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Graetz N, Hepburn P, Gershenson C, Porter SR, Sandler DH, Lemmerman E, Desmond M. Examining Excess Mortality Associated With the COVID-19 Pandemic for Renters Threatened With Eviction. JAMA 2024; 331:592-600. [PMID: 38497697 PMCID: PMC10879945 DOI: 10.1001/jama.2023.27005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/11/2023] [Indexed: 03/19/2024]
Abstract
Importance Residential evictions may have increased excess mortality associated with the COVID-19 pandemic. Objective To estimate excess mortality associated with the COVID-19 pandemic for renters who received eviction filings (threatened renters). Design, Setting, and Participants This retrospective cohort study used an excess mortality framework. Mortality based on linked eviction and death records from 2020 through 2021 was compared with projected mortality estimated from similar records from 2010 through 2016. Data from court records between January 1, 2020, and August 31, 2021, were collected via the Eviction Lab's Eviction Tracking System. Similar data from court records between January 1, 2010, and December 31, 2016, also collected by the Eviction Lab, were used to estimate projected mortality during the pandemic. We also constructed 2 comparison groups: all individuals living in the study area and a subsample of those individuals living in high-poverty, high-filing tracts. Exposures Eviction filing. Main Outcomes and Measures All-cause mortality in a given month. The difference between observed mortality and projected mortality was used as a measure of excess mortality associated with the pandemic. Results The cohort of threatened renters during the pandemic period consisted of 282 000 individuals (median age, 36 years [IQR, 28-47]). Eviction filings were 44.7% lower than expected during the study period. The composition of threatened renters by race, ethnicity, sex, and socioeconomic characteristics during the pandemic was comparable with the prepandemic composition. Expected cumulative age-standardized mortality among threatened renters during this 20-month period of the pandemic was 116.5 (95% CI, 104.0-130.3) per 100 000 person-months, and observed mortality was 238.6 (95% CI, 230.8-246.3) per 100 000 person-months or 106% higher than expected. In contrast, expected mortality for the population living in similar neighborhoods was 114.6 (95% CI, 112.1-116.8) per 100 000 person-months, and observed mortality was 142.8 (95% CI, 140.2-145.3) per 100 000 person-months or 25% higher than expected. In the general population across the study area, expected mortality was 83.5 (95% CI, 83.3-83.8) per 100 000 person-months, and observed mortality was 91.6 (95% CI, 91.4-91.8) per 100 000 person-months or 9% higher than expected. The pandemic produced positive excess mortality ratios across all age groups among threatened renters. Conclusions and Relevance Renters who received eviction filings experienced substantial excess mortality associated with the COVID-19 pandemic.
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Cantor JC, Tiderington E. The Promise of Service-Enriched, Hotel-Based Housing as an Alternative to Congregate Shelters for High-Need Persons Experiencing Homelessness. JAMA Netw Open 2022; 5:e2223895. [PMID: 35895065 DOI: 10.1001/jamanetworkopen.2022.23895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joel C Cantor
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Emmy Tiderington
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
- Rutgers University School of Social Work, New Brunswick, New Jersey
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Nie P, Clark AE, D'Ambrosio C, Ding L. Income-related health inequality in urban China (1991-2015): The role of homeownership and housing conditions. Health Place 2022; 73:102743. [PMID: 35045352 DOI: 10.1016/j.healthplace.2022.102743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/27/2021] [Accepted: 01/10/2022] [Indexed: 01/07/2023]
Abstract
Unprecedented economic growth has been experienced over the several decades worldwide, but such rapid economic growth wasn't accompanied by equally-substantial improvement in health, especially health inequalities between the rich and poor. This study examines the role of housing in income-related health inequalities (income-health gradient) in urban China. We here analyze 1991-2015 China Health and Nutrition Survey data to ask how housing affects income-related health inequalities in urban China. We find pro-poor inequalities in self-reported bad health but pro-rich inequalities in objective bad health (general overweight/obesity, central obesity and high blood pressure). Housing conditions serve to reduce the health gradient, especially for objective health. On the contrary, homeownership exacerbates the health gradient. Improving housing conditions thus appears to be an effective way of reducing the income-health gradient in urban China.
