center, Charleston, WV, USA
| | - Edward C Tobin
- Department of Surgery, Charleston Area Medical Center, Charleston, WV, USA
| | - Staci Deslich
- CAMC Health Education and Research Institute, Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Bryan K Richmond
- Department of Surgery, West Virginia University/Charleston Division, Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
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Pugazenthi S, Price M, De La Vega Gomar R, Kruchko C, Waite KA, Barnholtz-Sloan JS, Walsh KM, Kim AH, Ostrom QT. Association of county-level socioeconomic status with meningioma incidence and outcomes. Neuro Oncol 2024; 26:749-763. [PMID: 38087980 PMCID: PMC10995507 DOI: 10.1093/neuonc/noad223] [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: 04/06/2024] Open
Abstract
BACKGROUND Prior literature suggests that individual socioeconomic status (SES) may influence incidence, treatments, and survival of brain tumor cases. We aim to conduct the first national study to evaluate the association between US county-level SES and incidence, treatment, and survival in meningioma. METHODS The Central Brain Tumor Registry of the United States analytic dataset, which combines data from CDC's National Program of Cancer Registries (NPCR) and National Cancer Institute's Surveillance, Epidemiology, and End Results Program, was used to identify meningioma cases from 2006 to 2019. SES quintiles were created using American Community Survey data. Logistic regression models were used to evaluate associations between SES and meningioma. Cox proportional hazard models were constructed to assess the effect of SES on survival using the NPCR analytic dataset. RESULTS A total of 409 681 meningioma cases were identified. Meningioma incidence increased with higher county-level SES with Q5 (highest quintile) having a 12% higher incidence than Q1 (incidence rate ratios (IRR) = 1.12, 95%CI: 1.10-1.14; P < .0001). The Hispanic group was the only racial-ethnic group that had lower SES associated with increased meningioma incidence (Q5: age-adjusted incidence ratio (AAIR) = 9.02, 95%CI: 8.87-9.17 vs. Q1: AAIR = 9.33, 95%CI: 9.08-9.59; IRR = 0.97, 95%CI: 0.94-1.00; P = .0409). Increased likelihood of surgical treatment was associated with Asian or Pacific Islander non-Hispanic individuals (compared to White non-Hispanic (WNH)) (OR = 1.28, 95%CI: 1.23-1.33, P < .001) and males (OR = 1.31, 95%CI: 1.29-1.33, P < .001). Black non-Hispanic individuals (OR = 0.90, 95%CI: 0.88-0.92, P < .001) and those residing in metropolitan areas (OR = 0.96, 95%CI: 0.96-0.96, P < .001) were less likely to receive surgical treatment compared to WNH individuals. Overall median survival was 137 months, and survival was higher in higher SES counties (Q5 median survival = 142 months). CONCLUSIONS Higher county-level SES was associated with increased meningioma incidence, surgical treatment, and overall survival. Racial-ethnic stratification identified potential disparities within the meningioma population. Further work is needed to understand the underpinnings of socioeconomic and racial disparities for meningioma patients.
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Affiliation(s)
- Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
| | - Kyle M Walsh
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
- The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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27
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Asfaw ZK, Hernandez-Marquez GC, Naik A, Young T, Vega Perez R, Bickell N, Germano IM. The intersection of race and social determinants of health on clinical outcome of glioblastoma patients. J Neurosurg 2024:1-10. [PMID: 38579343 DOI: 10.3171/2024.1.jns232702] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/24/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Resection, chemotherapy, radiation therapy, and tumor treating fields significantly increase the overall survival (OS) of glioblastoma (GBM) patients. Yet, cost and healthcare disparities might limit access. Multiple studies have attributed more than 80% of the GBM disease burden to White patients. The aim of this study was to explore the intersections of race and social determinants of health (SDoH) with healthcare access and outcomes of GBM patients in a large metropolitan area. METHODS In this retrospective single-center study, the tumor registry at the authors' institution (2011-2019) was queried to identify a GBM cohort according to the updated WHO criteria. Data were supplemented by electronic health records to include demographics, outcome, National Cancer Institute Comorbidity Index (NCI-CI), and the Agency for Healthcare Research and Quality (AHRQ) socioeconomic status (SES) index. RESULTS A total of 276 unique patients met the study inclusion criteria; 46% of the cohort was female, and 45% was non-White. This racial proportion differs from previous reports indicating that 80% of patients with GBM are White. The proportion of non-White patients in this study was similar to that of the general US population and significantly lower than that of New York City (p < 0.05). Non-White patients predominantly composed the lowest AHRQ SES index quartile, while White patients constituted the highest quartile (p < 0.001). White patients were older at diagnosis compared with non-White patients (63 vs 58 years, p = 0.001). Older age (p = 0.03), higher NCI-CI (p = 0.0006), and lack of insurance (p = 0.03) reduced the odds of a home discharge. Private insurance (p = 0.005), younger age (p = 0.02), and the highest ("wealthiest") AHRQ SES index quartile (p = 0.02) predicted a lower hospital length of stay (LOS). Patients who underwent gross-total resection had greater OS than those who received a subtotal resection or biopsy, independent of race and SDoH (1.68 vs 1.4 years, p = 0.022). CONCLUSIONS This study is the first to report on race and SDoH of a cohort using the latest WHO criteria for GBM classification. In contrast to previous literature, the study cohort exhibits a higher proportion of non-White patients with GBM, similar to the representation of non-White individuals in the general US population. This study corroborates the impact of SDoH and not race on LOS and discharge location. Initiatives to identify and address these barriers are crucial for enhancing the care of all GBM patients.
