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Dalmau Llorca MR, Aguilar Martín C, Carrasco-Querol N, Hernández Rojas Z, Rodríguez Cumplido D, Castro Blanco E, Queiroga Gonçalves A, Fernández-Sáez J, Pérez-Villacastín J. Clinical value of a tool for managing oral anticoagulation in nonvalvular atrial fibrillation in primary health care. Randomized clinical trial. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:471-480. [PMID: 38056770 DOI: 10.1016/j.rec.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The management of atrial fibrillation is complex and requires improvement at strategic points, such as in the control of patients treated with vitamin K antagonists. The aim of this study was to evaluate the impact on health outcomes of a nonvalvular atrial fibrillation decision support tool based on visualization of the time in therapeutic range in primary care. METHODS The present randomized clinical trial was conducted in 2018 with a 1-year follow-up in 325 primary care centers in Catalonia. In the intervention centers, the decision support tool was installed to control the time in therapeutic range of patients treated with vitamin K antagonists. The tool was not visualized in the control group. RESULTS In total, 44 556 patients were studied. The intervention protected against admission for stroke (adjusted odds ratio [OR], 0.70; 95% confidence interval [95%CI], 0.55-0.88). The number needed to treat was 3502 (95%CI, 3305-3725) while the number of admissions for stroke avoided was 12.63 (95%CI, 11.88-13.38). The intervention also protected against mortality (adjusted OR, 0.78; 95%CI, 0.67-0.90), with a number needed to treat of 13 687 (95%CI, 10 789-18 714) and number of deaths avoided of 3.23 (95%CI, 2.36-4.10). CONCLUSIONS The decision support tool was associated with slight reductions in the numbers of admissions for ischemic stroke and mortality. Although the follow-up time was short and the effect of the intervention was small, the results are valuable and could improve implementation of the tool. This clinical trial was registered with ClinicalTrials.gov (NCT03367325).
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Affiliation(s)
- M Rosa Dalmau Llorca
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain.
| | - Carina Aguilar Martín
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain.
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain
| | - Zojaina Hernández Rojas
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Dolores Rodríguez Cumplido
- Departament de Farmacologia Clínica, Hospital Universitari Bellvitge, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Elisabet Castro Blanco
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Alessandra Queiroga Gonçalves
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain
| | - José Fernández-Sáez
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Julián Pérez-Villacastín
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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You W, Donnelly F. A cross-sectional study quantifies the independent contribution of nurses and midwives in child health outcomes. J Nurs Scholarsh 2024; 56:455-465. [PMID: 38108526 DOI: 10.1111/jnu.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION As the largest profession within the healthcare industry, nursing and midwifery workforce (NMW) provides comprehensive healthcare to children and their families. This study quantified the independent role of NMW in reducing under-5 mortality rate (U5MR) worldwide. DESIGN A retrospective, observational and correlational study to examine the independent role of NMW in protecting against U5MR. METHODS Within 266 "countries", the cross-sectional correlations between NMW and U5MR were examined with scatter plots, Pearson's r, nonparametric, partial correlation and multiple regression. The affluence, education and urban advantages were considered as the potential competing factors for the NMW-U5MR relationship. The NMW-U5MR correlations in both developing and developed countries were explored and compared. RESULTS Bivariate correlations revealed that NMW negatively and significantly correlated to U5MR worldwide. When the contributing effects of economic affluence, urbanization and education were removed, the independent NMW role in reducing U5MR remained significant. NMW independently explained 9.36% U5MR variance. Multilinear regression selected NMW as a significant factor contributing an extra 3% of explanation to U5MR variance when NMW, affluence, education and urban advantage were incorporated as the predicting variables. NMW correlated with U5MR significantly more strongly in developing countries than in developed countries. CONCLUSION NMW, indexing nursing and midwifery service, was a significant factor for reducing U5MR worldwide. This beneficial effect explained 9.36% of U5MR variance which was independent of economic affluence, urbanization and education. The NMW may be a more significant risk factor for protecting children from dying under 5 years old in developing countries. As a strategic response to the advocacy of the United Nations to reduce child mortality, it is worthy for health authorities to consider a further extension of nurses and midwives' practice scope to enable communities to have more access to NMW healthcare services.
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Affiliation(s)
- Wenpeng You
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
- Heart and Lung, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology & Respiratory, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Frank Donnelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
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Mann U, Bal DS, Panchendrabose K, Brar R, Patel P. Risk of major adverse cardiovascular events in rural vs urban settings among patients with erectile dysfunction: a propensity-weighted retrospective cohort study of 430 621 men. J Sex Med 2024:qdae043. [PMID: 38600710 DOI: 10.1093/jsxmed/qdae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/27/2024] [Accepted: 02/28/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The relationship between erectile dysfunction (ED) and cardiovascular (CV) events has been postulated, with ED being characterized as a potential harbinger of CV disease. Location of residence is another important consideration, as the impact of rural residence has been associated with worse health outcomes. AIM To investigate whether men from rural settings with ED are associated with a higher risk of major adverse CV events (MACEs). METHODS A propensity-weighted retrospective cohort study was conducted with provincial health administrative databases. ED was defined as having at least 2 ED prescriptions filled within 1 year. MACE was defined as the first hospitalization for an episode of acute myocardial infarction, heart failure, or stroke that resulted in a hospital visit >24 hours. We classified study groups into ED urban, ED rural, no ED urban, and no ED rural. A multiple logistic regression model was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. OUTCOMES A Cox proportional hazard model was used to examine our primary outcome of time to a MACE. RESULTS The median time to a MACE was 2731, 2635, 2441, and 2508 days for ED urban (n = 32 341), ED rural (n = 18 025), no ED rural (n = 146 358), and no ED urban (n = 233 897), respectively. The cohort with ED had a higher proportion of a MACE at 8.94% (n = 4503), as opposed to 4.58% (n = 17 416) for the group without ED. As compared with no ED urban, no ED rural was associated with higher risks of a MACE in stabilized time-varying comodels based on inverse probability treatment weighting (hazard ratio, 1.06-1.08). ED rural was associated with significantly higher risks of a MACE vs no ED rural, with the strength of the effect estimates increasing over time (hazard ratio, 1.10-1.74). CLINICAL IMPLICATIONS Findings highlight the need for physicians treating patients with ED to address CV risk factors for primary and secondary prevention of CV diseases. STRENGTHS AND LIMITATIONS This is the most extensive retrospective study demonstrating that ED is an independent risk factor for MACE. Due to limitations in data, we were unable to assess certain comorbidities, including obesity and smoking. CONCLUSIONS Our study confirms that ED is an independent risk factor for MACE. Rural men had a higher risk of MACE, with an even higher risk among those who reside rurally and are diagnosed with ED.