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Affiliation(s)
- Peng Nie
- School of Economics and Finance, Xi'an Jiaotong University, 710061, Xi'an, China; Institute for Health Care & Public Management, University of Hohenheim, 70599 Stuttgart, Germany; IZA, Bonn, Germany
| | | | | | - Lanlin Ding
- School of Economics and Finance, Xi'an Jiaotong University, 710061, Xi'an, China.
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Counts NZ, Taylor LA, Willison CE, Galea S. Healthcare lobbying on upstream social determinants of health in the US. Prev Med 2021; 153:106751. [PMID: 34343593 PMCID: PMC8694571 DOI: 10.1016/j.ypmed.2021.106751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 07/19/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Healthcare stakeholders are increasingly investing to address social determinants of health (SDOH) as they seek to improve health outcomes and reduce total healthcare costs in their communities. Policy heavily shapes SDOH, and healthcare lobbying on SDOH issues may offer large impacts through positive policy change. Federal lobbying disclosures from the ten highest spending health insurance and healthcare provider organizations and related associations between 2015 and 2019 were reviewed to identify lobbying reported on the salient SDOH issues, defined based on the Accountable Health Communities Model health-related social needs screening tool. Five of the organizations reported lobbying on some SDOH issues, including financial strain, employment, food insecurity, and interpersonal safety, but none reported lobbying on other issues, such as non-healthcare-related employment, housing instability, transportation, or education. Lobbying has been a missed opportunity for addressing SDOH. Healthcare organizations have the opportunity to expand their lobbying on upstream SDOH policy issues to increase the impact of their SDOH strategy and further improve population health.
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Affiliation(s)
- Nathaniel Z Counts
- Mental Health America, Alexandria, VA, United States of America; Albert Einstein College of Medicine, The Bronx, NY, United States of America.
| | - Lauren A Taylor
- NYU Grossman School of Medicine, New York, NY, United States of America
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, United States of America
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Diaz A, O'Reggio R, Norman M, Thumma JR, Dimick JB, Ibrahim AM. Association of Historic Housing Policy, Modern Day Neighborhood Deprivation and Outcomes After Inpatient Hospitalization. Ann Surg 2021; 274:985-91. [PMID: 34784665 DOI: 10.1097/SLA.0000000000005195] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the association of historical racist housing policies and modern-day healthcare outcomes. SUMMARY OF BACKGROUND DATA In 1933 the United States Government Home Owners Loan Corporation (HOLC) used racial composition of neighborhoods to determine creditworthiness and labeled them "Best", "Still Desirable", "Definitely Declining", and "Hazardous." Although efforts have been made to reverse these racist policies that structurally disadvantage those living in exposed neighborhoods, the lasting legacy on modern day healthcare outcomes is uncertain. METHODS We performed a cross-sectional retrospective review of 212,179 Medicare beneficiaries' living in 171,930 unique neighborhoods historically labeled by the HOLC who underwent 1 of 5 of common surgical procedures - coronary artery bypass, appendectomy, colectomy, cholecystectomy, and hernia repair - between 2012 and 2018. We compared 30-day mortality, complications, and readmissions across HOLC grade and Area Deprivation Index (ADI) of each neighborhood. Outcomes were risk-adjusted using a multivariable logistical regression model accounting for patient factors (age, sex, Elixhauser comorbidities), admission type (elective, urgent, emergency), type of operation, and each neighborhoods ADI; a modern day measure of neighborhood disadvantage that includes education, employment, housing-quality, and poverty measures. RESULTS Overall, 212,179 Medicare beneficiaries (mean age, 71.2 years; 54.2% women) resided in 171,930 unique neighborhoods historically graded by the HOLC. Outcomes worsened in a stepwise fashion across HOLC neighborhoods. Overall, 30-day postoperative mortality was 5.4% in "Best" neighborhoods, 5.8% in "Still Desirable", 6.1% in "Definitely Declining", and 6.4% in "Hazardous" (Best vs Hazardous Odds Ration: 1.23, 95% CI: 1.13-1.24, P < 0.001). The same stepwise pattern was seen from "Best" to "Hazardous" neighborhoods for complications (30.5% vs 32.2%; OR: 1.12 [95% CI: 1.07-1.17]; P < 0.001) and Readmissions (16.3% vs 17.1%; OR: 1.06 [95% CI: 1.01-1.11]; P = 0.023). After controlling for modern day deprivation using ADI, the patterns persisted with "Hazardous" neighborhoods having higher mortality (OR: 1.17 [95% CI: 1.08-1.27]; P < 0.001) and complications (OR: 1.07 [95% CI: 1.02-1.12]; P = 0.003), but not for readmissions (OR: 1.02 [95% CI: 0.97-1.07]; P = 0.546). CONCLUSIONS Patients residing in neighborhoods previously "redlined" or labeled "Hazardous" were more likely to experience worse outcomes after inpatient hospitalization compared to those living in "Best" neighborhoods, even after taking into account modern day measures of neighborhood disadvantage.
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Kua KP, Lee DSWH. Home environmental interventions for prevention of respiratory tract infections: a systematic review and meta-analysis. Rev Environ Health 2021; 36:297-307. [PMID: 33544536 DOI: 10.1515/reveh-2020-0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Poor housing conditions have been associated with increased risks of respiratory infections. This review aims to determine whether modifying the physical environment of the home has benefits in reducing respiratory infections. CONTENT We performed a systematic review and meta-analysis of the effectiveness of home environmental interventions for preventing respiratory tract infections. Ten electronic databases were searched to identify randomized controlled trials published from inception to July 31, 2020. Random-effects meta-analyses were used to assess the study outcomes. Our search identified 14 eligible studies across 12 countries, which comprised 87,428 households in total. The type of interventions on home environment included kitchen appliance and design, water supply and sanitation, house insulation, and home heating. Meta-analysis indicated a potential benefit of home environmental interventions in preventing overall respiratory tract infections (Absolute RR=0.89, 95% CI=0.78-1.01, p=0.07; Pooled adjusted RR=0.72, 95% CI=0.63-0.84, p<0.0001). Subgroup analyses depicted that home environmental interventions had no significant impact on lower respiratory tract infections, pneumonia, and severe pneumonia. A protective effect against respiratory infections was observed in high income country setting (RR=0.82, 95% CI=0.78-0.87, p<0.00001). SUMMARY AND OUTLOOK Home environmental interventions have the potential to reduce morbidity of respiratory tract infections. The lack of significant impact from stand-alone housing interventions suggests that multicomponent interventions should be implemented in tandem with high-quality health systems.
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Affiliation(s)
- Kok Pim Kua
- Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, Petaling, Malaysia
| | - Dr Shaun Wen Huey Lee
- School of Pharmacy, Monash University, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation, and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
- Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
- Faculty of Health and Medical Sciences, Taylor's University, Lakeside Campus, 47500 Subang Jaya, Selangor, Malaysia
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Gu J, Ming X. The Influence of Living Conditions on Self-Rated Health: Evidence from China. Int J Environ Res Public Health 2021; 18:9200. [PMID: 34501800 PMCID: PMC8431523 DOI: 10.3390/ijerph18179200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022]
Abstract
Despite growing attention to living conditions as a social determinant of health, few studies have focused on its diverse impacts on self-rated health. Using data from the China Family Panel Study in 2018, this study used logistic regression analysis to examine how living conditions affect self-rated health in China, finding that people cooking with sanitary water and clean fuel were more likely to report good health, and that homeownership was associated with higher self-rated health. The self-rated health of people living in high-quality housing was lower than that of people living in ordinary housing, and people living in tidy homes were more likely to report good health. The findings suggest that the link between multiple living conditions and self-rated health is dynamic. Public health policies and housing subsidy programs should therefore be designed based on a comprehensive account of not only housing grade or income status, but also whole dwelling conditions.