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Affiliation(s)
- Zerubabbel K Asfaw
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
- 2Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Anant Naik
- 3Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, Illinois; and
| | - Tirone Young
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
- 2Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Nina Bickell
- 4Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Isabelle M Germano
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Wartman C, Ott C. Improving mental healthcare for sexual and gender minorities: Insights and strategies for pharmacists. Am J Health Syst Pharm 2024; 81:340-344. [PMID: 38141255 DOI: 10.1093/ajhp/zxad320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Indexed: 12/25/2023] Open
Affiliation(s)
- Carolanne Wartman
- Department of Pharmacy Practice, The University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Carol Ott
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA
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Denny MC, Rosendale N, Gonzales NR, Leslie-Mazwi TM, Middleton S. Addressing Disparities in Acute Stroke Management and Prognosis. J Am Heart Assoc 2024; 13:e031313. [PMID: 38529656 DOI: 10.1161/jaha.123.031313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.
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Affiliation(s)
- M Carter Denny
- Department of Neurology Georgetown University School of Medicine Washington DC USA
- Department of Neurology, MedStar Health Washington DC USA
| | - Nicole Rosendale
- Department of Neurology University of California San Francisco San Francisco CA USA
- Weill Institute for Neurosciences, University of California San Francisco San Francisco CA USA
| | - Nicole R Gonzales
- Department of Neurology University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University Darlinghurst Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University Darlinghurst Australia
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30
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Tan MC, Yeo YH, Mirza N, San BJ, Tan JL, Lee JZ, Mazzarelli JK, Russo AM. Trends and Disparities in Cardiovascular Death in Sarcoidosis: A Population-Based Retrospective Study in the United States From 1999 to 2020. J Am Heart Assoc 2024; 13:e031484. [PMID: 38533928 DOI: 10.1161/jaha.123.031484] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/06/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Despite significant cardiac involvement in sarcoidosis, real-world data on death due to cardiovascular disease among patients with sarcoidosis is not well established. METHODS AND RESULTS We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for data on patients with sarcoidosis aged ≥25 years from 1999 to 2020. Diseases of the circulatory system except ischemic heart disease were listed as the underlying cause of death, and sarcoidosis was stated as a contributing cause of death. We calculated age-adjusted mortality rate (AAMR) per 1 million individuals and determined the trends over time by estimating the annual percentage change using the Joinpoint Regression Program. Subgroup analyses were performed on the basis of demographic and geographic factors. In the 22-year study period, 3301 cardiovascular deaths with comorbid sarcoidosis were identified. The AAMR from cardiovascular deaths with comorbid sarcoidosis increased from 0.53 (95% CI, 0.43-0.65) per 1 million individuals in 1999 to 0.87 (95% CI, 0.75-0.98) per 1 million individuals in 2020. Overall, women recorded a higher AAMR compared with men (0.77 [95% CI, 0.74-0.81] versus 0.58 [95% CI, 0.55-0.62]). People with Black ancestry had higher AAMR than people with White ancestry (3.23 [95% CI, 3.07-3.39] versus 0.39 [95% CI, 0.37-0.41]). A higher percentage of death was seen in the age groups of 55 to 64 years in men (23.11%) and women (21.81%), respectively. In terms of US census regions, the South region has the highest AAMR from cardiovascular deaths with comorbid sarcoidosis compared with other regions (0.78 [95% CI, 0.74-0.82]). CONCLUSIONS The increase of AAMR from cardiovascular deaths with comorbid sarcoidosis and higher cardiovascular mortality rates among adults aged 55 to 64 years highlight the importance of early screening for cardiovascular diseases among patients with sarcoidosis.
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Affiliation(s)
- Min Choon Tan
- Department of Internal Medicine New York Medical College at Saint Michael's Medical Center Newark NJ USA
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics Beaumont Health Royal Oak MI USA
| | - Noreen Mirza
- Department of Internal Medicine New York Medical College at Saint Michael's Medical Center Newark NJ USA
| | | | - Jian Liang Tan
- Department of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH USA
| | - Joanne K Mazzarelli
- Department of Medicine Cooper University Health System/Cooper Medical School of Rowan University Camden NJ USA
| | - Andrea M Russo
- Department of Medicine Cooper University Health System/Cooper Medical School of Rowan University Camden NJ USA
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Kumar N, Akosman I, Mortenson R, Kumar A, Xu G, Lathrop C, Bakhmat K, Amen TB, Hussain I. Gender disparities in postoperative outcomes following elective spine surgery: a systematic review and meta-analysis. J Neurosurg Spine 2024; 40:420-427. [PMID: 38157525 DOI: 10.3171/2023.11.spine23979] [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: 09/01/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Several studies have described disparities between male and female patients following spine surgery, but no pooled analyses have performed a robust review characterizing differences in postoperative outcomes based on gender. The purpose of this study was to broadly assess the effects of gender on postoperative outcomes following elective spine surgery. METHODS Between November 2022 and March 2023, PubMed, MEDLINE, ERIC, and Embase were queried using artificial intelligence-assisted software for relevant cohort studies. Cohort studies with a minimum sample of 100 patients conducted in the United States since 2010 were eligible. Studies related to trauma, tumors, infections, and spinal cord pathology were excluded. Independent extraction by multiple reviewers was performed using Nested Knowledge software. A fixed- or random-effects model was used if heterogeneity among included studies in a meta-analysis was < 50% or ≥ 50%, respectively. Risk of bias was assessed independently by multiple reviewers using the Newcastle-Ottawa Scale. Pooled effect sizes were calculated for readmission, nonroutine discharge (NRD), length of stay (LOS), extended LOS, reoperation, mortality, all medical complications (individual analyses for cardiovascular, deep venous thrombosis/pulmonary embolism, genitourinary, neurological, respiratory, and systemic infection complications), and wound-related complications. For each outcome, two subanalyses were performed with studies that used either center-based (single- or multi-institution) or high-volume (national or state-wide) databases. RESULTS Across 124 included studies, male patients had an increased incidence of mortality (OR 0.54, p < 0.0001) and all medical complications (OR 0.80, p = 0.0114), specifically cardiovascular (OR 0.68, p < 0.0001) and respiratory (OR 0.76, p = 0.0008) complications. Female patients were more likely to experience a wound-related surgical complication (OR 1.16, p = 0.0183). These findings persisted in the high-volume database subanalyses. Only center-based subanalyses showed that female patients were at greater odds of experiencing an NRD (OR 1.18, p = 0.0476), longer LOS (SMD 0.23, p = 0.0036), and extended LOS (OR 1.28, p < 0.0001). CONCLUSIONS Males are more likely to experience death and medical complications, whereas females were more likely to face wound-related surgical complications. At the institution level, females more often experience NRD and longer hospital stays. These findings may better inform preoperative expectation management and provide more detailed postoperative risk assessments based on the patient's gender.