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Affiliation(s)
- Uday Mann
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
| | - Dhiraj S Bal
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W2, Canada
| | - Kapilan Panchendrabose
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W2, Canada
| | - Ranveer Brar
- Chronic Disease Innovation Center, Winnipeg, MB, R2V 3M3, Canada
| | - Premal Patel
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
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Kovacs N, Piko P, Juhasz A, Nagy C, Oroszi B, Ungvari Z, Adany R. Comparative analysis of health status and health service utilization patterns among rural and urban elderly populations in Hungary: a study on the challenges of unhealthy aging. GeroScience 2024; 46:2017-2031. [PMID: 37798385 PMCID: PMC10828334 DOI: 10.1007/s11357-023-00926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/27/2023] [Indexed: 10/07/2023] Open
Abstract
The demographic transition poses a significant challenge for health systems, especially in Central and Eastern European (CEE) countries, where the healthcare needs of aging populations are on the rise. This study aimed to describe and compare the health status and utilization of health services among the elderly residing in urban and rural areas of the most deprived region in Hungary. A comprehensive health survey was conducted in 2022, involving a randomly selected sample of 443 older adults (≥ 65 years) in Northeast Hungary. Multivariable logistic regression models adjusting for age, sex, education, financial status, chronic diseases, and activity limitations were used to investigate the association between type of residence and health service use. Among the study participants, 62.3% were female, 38.3% attained primary education, 12.5% reported a bad or very bad financial situation and 52.6% lived in urban areas. Overall, 24% of the elderly rated their health as very good or good (27.8% in urban and 19.7% in rural areas), while 57.8% (52.6% and 63.5% in urban and rural areas) reported limitations in daily activities. Compared to urban residents, rural residents reported lower rates of dentist visits (p = 0.006), specialist visits (p = 0.028), faecal occult blood testing (p < 0.001), colorectal cancer screening with colonoscopy (p = 0.014), and breast cancer screening (p = 0.035), and a higher rate of blood pressure measurement (p = 0.042). Multivariable models indicated that urban residence was positively associated with faecal occult blood testing (OR = 2.32, p = 0.014), but negatively associated with blood pressure (OR = 0.42, p = 0.017) and blood glucose measurements (OR = 0.48, p = 0.009). These findings highlight the influence of residence on health service utilization among older adults in Hungary. Further comprehensive studies are needed to better understand the health needs of the elderly population and to develop policies aimed at promoting healthy aging in CEE countries.
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Affiliation(s)
- Nora Kovacs
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Piko
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Attila Juhasz
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Csilla Nagy
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Beatrix Oroszi
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Departments of Public Health and Translational Medicine, Semmelweis University, Budapest, Hungary
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Roza Adany
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- Center for Epidemiology and Surveillance, National Laboratory for Health Security, Semmelweis University, Budapest, Hungary.
- Department of Public Health, Semmelweis University, Budapest, Hungary.
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Wan R, Su Y, Zhu M, Huang Y. Elevated blood malondialdehyde level contributed to a high stroke risk in a Chinese elderly population from rural areas: a cross-sectional study. Sci Rep 2024; 14:4325. [PMID: 38383846 PMCID: PMC10881991 DOI: 10.1038/s41598-024-54419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Individuals living in rural areas have a higher incidence rate of stroke than their urban counterparts in China. However, few studies have investigated the association between blood malondialdehyde (MDA), an end product of lipid oxidation caused by reactive oxygen species (ROS), and stroke risk in rural populations. We aimed to investigate whether blood MDA levels contribute to a higher stroke risk in a Chinese elderly population from rural areas. Data from 2011 to 2012 from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national cohort of older adults in China, were analyzed. Smooth curve and multivariable correction analyses were used to evaluate the association between blood MDA levels and stroke risk in elderly populations from rural and urban areas, respectively. The median age of all included participants (N = 1598) was 84.04 years. The results of the smooth curve model revealed a gradual upward trend in the association of blood MDA levels with stroke risk in rural participants but not in urban participants. Similarly, the conditional logistic regression analysis suggested a significant association between MDA levels and stroke risk in rural participants but not in urban participants after adjustments for related confounding factors (age, sex, current smoker, current drinker, regular exercise, BMI and cardiovascular diseases (hypertension, heart disease, atrial fibrillation and diabetes)) were made. In brief, among the elderly population in China, elevated blood MDA levels were associated with increased stroke risk in rural participants but not in urban participants.
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Affiliation(s)
- Rong Wan
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yuhao Su
- Cardiovascular Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Meilan Zhu
- Rehabilitation Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Ying Huang
- Rehabilitation Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
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Howlader N, Bhattacharya M, Scoppa S, Miller D, Noone AM, Negoita S, Cronin K, Mariotto A. Cancer and COVID-19: US cancer incidence rates during the first year of the pandemic. J Natl Cancer Inst 2024; 116:208-215. [PMID: 37796818 PMCID: PMC10852612 DOI: 10.1093/jnci/djad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound global impact on health-care systems and patient outcomes. However, the specific effects of the pandemic on cancer incidence rates in the United States during its initial year remain unknown. METHODS In this study, we analyzed data from the Surveillance, Epidemiology, and End Results-22 registries, which encompass approximately 50% of the US population. We investigated changes in monthly incidence rates stratified by various factors, including cancer type, stage, age group, sex, race and ethnicity, socioeconomic status, rural-urban status, and registry locations. We compared the incidence rates observed during the pandemic with those from the previous year. RESULTS Our findings revealed a decline in incidence rates for all cancer sites combined starting in March 2020, coinciding with the implementation of stay-at-home orders. This decline reached its lowest point in April 2020 and persisted at a lower level until May 2020. Notably, compared with April 2019, the incidence rates in April 2020 dropped by 48.1% and did not consistently return to prepandemic levels. The reduction in cancer rates was more pronounced in urban and affluent counties. Across all cancer types, there was a statistically significant decrease in incidence rates during the pandemic, with the largest declines observed in thyroid (71.2%), prostate (57.9%), breast (54.9%), and colon and rectum cancers (54.1%). Furthermore, these decreases were primarily observed in early stage rather than late-stage disease. CONCLUSIONS The COVID-19 pandemic had a statistically significant impact on cancer outcomes. Monitoring long-term consequences of the pandemic on cancer incidence, stage at diagnosis, and mortality trends will be crucial.
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Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Manami Bhattacharya
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Steve Scoppa
- Information Management Services, Calverton, MD, USA
| | | | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Serban Negoita
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kathy Cronin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Angela Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Swanson MB, Weidemann DK, Harshman LA. The impact of rural status on pediatric chronic kidney disease. Pediatr Nephrol 2024; 39:435-446. [PMID: 37178207 PMCID: PMC10182542 DOI: 10.1007/s00467-023-06001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.