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Affiliation(s)
- Jiafeng Gu
- Institute of Social Science Survey, Peking University, Beijing 100871, China
| | - Xing Ming
- School of Sociology and Political Science, Shanghai University, Shanghai 200444, China;
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Abstract
IMPORTANCE More than 2 million families face eviction annually, a number likely to increase due to the coronavirus disease 2019 pandemic. The association of eviction with newborns' health remains to be examined. OBJECTIVE To determine the association of eviction actions during pregnancy with birth outcomes. DESIGN This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020. EXPOSURES Eviction actions occurring during gestation. MAIN OUTCOMES AND MEASURES Five metrics of neonatal health included birth weight (in grams), gestational age (in weeks), and dichotomized outcomes for low birth weight (LBW) (<2500 g), prematurity (gestational age <37.0 weeks), and infant death. RESULTS A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, -26.88 [95% CI, -39.53 to 14.24] g) and gestational age (difference, -0.09 [95% CI, -0.16 to -0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, -0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, -57.51 to -11.97) and 35.80 (95% CI, -52.91 to -18.69) g, respectively. CONCLUSIONS AND RELEVANCE These findings suggest that eviction actions during pregnancy are associated with adverse birth outcomes, which have been shown to have lifelong and multigenerational consequences. Ensuring housing, social, and medical assistance to pregnant women at risk for eviction may improve infant health.
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Affiliation(s)
- Gracie Himmelstein
- Office of Population Research, Princeton University, Princeton, New Jersey,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew Desmond
- Office of Population Research, Princeton University, Princeton, New Jersey,Department of Sociology, Princeton University, Princeton, New Jersey
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Kua KP, Lee SWH. Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis. PLoS One 2021; 16:e0244284. [PMID: 33417600 PMCID: PMC7793286 DOI: 10.1371/journal.pone.0244284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mosquito-borne diseases remain a significant public health problem in tropical regions. Housing improvements such as screening of doors and windows may be effective in reducing disease transmission, but the impact remains unclear. OBJECTIVES To examine whether housing interventions were effective in reducing mosquito densities in homes and the impact on the incidence of mosquito-borne diseases. METHODS In this systematic review and meta-analysis, we searched 16 online databases, including NIH PubMed, CINAHL Complete, LILACS, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials for randomized trials published from database inception to June 30, 2020. The primary outcome was the incidence of any mosquito-borne diseases. Secondary outcomes encompassed entomological indicators of the disease transmission. I2 values were used to explore heterogeneity between studies. A random-effects meta-analysis was used to assess the primary and secondary outcomes, with sub-group analyses for type of interventions on home environment, study settings (rural, urban, or mixed), and overall house type (traditional or modern housing). RESULTS The literature search yielded 4,869 articles. After screening, 18 studies were included in the qualitative review, of which nine were included in the meta-analysis. The studies enrolled 7,200 households in Africa and South America, reporting on malaria or dengue only. The type of home environmental interventions included modification to ceilings and ribbons to close eaves, screening doors and windows with nets, insecticide-treated wall linings in homes, nettings over gables and eaves openings, mosquito trapping systems, metal-roofed houses with mosquito screening, gable windows and closed eaves, and prototype houses using southeast Asian designs. Pooled analysis depicted a lower risk of mosquito-borne diseases in the housing intervention group (OR = 0.68; 95% CI = 0.48 to 0.95; P = 0.03). Subgroup analysis depicted housing intervention reduced the risk of malaria in all settings (OR = 0.63; 95% CI = 0.39 to 1.01; P = 0.05). In urban environment, housing intervention was found to decrease the risk of both malaria and dengue infections (OR = 0.52; 95% CI = 0.27 to 0.99; P = 0.05).Meta-analysis of pooled odds ratio showed a significant benefit of improved housing in reducing indoor vector densities of both Aedes and Anopheles (OR = 0.35; 95% CI = 0.23 to 0.54; P<0.001). CONCLUSIONS Housing intervention could reduce transmission of malaria and dengue among people living in the homes. Future research should evaluate the protective effect of specific house features and housing improvements associated with urban development.