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Affiliation(s)
- Neerav Kumar
- 1Weill Cornell Medical College, New York, New York
| | | | | | | | - Grace Xu
- 4Princeton University, Princeton, New Jersey
| | - Cooper Lathrop
- 5Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Troy B Amen
- 7Hospital for Special Surgery, New York, New York; and
| | - Ibrahim Hussain
- 8Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
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Federman A, Wisnivesky JP. Unveiling the reasons for disparities in prevalence of asthma and allergic conditions in Black children: The role of socioeconomic status. J Allergy Clin Immunol 2024; 153:983-984. [PMID: 38316270 DOI: 10.1016/j.jaci.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine, New York, NY
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine, New York, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, New York, NY.
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Venchiarutti RL, Clark JR, Palme CE, Dwyer P, Tahir ARM, Hill J, Ch'ng S, Elliott MS, Young JM. Associations between patient-level health literacy and diagnostic time intervals for head and neck cancer: A prospective cohort study. Head Neck 2024; 46:857-870. [PMID: 38213101 DOI: 10.1002/hed.27633] [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: 06/13/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Health literacy (HL) comprises skills and knowledge required to understand, access, and make decisions about healthcare. Our aim was to examine associations between patient HL and time intervals (defined in the Aarhus statement) along the pathway to treatment of head and neck cancer (HNC). METHODS A prospective cohort study was conducted from October 2018 to March 2020. Participants completed the Health Literacy Questionnaire (HLQ®) and described key events and dates along the pathway to treatment using validated questionnaires. Correlations between six diagnostic time intervals and domains of HL were explored, and factors predicting exceeding maximum acceptable timeframes were assessed using logistic regression. RESULTS One hundred patients with a diagnosis of HNC within the preceding 6 months were recruited. HLQ® Domain 2 (sufficient information to manage health) was significantly negatively associated with four intervals: the patient interval (first symptom to first presentation), primary care interval (first presentation to referral to secondary care), diagnostic interval (first presentation to diagnosis), and total interval (first symptom to treatment onset); correlation coefficients -0.25 to -0.27 (P < 0.05). Domain 8 (ability to find good information) was significantly negatively associated with three intervals (primary care interval, diagnostic interval, and total interval; correlation coefficients -0.23 to -0.34; P < 0.05). Higher education, age, and comorbidity levels were associated with shorter patient and diagnostic intervals. CONCLUSIONS HL may be a potential target to improve timeliness of HNC diagnosis and reduce disparities in outcomes.
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Affiliation(s)
- Rebecca L Venchiarutti
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Patrick Dwyer
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Abdul Rahim Mohd Tahir
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Jacques Hill
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Jane M Young
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Camperdown, New South Wales, Australia
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Croce EA, Parast L, Bhavnani D, Matsui EC. Lower socioeconomic status may help explain racial disparities in asthma and atopic dermatitis prevalence: A mediation analysis. J Allergy Clin Immunol 2024; 153:1140-1147.e3. [PMID: 37995856 DOI: 10.1016/j.jaci.2023.11.013] [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: 06/29/2023] [Revised: 10/09/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Racial disparities in atopic disease (atopic dermatitis [AD], asthma, and allergies) prevalence are well documented. Despite strong associations between race and socioeconomic deprivation in the United States, and socioeconomic status (SES) and atopic diseases, the extent to which SES explains these disparities is not fully understood. OBJECTIVE We sought to identify racial disparities in childhood atopic disease prevalence and determine what proportion of those disparities is mediated by SES. METHODS This study used the National Health Interview Survey (2011-2018) to investigate AD, asthma, and respiratory allergy prevalence in Black and White children and the extent to which measures of SES explain any identified disparities. RESULTS By race, prevalences were as follows: AD, White 11.8% (95% CI: 11.4%, 12.2%) and Black 17.4% (95% CI: 16.6%, 18.3%); asthma prevalence, White 7.4% (95% CI: 7.0%, 7.7%) and Black 14.3% (95% CI: 13.5%, 15.0%); respiratory allergy, White 11.4% (95% CI: 11.0%, 11.9%) and Black 10.9% (95% CI: 10.3%, 11.6%). The percentage of the disparity between racial groups and disease prevalence explained by a multivariable measure of SES was 25% (95% CI: 15%, 36%) for Black versus White children with AD and 47% (95% CI: 40%, 54%) for Black versus White children with asthma. CONCLUSIONS In a nationally representative US population, Black children had higher prevalence of AD and asthma than White children did and similar prevalence of respiratory allergy; a multivariable SES measure explained a proportion of the association between Black versus White race and AD and a much larger proportion for asthma.