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Affiliation(s)
- Morgan Bobb Swanson
- Department of Epidemiology, College of Medicine and College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Darcy K Weidemann
- Department of Pediatrics, Section of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa, 425 General Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Del Brutto OH, Mera RM, Rumbea DA, Sedler MJ. The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities. J Prim Care Community Health 2024; 15:21501319241228123. [PMID: 38263729 PMCID: PMC10807323 DOI: 10.1177/21501319241228123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Information on factors that increase mortality in remote settings is limited. This study aims to estimate the independent and joint role of several factors on mortality risk among older adults living in rural Ecuador. METHODS Participants were selected from community-dwelling older adults who were included in previous studies targeting mortality risk factors in the study population. Generalized structural equation modeling (GSEM) was utilized to evaluate prior causal assumptions, to redraw causal links, and to introduce latent variables that may help to explain how the independently significant variables are associated with mortality. RESULTS The study included 590 individuals (mean age: 67.9 ± 7.3 years; 57% women), followed for a median of 8.2 years. Mortality rate was 3.4 per 100 person-years. Prior work on separate multivariate Poisson and Cox models was used to build a tentative causal construct. A GSEM containing all variables showed that age, symptoms of depression, high social risk, high fasting glucose, a history of overt stroke, and neck circumference were directly associated with mortality. Two latent variables were introduced, 1 representing the impact of biological factors and another, the impact of social factors on mortality. The social variable significantly influenced the biological variable which carried most of the direct effect on mortality. CONCLUSIONS Several factors contributed to mortality risk in the study population, the most significant being biological factors which are highly influenced by social factors. High social risk interact with biological variables and play an important role in mortality risk.
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Mensah GA, Johnson LE, Zhang X, Stinson N, Carrington K, Malla G, Land SR, Huff E, Freeman N, Stoney C, Ampey B, Paltoo D, Clark D, Rajapakse N, Ilias MR, Haase KP, Punturieri A, Kurilla MG, Archer H, Bolek M, Santos M, Wilson-Frederick S, Devaney S, Marshall V, Farhat T, Hooper MW, Wilson DR, Perez-Stable EJ, Gibbons GH. Community Engagement Alliance (CEAL): A National Institutes of Health Program to Advance Health Equity. Am J Public Health 2024; 114:S12-S17. [PMID: 37944098 PMCID: PMC10785165 DOI: 10.2105/ajph.2023.307476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Affiliation(s)
- George A Mensah
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Lenora E Johnson
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Xinzhi Zhang
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Nathan Stinson
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Kelli Carrington
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Gargya Malla
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Stephanie R Land
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Erynn Huff
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Naomi Freeman
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Catherine Stoney
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Bryan Ampey
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Dina Paltoo
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Dave Clark
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Nishadi Rajapakse
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Maliha R Ilias
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Karen Plevock Haase
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Antonello Punturieri
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Michael G Kurilla
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Hillary Archer
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Michelle Bolek
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Melanie Santos
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Shondelle Wilson-Frederick
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Stephanie Devaney
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Vanessa Marshall
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Tilda Farhat
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Monica Webb Hooper
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - David R Wilson
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Eliseo J Perez-Stable
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Gary H Gibbons
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
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10
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Calatayud BM, Moss JL. Rural/Urban differences in uptake of preventive healthcare services: Variability in observed relationships across measures of rurality. J Public Health Res 2024; 13:22799036241238670. [PMID: 38505764 PMCID: PMC10949549 DOI: 10.1177/22799036241238670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/25/2024] [Indexed: 03/21/2024] Open
Abstract
Rural residents are generally less likely to receive preventive healthcare than are urban residents, but variable measurement of rurality introduces inconsistency to these findings. We assessed the relationships between perceived and objective measures of rurality and uptake of preventive healthcare. In our sample, rural participants generally had equal or higher uptake of healthcare (i.e. private health insurance, check-up in the past year, being up-to-date on colorectal and cervical cancer screening) than urban participants. Importantly, the perceived measure of rurality performed similarly to the objective measures, suggesting that participant report could be a valid way to assess rurality in health studies. Significance for Public Health The ability to access routine preventive healthcare is a key component of public health. Comparing uptake of cancer screening in rural versus urban areas is one way to assess equity of healthcare access. Generally, rural areas have a higher burden of cancer than urban areas. The built environment, socioeconomic status, and patient perceptions can impact an individual's access to routine cancer screening. Preventive healthcare is of great importance to public health as a whole because screening can facilitate earlier diagnosis and more successful treatment for many preventable cancers, which may ultimately increase the quality and quantity of life.
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11
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Arriola KJ, Merken TM, Bigger L, Haardörfer R, Hermstad A, Owolabi S, Daniel J, Kegler M. Understanding the relationship between social capital, health, and well-being in a southern rural population. J Rural Health 2024; 40:162-172. [PMID: 37438857 DOI: 10.1111/jrh.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/31/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Social capital is thought to contribute to health and well-being, but its application to a rural context is poorly understood. This study seeks to examine how different forms of social capital relate to health and well-being among rural residents and the extent to which race and degree of rurality moderates these relationships. METHODS Data from a population-based survey of 6 counties in rural Georgia (n = 1,385) are used. We examined 3 forms of social capital (diversity of interaction, civic engagement, and voting behavior) in relation to 3 health and well-being measures (overall life satisfaction, general health status, and 30-day physical health). FINDINGS Interacting with more diverse social networks was associated with higher overall life satisfaction for White but not Black participants (P ≤ .001). For those living in more rural communities, interacting with a more diverse social network was more strongly associated with greater general health as compared to those who lived "in town" (P ≤ .01). Greater civic engagement and voting behavior were associated with greater general health for White but not Black participants (Ps < .05). Likewise, voting in all 3 elections was associated with greater overall life satisfaction and fewer days of poor physical health for White but not Black participants (Ps ≤ .05). CONCLUSION Social capital may be associated with positive health and well-being among those living in rural areas, but it may vary by race and degree of community rurality, suggesting the need to further understand how social capital operates in a rural context.
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Affiliation(s)
- Kimberly Jacob Arriola
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tatenda Mangurenje Merken
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren Bigger
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Regine Haardörfer
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - April Hermstad
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shade Owolabi
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jerry Daniel
- Master of Social Work Program, Albany State University, Albany, Georgia, USA
| | - Michelle Kegler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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12
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Rhudy C, Schadler A, Huffmyer M, Porter L. Rural disparities in emergency department utilization for migraine care. Headache 2024; 64:37-47. [PMID: 38087895 DOI: 10.1111/head.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate differences in emergency department (ED) utilization and quality of care for migraine in patients with rural and nonrural residences. BACKGROUND Migraine is a significant problem in the United States with direct health-care utilization cost amounting to US $4.2 billion annually. A considerable portion of this cost is attributed to more than 4 million annual ED visits for migraine and headache. Previous research has documented health disparities among rural populations in other disease states, which can be influenced by factors such as socioeconomic status and health-care access. Given these associations, it was hypothesized that patients with rural residence in a national sample would have increased ED utilization for migraine compared to patients with nonrural residence. METHODS This was a cross-sectional epidemiologic study to evaluate rural disparities in ED utilization and quality of care for migraine in the United States in 2019. ED encounter data were collected from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) and Kentucky State Emergency Department Database (KY-SEDD). The primary outcome was crude and age-adjusted rates of ED encounters for migraine per 10,000 population. ED encounters were included if they had a primary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code of G43.xx. ED encounters lacking sufficient data to classify into a geographic group were excluded. Secondary outcomes examined differences in quality of care, including mean ED charges and the proportion of encounters with medication administration, imaging, and nerve block service codes between groups. RESULTS One hundred eighty-three thousand two hundred eleven national ED discharges were classified as rural patient encounters and 627,176 were classified as nonrural. The rural group had significantly higher crude and age-adjusted rates of ED utilization for migraine (crude: rural 39.8, 95% confidence interval [CI] 36.9-42.7; nonrural 22.2, 95% CI 21-23.5 and age-adjusted: rural 41.8, 95% CI 38.8-44.8; nonrural 23.4, 95% CI 22.1-24.7). Opioid utilization was higher in rural encounters (rural n = 26,764, 14.6%; nonrural n = 50,367, 8%; p < 0.001). A Kentucky sub-analysis found 5210 ED discharges were classified as Appalachian and 12,551 as non-Appalachian. The Appalachian group had significantly higher ED utilization rates for migraine compared to the non-Appalachian and national rural groups (crude: Appalachian 44.9, 95% CI 43.7-46.2; age-adjusted: Appalachian 47.4, 95% CI 46.1-48.8). The Kentucky Appalachian group also demonstrated significantly higher opioid analgesia use compared to the national rural group (Appalachian n = 1031, 19.8%; p < 0.001). CONCLUSION This study suggests rural populations, particularly in Appalachia, may experience significantly higher ED utilization for migraine compared to nonrural patients. Moreover, rural populations were more likely to receive suboptimal migraine management with opioid analgesia. Multimodal health-care interventions should be developed to improve access to outpatient migraine care and further investigate potential risk factors in the rural population. With high ED utilization, the Appalachian population may benefit most from such an intervention.
