Impact of Social Determinants of Health on Outcomes for Patients with Adult Congenital Heart Disease

PURPOSE OF REVIEW

The study of adults with congenital heart disease (ACHD) is a rapidly growing field; however, more research is needed on the disparities affecting outcomes. With advances in medicine, a high percentage of patients with congenital heart disease (CHD) are advancing to adulthood, leading to an increase in the number of ACHD. This creates a pressing need to evaluate the factors, specifically the social determinants of health (SDOH) contributing to the outcomes for ACHD.

RECENT FINDINGS

A myriad of factors, including, but not limited to, race, education, and socioeconomic status, have been shown to affect ACHD outcomes. Existing data from hospitalizations, mortality and morbidity, advanced care planning, patient and physician awareness, financial factors, and education alongside race and socioeconomic status present differences in ACHD outcomes. With SDOH having a significant impact on ACHD subspecialty care outcomes, ACHD centers need to be constantly adapting and innovating, incorporating SDOH into patient management, and providing additional healthcare resources to manage the care of ACHD.

Chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander peoples in Victoria, Australia: a population-based cohort study from 2015 to 2019

Background

This study examined chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander ('Indigenous') patients presenting to hospital via emergency medical services (EMS) with chest pain.

Methods

State-wide population-based cohort study of consecutive patients attended by ambulance for acute chest pain with individual linkage to emergency, hospital admission and mortality data in the state of Victoria, Australia from January 2015 to June 2019. Multivariable models were used to assess for differences in pre-hospital and hospital adherence to care quality, process measures and clinical outcomes.

Findings

From 204,969 EMS attendances for chest pain, 3890 attendances (1.9%) identified as Aboriginal or Torres Strait Islander. Age-standardized incidence rates were higher overall for Indigenous people (3128 vs. 1147 per 100,000 person-years, incidence rate ratio 2.73, 95% CI 2.72-2.74), this difference being particularly striking for younger patients, women, and those residing in outer regional areas. In multivariable models, adherence to care quality and process measures was lower for attendances involving Indigenous people. In the pre-hospital setting, Indigenous people were less likely to be provided intravenous access or analgesia. In the hospital setting, Indigenous people were less likely to be seen by emergency clinicians within target time and less likely to transferred following myocardial infarction to a revascularization capable centre.

Interpretation

Incidence of acute chest pain presentations is high among Indigenous people in Victoria, Australia. Opportunities to improve the quality of care for Indigenous Australians presenting with acute chest pain are identified.

Funding

National Health and Medical Research Council, National Heart Foundation.

Does race affect the long-term survival benefit of systemic therapy in pancreatic adenocarcinoma?

BACKGROUND

Systemic therapy is a key management component of pancreatic ductal adenocarcinoma(PDAC). Racial disparities exist in PDAC, often linked to socioeconomic variables. We investigated the impact of race in PDAC patients who had undergone systemic therapy and surgical resection.

METHODS

A retrospective analysis was performed for all patients who underwent surgical resection for PDAC from 2010 to 2018.

RESULTS

234 patients (78.2% White; 21.8% Black) were included. Black patients presented at a younger age with larger tumors. White patients benefited from systemic therapy with longer overall survival (35vs20 months, p = 0.002). This survival advantage was not present in Black patients (21vs15 months, p = 0.15). Black patients receiving systemic therapy had similar survival as White patients who did not (p = 0.81).

CONCLUSION

Black PDAC patients present at younger ages and with larger initial tumors. In our population, White patients had a longer overall survival after both surgical and systemic therapy. These findings may indicate differences in tumor biology. Further prospective studies are needed.

Improving Black Mental Health: A Collective Call to Action

A constellation of factors detrimentally affects Black mental health at individual and community levels. Issues such as racism, trauma, and a lack of culturally relevant services prevent access to timely, high-quality mental health treatment. These negative experiences, exacerbated by the current impacts of the COVID-19 pandemic, contribute to the increased prevalence of mental health conditions in Black communities. The authors call for a Wellness First approach to dismantle the status quo and to mobilize collective action among individuals, providers, organizations, funders, and policy makers to create equitable opportunities that promote healing and prevent further trauma in Black communities.