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Affiliation(s)
- Emily A Croce
- Dell Medical School, University of Texas at Austin, Austin, Tex; Steve Hicks School of Social Work, University of Texas at Austin, Austin, Tex; Dell Children's Medical Group, Austin, Tex
| | - Layla Parast
- Department of Statistics and Data Sciences, University of Texas at Austin, Austin, Tex
| | | | - Elizabeth C Matsui
- Dell Medical School, University of Texas at Austin, Austin, Tex; Dell Children's Medical Group, Austin, Tex.
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Shelton BA, Sen B, Becker DJ, MacLennan PA, Budhwani H, Locke JE. Quantifying the association of individual-level characteristics with disparities in kidney transplant waitlist addition among people with HIV. AIDS 2024; 38:731-737. [PMID: 38100633 PMCID: PMC10939916 DOI: 10.1097/qad.0000000000003817] [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: 06/11/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Over 45% of people with HIV (PWH) in the United States at least 50 years old and are at heightened risk of aging-related comorbidities including end-stage kidney disease (ESKD), for which kidney transplant is the optimal treatment. Among ESKD patients, PWH have lower likelihood of waitlisting, a requisite step in the transplant process, than individuals without HIV. It is unknown what proportion of the inequity by HIV status can be explained by demographics, medical characteristics, substance use history, and geography. METHODS The United States Renal Data System, a national database of all individuals ESKD, was used to create a cohort of people with and without HIV through Medicare claims linkage (2007-2017). The primary outcome was waitlisting. Inverse odds ratio weighting was conducted to assess what proportion of the disparity by HIV status could be explained by individual characteristics. RESULTS Six thousand two hundred and fifty PWH were significantly younger at ESKD diagnosis and more commonly Black with fewer comorbidities. PWH were more frequently characterized as using tobacco, alcohol and drugs. Positive HIV-status was associated with 57% lower likelihood of waitlisting [adjusted hazard ratio (aHR): 0.43, 95% confidence interval (CI): 0.46-0.48, P < 0.001]. Controlling for demographics, medical characteristics, substance use and geography explained 39.8% of this observed disparity (aHR: 0.69, 95% CI: 0.59-0.79, P < 0.001). CONCLUSION PWH were significantly less likely to be waitlisted, and 60.2% of that disparity remained unexplained. HIV characteristics such as CD4 + counts, viral loads, antiretroviral therapy adherence, as well as patient preferences and provider decision-making warrant further study.
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Affiliation(s)
- Brittany A. Shelton
- Department of Public Health, University of Tennessee, Knoxville, Tennessee
- Heersink School of Medicine
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bisakha Sen
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - David J. Becker
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Henna Budhwani
- College of Nursing, Florida State University, Tallahassee, Florida, USA
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Berkman AM, Choi E, Cheung CK, Salsman JM, Peterson SK, Andersen CR, Lu Q, Livingston JA, Hildebrandt MAT, Parsons SK, Roth ME. Socioeconomic Status and Chronic Health Conditions in Asian Survivors of Adolescent and Young Adult Cancers. J Adolesc Young Adult Oncol 2024; 13:262-270. [PMID: 37594775 DOI: 10.1089/jayao.2023.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/19/2023] Open
Abstract
Purpose: While there are known disparities in socioeconomic status (SES) and health outcomes among racially and ethnically minoritized adolescent and young adult (AYA; ages 15-39 years at diagnosis) cancer survivors compared with White survivors, outcomes in the Asian survivor population are understudied. To better understand the association of an AYA cancer diagnosis with SES and health outcomes within a minoritized population, the current study makes comparisons between individuals of the same race or ethnicity with and without a history of AYA cancer. Methods: Non-Hispanic, Asian AYA cancer survivors and non-Hispanic, Asian age- and sex-matched controls were identified from self-reported data in the National Health Interview Survey (2009-2020). Prevalence of chronic health conditions and socioeconomic factors were compared between groups using chi-square tests. Odds of chronic conditions by SES factors were determined within and between survivors and controls using logistic regression methods. Results: One hundred and thirty-one survivors and 1310 controls were included. Survivors were less likely to be married compared with controls; however, there were no differences in other SES factors examined. Survivors had higher odds of at least one chronic condition diagnosis (odds ratio = 4.17, p < 0.001) compared with controls. Of the chronic conditions assessed, survivors had higher odds of arthritis, pulmonary disease, and hypertension compared with controls. Conclusions: Asian AYA cancer survivors are at increased risk of chronic health conditions compared with Asian individuals without a cancer history. Culturally adapted targeted interventions are needed to improve health outcomes for this population.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eunju Choi
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qian Lu
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Institute, Houston, Texas, USA
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hale FB, Harris AL. Understanding the Psychological Risks to Maternal Mental Health, Maternal-Infant Bonding, and Infant Development During the COVID-19 Pandemic. Nurs Womens Health 2024; 28:152-158. [PMID: 38373696 DOI: 10.1016/j.nwh.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024]
Abstract
This short review summarizes two recent U.S.-based studies in which researchers evaluated the impact of the COVID-19 pandemic on postpartum outcomes. The first study examined the neurodevelopmental status of infants born to women infected with SARS-CoV-2, and the second examined psychological risks to maternal-infant bonding. Results indicated that pandemic-related stressors likely contributed to diminished maternal-infant health outcomes. It is imperative that nurses stay informed on the latest science exploring the impact the pandemic has had on the health and well-being of pregnant persons and infants.