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Affiliation(s)
- Christian Rhudy
- Specialty Pharmacy and Infusion Services, University of Kentucky Healthcare, Lexington, Kentucky, USA
| | - Aric Schadler
- Department of Pharmacy, Kentucky Children's Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Mark Huffmyer
- Specialty Pharmacy and Infusion Services, University of Kentucky Healthcare, Lexington, Kentucky, USA
| | - Lindsey Porter
- Specialty Pharmacy and Infusion Services, University of Kentucky Healthcare, Lexington, Kentucky, USA
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13
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Rhubart D, Santos A. Research Note Showing That the Rural Mortality Penalty Varies by Region, Race, and Ethnicity in the United States, 1999-2016. Demography 2023; 60:1699-1709. [PMID: 38015809 PMCID: PMC10796192 DOI: 10.1215/00703370-11078239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
This research note presents a new perspective on the rural mortality penalty in the United States. While previous work has documented a growing rural mortality penalty, there has been a lack of attention to heterogeneity in trends at the intersection of region, race, and ethnicity. We use age-adjusted mortality rates from the Centers for Disease Control and Prevention to examine the rural mortality penalty by region, race, and ethnicity for 1999-2016 (N = 44,792,050 deaths) and stratify by 2006 National Center for Health Statistics metropolitan-nonmetropolitan classifications. We find substantial variation at the intersection of region, race, and ethnicity, revealing heterogeneity in the rural penalty and-in some cases-a rural mortality advantage. For the Black/African American population, the rural mortality penalty is observed only in the South. On the other hand, for Hispanic/Latino populations, a small but persistent rural mortality penalty is present only in the South and the West. There is a rural mortality penalty in all regions for White and American Indian/Alaska Native populations. However, for the latter, there is substantial variation in the magnitude of the penalty by region of residence. This research documents heterogeneous patterns when the rural mortality penalty is analyzed by region, race, and ethnicity in the United States.
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Affiliation(s)
- Danielle Rhubart
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Alexis Santos
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
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14
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Zhang X, Shoben AB, Felix AS, Focht BC, Paskett ED. Differences in obesity-related health behaviors and health outcomes by rural and Appalachian residency. Cancer Causes Control 2023; 34:1113-1121. [PMID: 37498505 PMCID: PMC10547622 DOI: 10.1007/s10552-023-01741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Obesity and health behaviors are the major modifiable contributors to cancer and health disparities. We examined the differences in obesity-related health behaviors, and health outcomes by rural and Appalachian residency in Ohio. METHODS Cross-sectional survey data from the 2011-2019 Behavioral Risk Factor Surveillance System were obtained from the Ohio Department of Health. County-level identifiers were used to classify urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian residency. Self-reported weight, height, health behaviors, and health conditions were used. Logistic regression was used to assess the difference in health behaviors and health outcomes by rural and Appalachian residency. All analyses incorporated with sample weights. RESULTS Among Ohio residents, compared to urban non-Appalachian residents, urban Appalachian and rural Appalachian residents had a higher prevalence of obesity, hypertension, high cholesterol, and cardiovascular diseases, as well as lower rates of healthy diet and physical activity. No difference was found in trends of obesity and obesity-related health outcomes in 2011-2019 by rural and Appalachian residency. However, rural Appalachian residents had a greater increase in obesity, hypertension, and diabetes, whereas rural non-Appalachian had favorable changes in obesity-related health behaviors. Additionally, associations between health behaviors and obesity-related health outcomes differed by rural and Appalachian residency. CONCLUSIONS Findings underscore the importance of distinguishing between urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian populations when assessing health disparities. While the trends of obesity and obesity-related health outcomes did not differ, the association between health behaviors and obesity-related outcomes differed by rural and Appalachian residency.
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Affiliation(s)
- Xiaochen Zhang
- Public Health Sciences, Fred Hutchison Cancer Center, Seattle, WA, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH, USA
| | - Abigail B Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Brian C Focht
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH, USA.
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15
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Dahal A, Kardonsky K, Cunningham M, Evans DV, Keys T. The Effect of Rural Underserved Opportunities Program Participation on Medical Graduates' Decision to Work in Rural Areas. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1288-1293. [PMID: 36724293 DOI: 10.1097/acm.0000000000005162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE There is a persistent rural physician shortage in the United States. Policies to scale up the health workforce in response to this shortage must include measures to draw and maintain existing and newly trained health care workers to rural regions. Prior studies have found that experience in community medicine in rural practice settings increases the likelihood of medical graduates practicing in those regions but have not accounted for selection bias. This study examined the impact of a community-based clinical immersion program on medical graduates' decision to work in rural regions, adjusting for covariates to control for selection bias. METHOD Data on sociodemographic characteristics and career interests and preferences for all 1,172 University of Washington School of Medicine graduates between 2009 and 2014 were collected. A logistic model (model 1) was used to evaluate the impact of Rural Underserved Opportunities Program (RUOP) participation on the probability of physicians working in a rural region. Another model (model 2) included the propensity score as a covariate in the regression to control for possible confounding based on differences among those who did and did not participate in the RUOP. RESULTS Of the 994 students included in the analysis, 570 (57.3%) participated in RUOP training, and 111 (11.2%) were currently working in rural communities after their training. Regression analysis results showed that the odds of working in a rural region were 1.83 times higher for graduates who participated in RUOP in model 1 ( P = .03) and 1.77 times higher in model 2 ( P = .04). CONCLUSIONS The findings of this study emphasize that educational programs and policies are crucial public health interventions that can promote health equity through proper distribution of health care workers across rural regions of the United States.