Evaluating skin of color education in dermatology residency programs: data from a national survey: Edited by Stephen P. Stone, MD

A dearth of skin of color (SOC) education exists among dermatology residency programs despite the increasingly diverse United States population; a 2008 study reported that 52% of dermatology residency programs had didactic sessions or lectures focusing on diseases in SOC. In the last decade, no new studies have examined the state of residency SOC education. In this study, dermatology residents across the United States were surveyed anonymously about SOC education at their residency program, satisfaction with SOC education, opinions on improving SOC education, and perspective on cultural competence. Of the 125 respondents, 63.2% reported their program provides SOC-related didactics; 44.0% had a rotation where residents primarily saw patients with SOC, though only 11.2% had a dedicated SOC rotation. While over 60% of residents reported being satisfied or very satisfied with their SOC education, residents' satisfaction with their knowledge of diseases primarily seen in SOC was lowest (56.8%). Thematic analysis revealed four major themes for improvement of SOC education, including curricular reform, clinical exposure, emphasizing determinants of health, and opportunities to learn from faculty with diverse interests and expertise about SOC. These findings highlight unique opportunities for dermatologists to enhance SOC education and care for patients of all backgrounds.

Overview of Ten Child Mental Health Clinical Outcome Measures: Testing of Psychometric Properties with Diverse Client Populations in the U.S

While many standardized assessment measures exist to track child mental health treatment outcomes, the degree to which such tools have been adequately tested for reliability and validity across race, ethnicity, and class is uneven. This paper examines the corpus of published tests of psychometric properties for the ten standardized measures used in U.S. child outpatient care, with focus on breadth of testing across these domains. Our goal is to assist care providers, researchers, and legislators in understanding how cultural mismatch impacts measurement accuracy and how to select tools appropriate to the characteristics of their client populations. We also highlight avenues of needed research for measures that are in common use. The list of measures was compiled from (1) U.S. state Department of Mental Health websites; (2) a survey of California county behavioral health agency directors; and (3) exploratory literature scans of published research. Ten measures met inclusion criteria; for each one a systematic review of psychometrics literature was conducted. Diversity of participant research samples was examined as well as differences in reliability and validity by gender, race or ethnicity, and socio-economic class. All measures showed adequate reliability and validity, however half lacked diverse testing across all three domains and all lacked testing with Asian American/Pacific Islander and Native American children. ASEBA, PSC, and SDQ had the broadest testing.

Esophageal Cancer Treatment Is Underutilized Among Elderly Patients in the USA

OBJECTIVES

Large numbers of elderly patients in the USA receive no treatment for esophageal cancer, despite evidence that multimodality treatment can increase survival. Our goal is to identify factors that may contribute to lack of treatment.

MATERIALS AND METHODS

Using Surveillance Epidemiology and End Results (SEER)-Medicare Linked Database (2001-2009), we identified regional esophageal cancer patients ≥65 years old. Treatment was defined as receiving any medical or surgical therapy for esophageal cancer. Logistic regression analysis was performed to identify factors associated with failure to receive treatment. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox proportional hazard model.

RESULTS

There were 5072 patients (median age, 75 years; interquartile range (IQR), 71-81 years). Majority were treated with definitive chemoradiation (48.49 %). Factors associated with lack of treatment included West geographic region and ≥80 years old. Patients who received therapy had better OS (log-rank, p < 0.001). Compared with treated patients, non-treated patients had worse adjusted OS (HR, 1.43; 95 % confidence interval (CI), 1.33-1.55; p < 0.001).

CONCLUSIONS

Elderly patients with locally advanced esophageal cancer who received treatment had improved 5-year survival compared with patients without treatment. Disparities in utilization of treatment are associated with regional and socioeconomic factors, not presence of comorbidities.

Social determinants of health in epilepsy

Social factors have been identified as key drivers of epilepsy care, outcomes, and disparities, but there is a limited understanding of what these factors are and how they translate into disparities. This targeted review provides an overview of the social determinants of health framework and applies this perspective to the literature about social and psychosocial factors in epilepsy; a social determinants of health--epilepsy model is proposed. The key social determinants of health in epilepsy include socioeconomic status, race/ethnicity, age, and gender. For example, low socioeconomic status and minority status have been associated with a higher risk of epilepsy, more hospitalizations and emergency room visits (versus neurology services), antiepileptic drug nonadherence, and a lower rate of epilepsy surgery. Such differences in care/treatment and outcomes translate into health disparities, many of which are considered unjust (inequitable) and modifiable through social action. Other social determinants of health include structural and sociocultural contextual conditions (e.g., health economy, policy, and social stigma/discrimination) and mediating mechanisms including material (e.g., housing), behavioral/biological (e.g., adherence), psychosocial (e.g., perceived stigma), and health system (e.g., access) factors. There are complex relationships among social determinants of health in epilepsy, which remain poorly understood and hamper efforts to address and eliminate disparities in epilepsy care and outcomes. Further empirical work grounded in sound theory and robust methodologies is needed to identify points of intervention and design effective and socially acceptable solutions to any pervasive disparities in epilepsy.