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Kaplan CM, Waters TM, Clear ER, Graves EE, Henderson S. The Impact of Prescription Drug Coverage on Disparities in Adherence and Medication Use: A Systematic Review. Med Care Res Rev 2024; 81:87-95. [PMID: 38174355 DOI: 10.1177/10775587231218050] [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] [Indexed: 01/05/2024]
Abstract
Prescription drug cost-sharing is a barrier to medication adherence, particularly for low-income and minority populations. In this systematic review, we examined the impact of prescription drug cost-sharing and policies to reduce cost-sharing on racial/ethnic and income disparities in medication utilization. We screened 2,145 titles and abstracts and identified 19 peer-reviewed papers that examined the interaction between cost-sharing and racial/ethnic and income disparities in medication adherence or utilization. We found weak but inconsistent evidence that lower cost-sharing is associated with reduced disparities in adherence and utilization, but studies consistently found that significant disparities remained even after adjusting for differences in cost-sharing across individuals. Study designs varied in their ability to measure the causal effect of policy or cost-sharing changes on disparities, and a wide range of policies were examined across studies. Further research is needed to identify the types of policies that are best suited to reduce disparities in medication adherence.
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Gilja S, Kumar A, Kapustin D, Su V, Rubin SJ, Chai R, Roof SA, Khan MN. The Impact of Hospital Safety-Net Burden Status on Patients with HPV-Positive Oropharyngeal Cancer. Laryngoscope 2024; 134:1733-1740. [PMID: 37933810 DOI: 10.1002/lary.31131] [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: 06/26/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The objective of this study was to compare treatment characteristics and outcomes between patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety-net burden status. METHODS Patients with cT1-4, N0-3, M0 HPV-positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety-net burden status, defined as the percentage of uninsured and Medicaid-insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0-25th percentile), medium burden (MBH: 25th-75th percentile), or high burden (HBH: 75th-100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable-adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis. RESULTS Of the 19,810 patients with cT1-4, N0-3, M0 HPV-positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable-adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12-1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24-0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13-1.43, p < 0.001). CONCLUSION These findings highlight underlying disparities at higher safety-net burden facilities that impact patterns of care and outcomes for patients with OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1733-1740, 2024.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Danielle Kapustin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Vivian Su
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Samuel J Rubin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Raymond Chai
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
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Beaudoin JR, Curran J, Alexander GC. Impact of Race on Classification of Atherosclerotic Risk Using a National Cardiovascular Risk Prediction Tool. AJPM Focus 2024; 3:100200. [PMID: 38440670 PMCID: PMC10910235 DOI: 10.1016/j.focus.2024.100200] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Introduction The use of race in clinical risk prediction tools may exacerbate racial disparities in healthcare access and outcomes. This study quantified the number of individuals reclassified for primary prevention of cardiovascular disease owing to a change in their race alone on the basis of a commonly used risk prediction tool. Methods This is a cross-sectional analysis of individuals aged 40-75 years without a history of cardiovascular events, diabetes, or other high-risk features using the 2005-2018 National Health and Nutritional Examination Survey. Authors compared atherosclerotic cardiovascular disease risk scores using the American Heart Association/American College of Cardiology equation recommended for White individuals or individuals of other races with that recommended for Black individuals. Results A total of 2,946 White individuals; 1,361 Black individuals; and 2,495 individuals of other races were included in the analysis. Using the American Heart Association/American College of Cardiology equation, the mean 10-year atherosclerotic cardiovascular disease risk was 5.80% (95% CI=5.54, 6.06) for White individuals, 7.04% (956% CI=6.69, 7.39) for Black individuals, and 4.93% (95% CI=4.61, 5.24) for individuals of other races. When using the American Heart Association/American College of Cardiology equation designated for the opposite race (White/other race versus Black), the mean atherosclerotic cardiovascular disease risk score increased by 1.02% (95% CI=0.90, 1.13) for White individuals, decreased by 1.82% (95% CI= -1.67, -1.96) for Black individuals, and increased by 0.98% (95% CI=0.85, 1.10) for individuals of other races. When using clinical atherosclerotic cardiovascular disease categories of <7.5%, 7.5%-10%, and >10%, 16.93% of all individuals were reclassified when using the American Heart Association/American College of Cardiology's equation designated for the opposite race. Conclusions Changing race within a commonly used cardiovascular risk prediction tool results in significant changes in risk classification among eligible White and Black individuals in the U.S.
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Affiliation(s)
- Jarett R. Beaudoin
- Department of Family and Community Medicine, University of California, Davis, California
| | - Jill Curran
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Avery M, Wolfe J, DeCourcey DD. Economic Hardship at the End of Life for Families of Children With Complex Chronic Conditions. J Pain Symptom Manage 2024; 67:e313-e319. [PMID: 38151216 DOI: 10.1016/j.jpainsymman.2023.12.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023]
Abstract
CONTEXT Many children with complex chronic medical conditions (CCC), though living longer, die prematurely. Little is known about family economic hardship during end of life (EOL), nor associated differences in patterns of care. OBJECTIVES To describe the prevalence, experience, and characteristics of families of patients with CCC who report great economic hardship (GEH), and associations with end-of-life care patterns and suffering. METHODS We conducted a 183-item cross-sectional survey of bereaved parents of patients cared for at Boston Children's Hospital and chart reviews for each patient. Fifteen survey items on economic hardship related to financial and material hardships including food, housing, and utility insecurity. RESULTS A total of 114 bereaved parents completed the survey (54% response rate) and economic hardship data was analyzed for 105. Nearly a fifth reported GEH. This group was characterized by fewer two parent households. Children from families with GEH had spent more time hospitalized than those without GEH. CONCLUSION Economic burden on families of children with CCC correlates with higher health care utilization demonstrating the need for ameliorative resources and preventative measures.