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Affiliation(s)
- Arati Dahal
- A. Dahal is a research scientist, Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington
| | - Kim Kardonsky
- K. Kardonsky is assistant professor, Department of Family Medicine, University of Washington, Seattle, Washington
| | - Matthew Cunningham
- M. Cunningham is assistant professor, Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - David V Evans
- D.V. Evans is professor, Department of Family Medicine, University of Washington, Seattle, Washington
| | - Toby Keys
- T. Keys is assistant teaching professor, Department of Family Medicine, University of Washington, Seattle, Washington
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16
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Choi ST. Administrative regional variation in cardiovascular risk among patients with gout: implications for the management of cardiovascular complications. JOURNAL OF RHEUMATIC DISEASES 2023; 30:209-210. [PMID: 37736587 PMCID: PMC10509636 DOI: 10.4078/jrd.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Sang Tae Choi
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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17
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Raisi‐Estabragh Z, Kobo O, Mieres JH, Bullock‐Palmer RP, Van Spall HG, Breathett K, Mamas MA. Racial Disparities in Obesity-Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020. J Am Heart Assoc 2023; 12:e028409. [PMID: 37671611 PMCID: PMC10547286 DOI: 10.1161/jaha.122.028409] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/07/2023] [Indexed: 09/07/2023]
Abstract
Background Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesity-related cardiovascular mortality in the US population between 1999 and 2020. Methods and Results The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and age-adjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281 135 obesity-related cardiovascular deaths demonstrated a 3-fold increase in AAMRs from 1999 to 2020 (2.2-6.6 per 100 000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individuals had the greatest temporal increase in AAMRs (+415%). Ischemic heart disease was the most common primary cause of death. The second most common cause of death was hypertensive disease, which was most common in the Black racial group (31%). Among Black individuals, women had higher AAMRs than men; across all other racial groups, men had a greater proportion of obesity-related cardiovascular mortality cases and higher AAMRs. Black individuals had greater AAMRs in urban compared with rural settings; the reverse was observed for all other races. Conclusions Obesity-related cardiovascular mortality is increasing with differential trends by race, sex, and place of residence.
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Affiliation(s)
- Zahra Raisi‐Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular ImagingQueen Mary UniversityLondonUnited Kingdom
- Barts Heart Centre, St. Bartholomew’s HospitalBarts Health NHS Trust, West SmithfieldLondonUnited Kingdom
| | - Ofer Kobo
- Keele Cardiovascular Research GroupKeele UniversityKeeleUnited Kingdom
- Department of CardiologyHillel Yaffe Medical CenterHaderaIsrael
| | - Jennifer H. Mieres
- Department of Cardiology, Hofstra Northwell School of MedicineHofstra University, Lake SuccessNew YorkNYUSA
| | | | - Harriette G.C. Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research InstituteResearch Institute of St. Joe’s, McMaster UniversityHamiltonOntarioCanada
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Department of MedicineIndiana UniversityIndianapolisINUSA
| | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityKeeleUnited Kingdom
- Institute of Population HealthUniversity of ManchesterManchesterUnited Kingdom
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18
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Howard KA, Griffin SF, Stuenkel M, Sease KK. Community features' varying insight into emergency department use for different childhood injuries. JOURNAL OF SAFETY RESEARCH 2023; 86:209-212. [PMID: 37718048 DOI: 10.1016/j.jsr.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/11/2023] [Accepted: 05/15/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Community-level factors, including poverty level, minority population, and rurality are predictive of child injury rates. Community-based interventions targeting high-risk communities have been suggested for prevention and are reliant on understanding details of the community and prevalent types of injuries. The present study assessed injury rates based on characteristics of the community and for different types of injuries. METHOD A retrospective review of emergency department visits identified zip-code and injury type data for children 0-19. Injuries related to bicycles, falls, motor-vehicle traffic (MTV), and violence were examined. Poverty level, minority population, rural classification, and insured population were obtained at the zip-code level. Regression models examined the association between community features and injury rates for the four categories of injuries. RESULTS The results showed that the relationship between community features and injury rates was dependent on injury type. Rurality was associated with a lower rate for bicycle and falls, but a higher rate of MVT; higher insured population was associated with higher MVT and violence rates; higher minority population was associated with lower rates for falls and MTV; and higher population in poverty was associated with lower rate for MTV. CONCLUSIONS The findings indicate that injury rates not only cluster among community-level characteristics, but also the type of injury. Variation in community features and injury types offer insight into a holistic approach to child health. PRACTICAL APPLICATIONS In addition to other factors related to risk for injuries, health providers' knowledge of features of the local community and prevalent injuries in the environment may be helpful additions to programming geared toward lessening the burden of injuries on children and healthcare systems.
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Affiliation(s)
- Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Mackenzie Stuenkel
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Kerry K Sease
- Department of Pediatrics, Prisma Health Children's Hospital - Upstate, Greenville, SC, USA; University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
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Nicolau JC, Owen R, Furtado RHM, Goodman SG, Granger CB, Cohen MG, Westermann D, Yasuda S, Simon T, Hedman K, Hunt PR, Brieger DB, Pocock SJ. Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry. Open Heart 2023; 10:e002326. [PMID: 37604649 PMCID: PMC10445369 DOI: 10.1136/openhrt-2023-002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural and urban settings are limited. METHODS The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged ≥50 years 1-3 years post-AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all-cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months. RESULTS There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all-cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke. CONCLUSIONS Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed. TRIAL REGISTRATION NUMBER NCT01866904.
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Affiliation(s)
- Jose Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Remo H M Furtado
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Mauricio G Cohen
- Cleveland Clinic Florida, Heart & Vascular Center, Cleveland, Ohio, USA
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tabassome Simon
- Department of Clinical Pharmacology and Research Platform of East of Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Katarina Hedman
- BioPharmaceuticals R&D, CVRM Biometrics, AstraZeneca, Gothenburg, Sweden
| | | | - David B Brieger
- Cardiology Department, Concord Hospital, Sydney, New South Wales, Australia
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20
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Kim I. Contributions of the life expectancy gap reduction between urban and rural areas to the increase in overall life expectancy in South Korea from 2000 to 2019. Int J Equity Health 2023; 22:141. [PMID: 37507677 PMCID: PMC10375755 DOI: 10.1186/s12939-023-01960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND This study aimed to quantify the contribution of narrowing the life expectancy gap between urban and rural areas to the overall life expectancy at birth in Korea and examine the age and death cause-specific contribution to changes in the life expectancy gap between urban and rural areas. METHODS We used the registration population and death statistics from Statistics Korea from 2000 to 2019. Assuming two hypothetical scenarios, namely, the same age-specific mortality change rate in urban and rural areas and a 20% faster decline than the observed decline rate in rural areas, we compared the increase in life expectancy with the actual increase. Changes in the life expectancy gap between urban and rural areas were decomposed into age- and cause-specific contributions. RESULTS Rural disadvantages of life expectancy were evident. However, life expectancies in rural areas increased more rapidly than in urban areas. Life expectancy would have increased 0.3-0.5 less if the decline rate of age-specific mortality in small-to-middle urban and rural areas were the same as that of large urban areas. Life expectancy would have increased 0.7-0.9 years further if the decline rate of age-specific mortality in small-to-middle urban and rural areas had been 20% higher. The age groups 15-39 and 40-64, and chronic diseases, such as neoplasms and diseases of the digestive system, and external causes significantly contributed to narrowing the life expectancy gap between urban and rural areas. CONCLUSION Pro-health equity interventions would be a good strategy to reduce the life expectancy gap and increase overall life expectancy, particularly in societies where life expectancies have already increased.