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Affiliation(s)
- Kok Pim Kua
- Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, Petaling, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Sunway City, Malaysia
- Asian Center for Evidence Synthesis in Population, Implementation, and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Sunway City, Malaysia
- Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Sunway City, Malaysia
- Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
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Affiliation(s)
- Maya Vijayaraghavan
- 8785 Division of General Internal Medicine/Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Brian A King
- 314421 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Wadhera RK, Khatana SAM, Choi E, Jiang G, Shen C, Yeh RW, Joynt Maddox KE. Disparities in Care and Mortality Among Homeless Adults Hospitalized for Cardiovascular Conditions. JAMA Intern Med 2020; 180:357-366. [PMID: 31738826 PMCID: PMC6865320 DOI: 10.1001/jamainternmed.2019.6010] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Cardiovascular disease is a major cause of death among homeless adults, with mortality rates that are substantially higher than in the general population. It is unknown whether differences in hospitalization-related care contribute to these disparities in cardiovascular outcomes. OBJECTIVE To evaluate differences in intensity of care and mortality between homeless and nonhomeless individuals hospitalized for cardiovascular conditions (ie, acute myocardial infarction, stroke, cardiac arrest, or heart failure). DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included all hospitalizations for cardiovascular conditions among homeless adults (n = 24 890) and nonhomeless adults (n = 1 827 900) 18 years or older in New York, Massachusetts, and Florida from January 1, 2010, to September 30, 2015. Statistical analysis was performed from February 6 to July 16, 2019. MAIN OUTCOMES AND MEASURES Risk-standardized diagnostic and therapeutic procedure rates and in-hospital mortality rates. RESULTS Of the 1 852 790 total hospitalizations for cardiovascular conditions across 525 hospitals, 24 890 occurred among patients who were homeless (11 452 women and 13 438 men; mean [SD] age, 65.1 [14.8] years) and 1 827 900 occurred among patients who were not homeless (850 660 women and 977 240 men; mean [SD] age, 72.1 [14.6] years). Most hospitalizations among homeless individuals were primarily concentrated among 11 hospitals. Homeless adults were more likely than nonhomeless adults to be black (38.6% vs 15.6%) and insured by Medicaid (49.3% vs 8.5%). After accounting for differences in demographics (age, sex, and race/ethnicity), insurance payer, and clinical comorbidities, homeless adults hospitalized for acute myocardial infarction were less likely to undergo coronary angiography compared with nonhomeless adults (39.5% vs 70.9%; P < .001), percutaneous coronary intervention (24.8% vs 47.4%; P < .001), and coronary artery bypass graft (2.5% vs 7.0%; P < .001). Among adults hospitalized with stroke, those who were homeless were less likely than nonhomeless individuals to undergo cerebral angiography (2.9% vs 9.5%; P < .001) but were as likely to receive thrombolytic therapy (4.8% vs 5.2%; P = .28). In the cardiac arrest cohort, homeless adults were less likely than nonhomeless adults to undergo coronary angiography (10.1% vs 17.6%; P < .001) and percutaneous coronary intervention (0.0% vs 4.7%; P < .001). Risk-standardized mortality was higher for homeless persons with ST-elevation myocardial infarction compared with nonhomeless persons (8.3% vs 6.2%; P = .04). Mortality rates were also higher for homeless persons than for nonhomeless persons hospitalized with stroke (8.9% vs 6.3%; P < .001) or cardiac arrest (76.1% vs 57.4%; P < .001) but did not differ for heart failure (1.6% vs 1.6%; P = .83). CONCLUSIONS AND RELEVANCE There are significant disparities in in-hospital care and mortality between homeless and nonhomeless adults with cardiovascular conditions. There is a need for public health and policy efforts to support hospitals that care for homeless persons to reduce disparities in hospital-based care and improve health outcomes for this population.