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Affiliation(s)
- Madeline Avery
- Pediatric Palliative Care (M.V., J.W.), Department of Pediatrics, Massachusetts General Hospital, Boston Massachusetts, USA.
| | - Joanne Wolfe
- Pediatric Palliative Care (M.V., J.W.), Department of Pediatrics, Massachusetts General Hospital, Boston Massachusetts, USA
| | - Danielle D DeCourcey
- Division of Medical Critical Care (D.D.D.), Department of Pediatrics, Boston Children's Hospital, Boston Massachusetts, USA
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Goff SL, Shieh MS, Lindenauer PK, Ash AS, Krishnan JA, Geissler KH. Differences in Health Care Utilization for Asthma by Children with Medicaid versus Private Insurance. Popul Health Manag 2024; 27:105-113. [PMID: 38574325 PMCID: PMC11001504 DOI: 10.1089/pop.2023.0244] [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: 04/06/2024] Open
Abstract
Asthma is the most common chronic disease in children, disproportionately affects families with lower incomes, and is a leading reason for acute care visits and hospitalizations. This retrospective cohort study used the Massachusetts All Payer Claims Database (2014-2018) to examine differences in acute care utilization and quality of care for asthma between Medicaid- and privately insured children in Massachusetts. Outcomes included acute care use (emergency department [ED] or hospitalization), ED visits with asthma, routine asthma visits, and filled prescriptions for asthma medications. Multivariable logistic regression was used to account for differences in demographics, ZIP codes, health status, and asthma severity. Overall, 10.0% of Medicaid-insured children and 5.6% of privately insured were classified as having asthma. Among 317,596 child-year observations for children with asthma, 64.4% were insured by Medicaid. Medicaid-insured children had higher rates of any acute care use (50.4% vs. 30.0%) and ED visits with an asthma diagnosis (27.2% vs. 13.3%) compared to privately insured children. Only 65.4% of Medicaid enrollees had at least one routine asthma visit compared to 74.3% of privately insured children. Most children received at least one asthma medication (88.6% Medicaid vs. 83.3% privately insured), but a higher percentage of Medicaid-insured children received at least one rescue medication (84.0% vs. 73.7%), and a lower percentage of Medicaid-insured (46.1% vs. 49.2%) received a controller medication. These results suggest that opportunities for improvement in childhood asthma persist, particularly for children insured by Medicaid.
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Affiliation(s)
- Sarah L. Goff
- Department of Health Promotion and Policy, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Jerry A. Krishnan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago, Chicago, Illinois, USA
- Institute for Healthcare Delivery Design, University of Illinois Chicago, Chicago, Illinois, USA
| | - Kimberley H. Geissler
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
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Lentine KL, Miyata KN, Lam NN, Joseph C, McAdams-DeMarco M, Bae S, Chen Y, Caliskan Y, Sarabu N, Dhindsa S, Xiao H, Segev DL, Axelrod DA, Schnitzler MA. Sociodemographic disparities in sodium-glucose cotransporter-2 inhibitor use among US kidney transplant recipients: An observational study of real-world pharmacy records. Clin Transplant 2024; 38:e15257. [PMID: 38563475 DOI: 10.1111/ctr.15257] [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: 08/28/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Recent clinical trials demonstrate benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with chronic kidney disease, but data on use in kidney transplant (KTx) recipients are limited. METHODS We examined a novel database linking SRTR registry data for KTx recipients (2000-2021) with outpatient fill records from a large pharmaceutical claims warehouse (2015-2021). Adult (≥18 years) KTx recipients treated with SGLT2i were compared to those who received other noninsulin diabetes medications without SGLT2i. Characteristics associated with SGLT2i use were quantified by multivariable logistic regression (adjusted odds ratio, 95%LCLaOR95%UCL). RESULTS Among 18 988 KTx recipients treated with noninsulin diabetes agents in the study period, 2224 filled an SGLT2i. Mean time from KTx to prescription was 6.7 years for SGLT2i versus 4.7 years for non-SGLT2i medications. SGLT2i use was more common in Asian adults (aOR, 1.091.311.58) and those aged > 30-59 years (compared with 18-30 years) or with BMI > 35 kg/m2 (aOR, 1.191.411.67), and trended higher with self-pay status. SGLT2i use was lower among KTx recipients who were women (aOR, .79.87.96), Black (aOR, .77.881.00) and other (aOR, .52.751.07) race, publicly insured (aOR, .82.921.03), or with less than college education (aOR, .78.87.96), and trended lower in those age 75 years and older. SGLT2i use in KTx patients increased dramatically in 2019-2021 (aOR, 5.015.636.33 vs. prior years). CONCLUSION SGLT2i use is increasing in KTx recipients but varies with factors including race, education, and insurance. While ongoing study is needed to define risks and benefits of SGLT2i use in KTx patients, attention should also focus on reducing treatment disparities related to sociodemographic traits.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, Saint Louis, Missouri, USA
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Kana N Miyata
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Ngan N Lam
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Corey Joseph
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sunjae Bae
- New York University, New York, New York, USA
| | - Yusi Chen
- New York University, New York, New York, USA
| | - Yasar Caliskan
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, Saint Louis, Missouri, USA
| | | | - Sandeep Dhindsa
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Huiling Xiao
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Dorry L Segev
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- New York University, New York, New York, USA
| | - David A Axelrod
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- University of Iowa, Iowa City, Iowa, USA
| | - Mark A Schnitzler
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, Saint Louis, Missouri, USA
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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White M, McDermott KM, Bose S, Wang C, Srinivas T, Kalbaugh C, Hicks CW. Risks and Benefits of the Proposed Amputation Reduction and Compassion Act for Disadvantaged Patients. Ann Vasc Surg 2024; 101:179-185. [PMID: 38142961 PMCID: PMC10957305 DOI: 10.1016/j.avsg.2023.12.003] [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: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023]
Abstract
Racial, ethnic, and socioeconomic disparities in the major risk factors for vascular disease and access to vascular specialist care are well-documented.1-3 The higher incidence of diabetes, peripheral artery disease (PAD), and related nontraumatic lower extremity amputation among racial and ethnic minority groups, those of low socioeconomic status, and those with poor access to care based on geography (together, referred to below as disadvantaged groups) are particularly pervasive.1,4-9 Practitioners of vascular surgery and endovascular therapy are uniquely positioned to address health inequities in lower extremity screening, medical management, intervention, and limb preservation among the population of adults at the highest risk for limb loss.