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Affiliation(s)
- Ikhan Kim
- Department of Medical Humanities and Social Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, Republic of Korea.
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21
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Kassas P, Gogou E, Varsamas C, Vogiatzidis K, Psatha A, Pinaka M, Siachpazidou D, Sistou A, Papazoglou ED, Kalousi D, Vatzia K, Astara K, Tsiouvakas N, Zarogiannis SG, Gourgoulianis K. The Alonissos Study: Cross-Sectional Study of the Healthcare Access and User Satisfaction in the Community of a Non-Profit-Line Greek Island. Healthcare (Basel) 2023; 11:1931. [PMID: 37444765 DOI: 10.3390/healthcare11131931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Healthcare access and a high quality of the provided services to healthcare users are fundamental human rights according to the Alma Ata Declaration of 1978. Although 45 years have passed since then, health inequalities still exist, not only among countries but also within populations of the same country. For example, several small Greek islands have only a small Primary Healthcare Center in order to provide healthcare services to the insular population. In the current study, we investigated the level of self-reported overall, dental and mental health status and the level of satisfaction regarding the access to and the quality of the healthcare services provided by the Primary Healthcare center of Alonissos, along with registering the requirements for transportation to the mainland in order to receive such services. In this questionnaire-based cross-sectional study, 235 inhabitants of the remote Greek island of Alonissos that accounts for nearly 9% of the population participated (115 males and 120 females). The self-reported overall health status was reported to be moderate to very poor at a percentage of 31.49%, and the results were similar for dental and self-reported mental health status. Although nearly 60% of the participants reported very good/good quality of the healthcare provision, only 37.45% reported that the access to healthcare was very good/good, while around 94% had at least one visit to the mainland in order to receive proper healthcare services. Strategies for improving access to healthcare services need to be placed in remote Greek islands like Alonissos.
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Affiliation(s)
- Petros Kassas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Eudoxia Gogou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Charalampos Varsamas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Konstantinos Vogiatzidis
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Aggeliki Psatha
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Maria Pinaka
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Dimitra Siachpazidou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Alexandra Sistou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Eleftherios D Papazoglou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Despoina Kalousi
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Konstantina Vatzia
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Kyriaki Astara
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Nikolaos Tsiouvakas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Sotirios G Zarogiannis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Konstantinos Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
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Kim HJ, Ghang B, Kim J, Ahn HS. Regional variations of cardiovascular risk in gout patients: a nationwide cohort study in Korea. JOURNAL OF RHEUMATIC DISEASES 2023; 30:185-197. [PMID: 37476678 PMCID: PMC10351371 DOI: 10.4078/jrd.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 07/22/2023]
Abstract
Objective The extent of regional variations in cardiovascular risk and associated risk factors in patients with gout in South Korea remains unclear. Therefore, we aimed to investigate the risk of major cardiovascular events in gout patients in different regions. Methods This was a nationwide cohort study based on the claims database of the Korean National Health Insurance and the National Health Screening Program. Patients aged 20 to 90 years newly diagnosed with gout after January 2012 were included. After cardiovascular risk profiles before gout diagnosis were adjusted, the relative risks of incident cardiovascular events (myocardial infarction, cerebral infarction, and cerebral hemorrhage) in gout patients in different regions were assessed. Results In total, 231,668 patients with gout were studied. Regional differences in cardiovascular risk profiles before the diagnosis were observed. Multivariable analysis showed that patients with gout in Jeolla/Gwangju had a significantly high risk of myocardial infarction (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.02~1.56; p=0.03). In addition, patients with gout in Gangwon (aHR, 1.38; 95% CI, 1.09~1.74; p<0.01), Jeolla/Gwangju (aHR, 1.41; 95% CI, 1.19~1.67; p<0.01), and Gyeongsang/Busan/Daegu/Ulsan (aHR, 1.37; 95% CI, 1.19~1.59; p<0.01) had a significantly high risk of cerebral infarction. Conclusion We found there were regional differences in cardiovascular risk and associated risk factors in gout patients. Physicians should screen gout patients for cardiovascular risk profiles in order to facilitate prompt diagnosis and treatment.
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Affiliation(s)
- Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Byeongzu Ghang
- Division of Rheumatology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jinseok Kim
- Division of Rheumatology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
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23
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Whittington KJ, Malone SM, Hogan PG, Ahmed F, Flowers J, Milburn G, Morelli JJ, Newland JG, Fritz SA. Staphylococcus aureus Bacteremia in Pediatric Patients: Uncovering a Rural Health Challenge. Open Forum Infect Dis 2023; 10:ofad296. [PMID: 37469617 PMCID: PMC10352649 DOI: 10.1093/ofid/ofad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/30/2023] [Indexed: 07/21/2023] Open
Abstract
Background Staphylococcus aureus bacteremia poses significant risk for morbidity and mortality. This may be exacerbated in rural populations facing unique health challenges. Methods To investigate factors influencing S. aureus bacteremia outcomes, we conducted a retrospective cohort study of children admitted to St. Louis Children's Hospital (SLCH) from 2011 to 2019. Exposures included rurality (defined by the Rural-Urban Continuum Code), Area Deprivation Index, and outside hospital (OSH) admission before SLCH admission. The primary outcome was treatment failure, a composite of 90-day all-cause mortality and hospital readmission. Results Of 251 patients, 69 (27%) were from rural areas; 28 (11%) were initially admitted to an OSH. Treatment failure occurred in 39 (16%) patients. Patients from rural areas were more likely to be infected with methicillin-resistant S. aureus (45%) vs urban children (29%; P = .02). Children initially admitted to an OSH, vs those presenting directly to SLCH, were more likely to require intensive care unit-level (ICU) care (57% vs 29%; P = .002), have an endovascular source of infection (32% vs 12%; P = .004), have a longer duration of illness before hospital presentation (4.1 vs 3.0 days; P = .04), and have delayed initiation of targeted antibiotic therapy (3.9 vs 2.6 days; P = .01). Multivariable analysis revealed rural residence (adjusted odds ratio [aOR], 2.3; 95% CI, 1.1-5.0), comorbidities (aOR, 2.9; 95% CI, 1.3-6.2), and ICU admission (aOR, 3.9; 95% CI, 1.9-8.3) as predictors of treatment failure. Conclusions Children from rural areas face barriers to specialized health care. These challenges may contribute to severe illness and worse outcomes among children with S. aureus bacteremia.