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Affiliation(s)
- Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sameed Ahmed M Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Eunhee Choi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ginger Jiang
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri.,Center for Health Economics and Policy, Institute for Public Health at Washington University, St Louis, Missouri
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Stanic A, Rybin D, Cannata F, Hohl C, Brody J, Gaeta J, Bharel M. The impact of the housing status on clinical outcomes and health care utilization among individuals living with HIV. AIDS Care 2019; 33:1-9. [PMID: 31766866 DOI: 10.1080/09540121.2019.1695728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/25/2022]
Abstract
The lack of stable housing can impair access and continuity of care for patients living with human immunodeficiency virus (HIV). This study investigated the relationship between housing status assessed at multiple time points and several core HIV-related outcomes within the same group of HIV patients experiencing homelessness. Patients with consistently stable housing (CSH) during the year were compared to patients who lacked CSH (non-CSH group). The study outcomes included HIV viral load (VL), CD4 counts, and health care utilization. Multivariable and propensity weighted analyses were used to assess outcomes adjusting for potential group differences. Of 208 patients, 88 (42%) had CSH and 120 (58%) were non-CSH. Patients with CSH had significantly higher proportion of VL suppression and higher mean CD4 counts. The frequency of nurse visits in the CSH group was less than a half of that in the non-CSH group. Patients with CSH were less likely to be admitted to the medical respite facility, and if admitted, their length of stay was about a half of that for the non-CSH group. Our study findings show that patients with CSH had significantly better HIV virologic control and immune status as well as improved health care utilization.
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Affiliation(s)
- Anela Stanic
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA.,Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Francis Cannata
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA
| | - Carole Hohl
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Jennifer Brody
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Jessie Gaeta
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Monica Bharel
- Boston Health Care for the Homeless Program, Boston, MA, USA
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Abstract
CONTEXT Given a large and consistent literature revealing a link between housing and health, publicly supported housing assistance programs might play an important role in promoting the health of disadvantaged children. OBJECTIVE To summarize and evaluate research in which authors examine housing assistance and child health. DATA SOURCES PubMed, Web of Science, PsycInfo, and PAIS (1990-2017). STUDY SELECTION Eligible studies were required to contain assessments of public housing, multifamily housing, or vouchers in relation to a health outcome in children (ages 0-21); we excluded neighborhood mobility interventions. DATA EXTRACTION Study design, sample size, age, location, health outcomes, measurement, program comparisons, analytic approach, covariates, and results. RESULTS We identified 14 studies, including 4 quasi-experimental studies, in which authors examined a range of health outcomes. Across studies, the relationship between housing assistance and child health remains unclear, with ∼40% of examined outcomes revealing no association between housing assistance and health. A sizable proportion of observed relationships within the quasi-experimental and association studies were in favor of housing assistance (50.0% and 37.5%, respectively), and negative outcomes were less common and only present among association studies. LIMITATIONS Potential publication bias, majority of studies were cross-sectional, and substantial variation in outcomes, measurement quality, and methods to address confounding. CONCLUSIONS The results underscore a need for rigorous studies in which authors evaluate specific housing assistance programs in relation to child outcomes to establish what types of housing assistance, if any, serve as an effective strategy to reduce disparities and advance equity across the lifespan.
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