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Affiliation(s)
- Midori White
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Sanuja Bose
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Caroline Wang
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Tara Srinivas
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Corey Kalbaugh
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University, Baltimore, MD.
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Armstrong-Hough M, Lin P, Venkatesh S, Ghous M, Hough CL, Cook SH, Iwashyna TJ, Valley TS. Ethnic Disparities in Deep Sedation of Patients with Acute Respiratory Distress Syndrome in the United States: Secondary Analysis of a Multicenter Randomized Trial. Ann Am Thorac Soc 2024; 21:620-626. [PMID: 38324712 PMCID: PMC10995555 DOI: 10.1513/annalsats.202307-600oc] [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: 07/08/2023] [Accepted: 02/05/2024] [Indexed: 02/09/2024] Open
Abstract
Rationale: Patients identified as Hispanic, the largest minority group in the United States, are more likely to die from acute respiratory distress syndrome (ARDS) than non-Hispanic patients. Mechanisms to explain this disparity remain unidentified. However, Hispanic patients may be at risk of overexposure to deep sedation because of language differences between patients and clinicians, and deep sedation is associated with higher ARDS mortality.Objective: We examined associations between Hispanic ethnicity and exposure to deep sedation among patients with ARDS.Methods: A secondary analysis was conducted of patients enrolled in the control arm of a randomized trial of neuromuscular blockade for ARDS across 48 U.S. hospitals. Exposure to deep sedation was measured over the first 5 days that a patient was alive and received mechanical ventilation. Multilevel mixed-effects models were used to evaluate associations between Hispanic ethnicity and exposure to deep sedation, controlling for patient characteristics.Results: Patients identified as Hispanic had approximately five times the odds of deep sedation (odds ratio, 4.98; 95% confidence interval, 2.02-12.28; P < 0.0001) on a given day, compared with non-Hispanic White patients. Hospitals with at least one enrolled Hispanic patient kept all enrolled patients deeply sedated longer than hospitals without any enrolled Hispanic patients (85.8% of ventilator-days vs. 65.5%; P < 0.001).Conclusions: Hispanic patients are at higher risk of exposure to deep sedation than non-Hispanic White patients. There is an urgent need to understand and address disparities in sedation delivery.
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Affiliation(s)
- Mari Armstrong-Hough
- Department of Epidemiology and
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York
| | - Paul Lin
- Institute for Healthcare Policy and Innovation
| | | | - Muhammad Ghous
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and
| | - Catherine L. Hough
- Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, Oregon
| | - Stephanie H. Cook
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York
| | - Theodore J. Iwashyna
- Department of Medicine and Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland; and
| | - Thomas S. Valley
- Institute for Healthcare Policy and Innovation
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
- VA Center for Clinical Management Research, Ann Arbor, Michigan
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Hsuan C, Vanness DJ, Zebrowski A, Carr BG, Norton EC, Buckler DG, Wang Y, Leslie DL, Dunham EF, Rogowski JA. Racial and ethnic disparities in emergency department transfers to public hospitals. Health Serv Res 2024; 59:e14276. [PMID: 38229568 PMCID: PMC10915485 DOI: 10.1111/1475-6773.14276] [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: 01/18/2024] Open
Abstract
OBJECTIVE To examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences. DATA SOURCES AND STUDY SETTING ED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010-2019); American Hospital Association Annual Survey (2009-2018). STUDY DESIGN Logistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients. The base model was controlled for patient and hospital characteristics and year fixed effects. Models II and III added urbanicity and hospital referral region (HRR), respectively. Model IV used hospital fixed effects, which compares patients within the same hospital. Models V and VI stratified Model IV by payer and condition, respectively. Conditions were classified as emergency care sensitive conditions (ECSCs), where transfer is protocolized, and non-ECSCs. We reported marginal effects at the means. DATA COLLECTION/EXTRACTION METHODS We examined 1,265,588 adult ED patients transferred from 187 hospitals. PRINCIPAL FINDINGS Black patients were more likely to be transferred to public hospitals compared with White patients in all models except ECSC patients within the same initial hospital (except trauma). Black patients were 0.5-1.3 percentage points (pp) more likely to be transferred to public hospitals than White patients in the same hospital with the same payer. In the base model, Hispanic patients were more likely to be transferred to public hospitals compared with White patients, but this difference reversed after controlling for HRR. Hispanic patients were - 0.6 pp to -1.2 pp less likely to be transferred to public hospitals than White patients in the same hospital with the same payer. CONCLUSIONS Large population-level differences in whether ED patients of different races/ethnicities were transferred to public hospitals were largely explained by hospital market and the initial hospital, suggesting that they may play a larger role in explaining differences in transfer to public hospitals, compared with other external factors.