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Affiliation(s)
- Kyle J Whittington
- Correspondence: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 (); or Kyle Whittington, MD, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 ()
| | - Sara M Malone
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Faria Ahmed
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - JessieAnn Flowers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grace Milburn
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John J Morelli
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Correspondence: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 (); or Kyle Whittington, MD, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 ()
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24
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Gyngell C, Lynch F, Vears D, Bowman-Smart H, Savulescu J, Christodoulou J. Storing paediatric genomic data for sequential interrogation across the lifespan. JOURNAL OF MEDICAL ETHICS 2023:jme-2022-108471. [PMID: 37263770 DOI: 10.1136/jme-2022-108471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/02/2023] [Indexed: 06/03/2023]
Abstract
Genomic sequencing (GS) is increasingly used in paediatric medicine to aid in screening, research and treatment. Some health systems are trialling GS as a first-line test in newborn screening programmes. Questions about what to do with genomic data after it has been generated are becoming more pertinent. While other research has outlined the ethical reasons for storing deidentified genomic data to be used in research, the ethical case for storing data for future clinical use has not been explicated. In this paper, we examine the ethical case for storing genomic data with the intention of using it as a lifetime health resource. In this model, genomic data would be stored with the intention of reanalysis at certain points through one's life. We argue this could benefit individuals and create an important public resource. However, several ethical challenges must first be met to achieve these benefits. We explore issues related to privacy, consent, justice and equality. We conclude by arguing that health systems should be moving towards futures that allow for the sequential interrogation of genomic data throughout the lifespan.
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Affiliation(s)
- Christopher Gyngell
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Lynch
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Law School, The University of Melbourne, Parkville, VIC, Australia
| | - Danya Vears
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hilary Bowman-Smart
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of South Australia, Adeliade, South Australia, Australia
| | - Julian Savulescu
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Faculty of Philosophy, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics - Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John Christodoulou
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
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Lawrence E, John SE, Bhatta T. Urbanicity and cognitive functioning in later life. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12429. [PMID: 37124156 PMCID: PMC10130675 DOI: 10.1002/dad2.12429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 05/02/2023]
Abstract
Introduction Prior research has shown disparities in cognitive functioning across the rural-urban continuum. We examine individual- and contextual-level factors to understand how and why urbanicity shapes cognitive functioning across older adulthood. Methods Using a nationally representative sample from 1996 to 2016 waves of the Health and Retirement Study (HRS) and growth curve models, we assess urban-suburban-exurban differences in older adult cognitive functioning. Results Results demonstrate that older adult men and women living in exurban areas, and older adult men in suburban areas, have lower cognitive functioning scores compared to their urban peers. Educational attainment and marital status contribute to but do not fully explain these differences. There were no differences in the trajectory over age, suggesting that urbanicity disparities in cognition occur earlier in life, with average differences remaining the same across older adulthood. Discussion Differences in cognitive functioning across urbanicity are likely due to factors accumulating prior to older adulthood.
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Affiliation(s)
| | - Samantha E. John
- Department of Brain HealthUniversity of NevadaLas VegasNevadaUSA
| | - Tirth Bhatta
- Department of SociologyUniversity of NevadaLas VegasNevadaUSA
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Kegler MC, Hermstad A, Haardörfer R, Arriola KJ, Gauthreaux N, Tucker S, Nelson G. Evaluation Design for The Two Georgias Initiative: Assessing Progress Toward Health Equity in the Rural South. HEALTH EDUCATION & BEHAVIOR 2023; 50:268-280. [PMID: 35306908 DOI: 10.1177/10901981211060330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As persistent inequities in health gained increased attention nationally due to COVID-19 and racial justice protests in 2020, it has become increasingly important to evaluate both the process and outcomes associated with coalition-based efforts to address health inequities. The Two Georgias Initiative supports coalitions in 11 rural counties to (1) achieve greater health equity, (2) improve health and health care, (3) build healthier rural communities and improve social conditions that impact the health of rural populations, and (4) build community, organizational, and individual leadership capacity for health equity. Rural communities suffer significant health disparities relative to urban areas, and also experience internal inequities by race and poverty level. The evaluation framework for The Two Georgias Initiative provides a comprehensive mixed methods approach to evaluating both processes and outcomes. Early results related to community readiness and capacity to address health inequities, measured through a coalition member survey (n = 236) conducted at the end of the planning phase, suggest coalitions were in the preparation stage, with higher levels of readiness among coalition members and organizations/groups similar to the coalition members' own, lower levels among public officials and other leaders, and the lowest levels among county residents. In addition, coalition members reported more experience with downstream drivers (e.g., access to care) of health than upstream drivers (e.g., affordable housing, environmental or racial justice). By providing a logic model, evaluation questions and associated indicators, as well as a range of data collection methods, this evaluation approach may prove practical to others aiming to evaluate their efforts to address health equity.
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Affiliation(s)
| | | | | | | | | | | | - Gary Nelson
- Healthcare Georgia Foundation, Atlanta, GA, USA
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Zang E, Flores Morales J, Luo L, Baid D. Explaining obesity disparities by urbanicity, 2006 to 2016: A decomposition analysis. Obesity (Silver Spring) 2023; 31:487-495. [PMID: 36621926 PMCID: PMC9877136 DOI: 10.1002/oby.23608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A large, and potentially growing, disparity in obesity prevalence exists between large central metros and less urban United States counties. This study examines its key predictors. METHODS Using a rich county-year data set spanning 2006 to 2016, the authors conducted a Gelbach decomposition to examine the relative importance of demographic, socioeconomic, environmental, and behavioral factors in shaping the baseline obesity gap and the growth rate over time between large central metros and other counties. RESULTS Predictors included in this model explain almost the entire obesity gap between large central metros and other counties in the baseline year but can explain only ~32% of the growing gap. At baseline, demographic predictors explain more than half the obesity gap, and socioeconomic and behavioral predictors explain the other half. Behavioral and socioeconomic predictors explain more than half the growing gap over time whereas controlling for environmental and demographic predictors decreases the obesity gap by urbanicity over time. CONCLUSIONS Results suggest policy makers should prioritize interventions targeting health behaviors of residents in non-large central metros to slow the growth of the obesity gap between large central metros and other counties. However, to fundamentally eliminate the obesity gap, in addition to improving health behaviors, policies addressing socioeconomic inequalities are needed.