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Affiliation(s)
- Charleen Hsuan
- Department of Health Policy & AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - David J. Vanness
- Department of Health Policy & AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Alexis Zebrowski
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Brendan G. Carr
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Edward C. Norton
- Department of Health Management and PolicyUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
- Department of EconomicsUniversity of MichiganAnn ArborMichiganUSA
| | - David G. Buckler
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Yinan Wang
- Department of Health Policy & AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Douglas L. Leslie
- Department of Public Health Sciences, College of MedicinePennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Eleanor F. Dunham
- Department of Emergency Medicine, College of MedicinePennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Jeannette A. Rogowski
- Department of Health Policy & AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
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Goode RW, Wilfred SA, Reyes-Rodríguez ML. From disparities to equity: striving for more in our treatments for feeding and eating disorders. Trends Mol Med 2024; 30:308-310. [PMID: 38135600 PMCID: PMC11009073 DOI: 10.1016/j.molmed.2023.11.015] [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: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Adopting a framework of equity is urgently needed to reduce disparities persistent in feeding and eating disorder (FED) treatment models. This framework must emphasize the exchange of knowledge between relevant stakeholders and implementation strategies to impact practice and embrace a systemic change in the FED field.
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Affiliation(s)
- Rachel W Goode
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Nutrition Research Institute, The University of North Carolina, Kannapolis, NC, USA
| | | | - Mae Lynn Reyes-Rodríguez
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Maestre G, Hill C, Griffin P, Hall S, Hu W, Flatt J, Babulal G, Thorpe R, Henderson JN, Buchwald D, Manson S, Cicero E, Gilmore-Bykovskyi A, Gamaldo A, Glover C, Barnes L, Kind A, James B, Zeki Al Hazzouri A, Wharton W, Caramelli P, Szanton S, Whitmer R, Benn Torres J, Deters K, Okonkwo O, Das R, Martinez-Gonzalez K, Carrillo M. Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias. Alzheimers Dement 2024; 20:3099-3107. [PMID: 38460119 DOI: 10.1002/alz.13752] [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: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.
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Affiliation(s)
- Gladys Maestre
- School of Medicine, Alzheimer's Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Carl Hill
- Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Percy Griffin
- Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Stephen Hall
- Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - William Hu
- Rutgers Robert Wood Johnson Medical School and Rutgers Institute for Health, Health Care Policy, and Aging Research, New Brunswick, New Jersey, USA
| | - Jason Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ganesh Babulal
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Roland Thorpe
- Center on Aging, Center on Health Disparities Solutions, Hopkins Population Center, Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health Elson S Floyd College of Medicine Washington State University, Seattle, Washington, USA
| | - Spero Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alyssa Gamaldo
- Pennsylvania State University, State College, Pennsylvania, USA
| | | | - Lisa Barnes
- Rush University Medical Center, Chicago, Illinois, USA
| | - Amy Kind
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bryan James
- Rush University Medical Center, Chicago, Illinois, USA
| | - Adina Zeki Al Hazzouri
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sarah Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Rachel Whitmer
- Department of Public Health Sciences, Department of Neurology, University of California Davis, Davis, California, USA
| | | | - Kacie Deters
- Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Ozioma Okonkwo
- Department of Medicine and the Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rina Das
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | | | - Maria Carrillo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
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Landis RK, Stein BD, Dick AW, Griffin BA, Saloner BK, Terplan M, Faherty LJ. Trends and Disparities in Perinatal Opioid Use Disorder Treatment in Medicaid, 2007-2012. Med Care Res Rev 2024; 81:145-155. [PMID: 38160405 DOI: 10.1177/10775587231216515] [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] [Indexed: 01/03/2024]
Abstract
We described Medicaid-insured women by receipt of perinatal opioid use disorder (OUD) treatment; and trends and disparities in treatment. Using 2007 to 2012 Medicaid Analytic eXtract data from 45 states and D.C., we identified deliveries among women with OUD. Regressions modeled the association between patient characteristics and receipt of any OUD treatment, medication for OUD (MOUD), and counseling alone during the perinatal period. Rates of any OUD treatment and MOUD for women with perinatal OUD increased over the study period, but trends differed by subgroup. Compared with non-Hispanic White women, Black and American Indian/Alaskan Native (AI/AN) women were less likely to receive any OUD treatment, and Black women were less likely to receive MOUD. Over time, the disparity in receipt of MOUD between Black and White women increased. Overall gains in OUD treatment were driven by improvements in perinatal OUD care for White women and obscured disparities for Black and AI/AN women.
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Affiliation(s)
| | | | | | | | | | | | - Laura J Faherty
- RAND Corporation, Boston, MA, USA
- Maine Medical Center, Portland, ME, USA
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50
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Nikpour J, Brom H, Mason A, Chittams J, Poghosyan L, Carthon MB. Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients. Med Care 2024; 62:217-224. [PMID: 38036459 PMCID: PMC10949042 DOI: 10.1097/mlr.0000000000001951] [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: 12/02/2023]
Abstract
BACKGROUND Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases. METHODS Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients' odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores. RESULTS After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23). CONCLUSIONS As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs' clinical practice environment is a key opportunity to reduce hospitalization disparities.
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Affiliation(s)
- Jacqueline Nikpour
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Heather Brom
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Aleigha Mason
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Jesse Chittams
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Lusine Poghosyan
- Center for Healthcare Delivery Research & Innovations,
Columbia School of Nursing, New York, NY
| | - Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
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