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Affiliation(s)
- Emma Zang
- Department of Sociology, Yale University, New Haven, CT, USA
| | | | - Liying Luo
- Department of Sociology and Criminology, Penn State University, University Park, PA, USA
| | - Drishti Baid
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
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28
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Lee JH, Wheeler DC, Zimmerman EB, Hines AL, Chapman DA. Urban-Rural Disparities in Deaths of Despair: A County-Level Analysis 2004-2016 in the U.S. Am J Prev Med 2023; 64:149-156. [PMID: 38584644 PMCID: PMC10997338 DOI: 10.1016/j.amepre.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction The purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk. Methods The authors applied a Bayesian spatial regression technique to investigate the association between U.S. county-level characteristics and drug, alcohol, and suicide mortality rates for 2004-2016, accounting for spatial correlation that occurs among counties. Results Mortality risks from drug, alcohol, and suicide were positively associated with the degree of rurality, the proportion of vacant housing units, the population with a disability, the unemployed population, the population with low access to grocery stores, and the population with no health insurance. Conversely, risks were negatively associated with Hispanic population, non-Hispanic Black population, and population with a bachelor's degree or higher. Conclusions Spatial disparities in drug, alcohol, and suicide mortality exist at the county level across the U.S. social determinants of health; educational attainment, degree of rurality, ethnicity, disability, unemployment, and health insurance status are important factors associated with these mortality rates. A comprehensive strategy that includes downstream interventions providing equitable access to healthcare services and upstream efforts in addressing socioeconomic conditions is warranted to effectively reduce these mortality burdens.
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Affiliation(s)
- Jong Hyung Lee
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Emily B. Zimmerman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Anika L. Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Derek A. Chapman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
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O'Neill JC, Ashburn NP, Paradee BE, Snavely AC, Stopyra JP, Noe G, Mahler SA. Rural and socioeconomic differences in the effectiveness of the HEART Pathway accelerated diagnostic protocol. Acad Emerg Med 2023; 30:110-123. [PMID: 36527333 PMCID: PMC10009897 DOI: 10.1111/acem.14643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The HEART Pathway is a validated accelerated diagnostic protocol (ADP) for patients with possible acute coronary syndrome (ACS). This study aimed to compare the safety and effectiveness of the HEART Pathway based on patient rurality (rural vs. urban) or socioeconomic status (SES). METHODS We performed a preplanned subgroup analysis of the HEART Pathway Implementation Study. The primary outcomes were death or myocardial infarction (MI) and hospitalization at 30 days. Proportions were compared by SES and rurality with Fisher's exact tests. Logistic regression evaluated for interactions of ADP implementation with SES or rurality and changes in outcomes within subgroups. RESULTS Among 7245 patients with rurality and SES data, 39.9% (2887/7245) were rural and 22.2% were low SES (1607/7245). The HEART Pathway identified patients as low risk in 32.2% (818/2540) of urban versus 28.1% (425/1512) of rural patients (p = 0.007) and 34.0% (311/915) of low SES versus 29.7% (932/3137) high SES patients (p = 0.02). Among low-risk patients, 30-day death or MI occurred in 0.6% (5/818) of urban versus 0.2% (1/425) rural (p = 0.67) and 0.6% (2/311) with low SES versus 0.4% (4/932) high SES (p = 0.64). Following implementation, 30-day hospitalization was reduced by 7.7% in urban patients (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI] 0.66-0.87), 10.6% in low SES patients (aOR 0.68, 95% CI 0.54-0.86), and 4.5% in high SES patients (aOR 0.83, 95% CI 0.73-0.94). However, rural patients had a nonsignificant 3.3% reduction in hospitalizations. CONCLUSIONS HEART Pathway implementation decreased 30-day hospitalizations regardless of SES and for urban patients but not rural patients. The 30-day death or MI rate was similar among low-risk patients.
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Affiliation(s)
- James C O'Neill
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicklaus P Ashburn
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Brennan E Paradee
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna C Snavely
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jason P Stopyra
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Greg Noe
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Simon A Mahler
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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30
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Arsenault-Lapierre G, Bui TX, Le Berre M, Bergman H, Vedel I. Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review. BMC Health Serv Res 2023; 23:102. [PMID: 36721162 PMCID: PMC9887943 DOI: 10.1186/s12913-023-09100-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are challenges in healthcare service delivery in rural areas, and this may be especially true for persons with dementia, who have higher needs to access to the healthcare system, and may have difficulties to commute easily and safely to these services. There is a growing body of literature regarding geographical disparities, but there is no comprehensive systematic review of geographical differences in persons with dementia across all domains of care quality. Therefore, the objective of this study is to conduct a systematic review of the literature on rural and urban differences in quality of dementia care outcomes of persons with dementia across all quality-of-care domains. METHODS We performed a digital search in Ovid MEDLINE on July 16, 2019, updated on May 3, 2021, for French or English records. We selected studies that reported outcome from at least one domain of quality of dementia care (Access, Integration, Effective Care, Efficient Care, Population Health, Safety, and Patient-Centered) in both rural and urban persons with dementia or caregivers. We used rigorous, systematic methods for screening, selection, data extraction and we analyzed outcomes reported by at least two studies using vote counting and appraised the certainty of evidence. Finally, we explored sources of heterogeneity. RESULTS From the 38 included studies, we found differences in many dementia care domains. Rural persons with dementia had higher mortality rates (Population Health), lower visits to any physicians (Access), more hospitalizations but shorter stays (Integration), higher antipsychotic medications (Safety), lower use of home care services and higher use of nursing home (Patient-Centered Care) compared to urban persons with dementia. CONCLUSIONS This comprehensive portrait of rural-urban differences in dementia care highlights possible geographically based inequities and can be used by researchers and decision makers to guide development of more equitable dementia care policies.
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Affiliation(s)
- Geneviève Arsenault-Lapierre
- Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada.
| | - Tammy X. Bui
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada
| | - Mélanie Le Berre
- grid.14848.310000 0001 2292 3357Université de Montréal, Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montreal, H3W 1W5 Canada
| | - Howard Bergman
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Isabelle Vedel
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada ,grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
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Felzer JR, Finney Rutten LJ, Wi CI, LeMahieu AM, Beam E, Juhn YJ, Jacobson RM, Kennedy CC. Disparities in vaccination rates in solid organ transplant patients. Transpl Infect Dis 2023; 25:e14010. [PMID: 36715676 PMCID: PMC10085850 DOI: 10.1111/tid.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/23/2022] [Accepted: 11/06/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Vaccinations against preventable respiratory infections such as Streptococcus pneumoniae and influenza are important in immunosuppressed solid organ transplant (SOT) recipients. Little is known about the role of age, race, ethnicity, sex, and sociodemographic factors including rurality, or socioeconomic status (SES) associated with vaccine uptake in this population. METHODS We conducted a population-based study using the Rochester Epidemiology Project, a medical records linkage system, to assess socioeconomic and demographic factors associated with influenza and pneumococcal vaccination rates among adult recipients of solid organ transplantation (aged 19-64 years) living in four counties in southeastern Minnesota. Vaccination data were obtained from the Minnesota Immunization Information Connection from June 1, 2010 to June 30, 2020. Vaccination rate was assessed with Poisson and logistic regression models. RESULTS A total of 468 SOT recipients were identified with an overall vaccination rate of 57%-63% for influenza and 56% for pneumococcal vaccines. As expected, vaccination for pneumococcal vaccine positively correlated with influenza vaccination. Rural patients had decreased vaccination in both compared to urban patients, even after adjusting for age, sex, race, ethnicity, and SES. Although the population was mostly White and non-Hispanic, neither vaccination differed by race or ethnicity, but influenza vaccination did by SES. Among organ transplant groups, liver and lung recipients were least vaccinated for influenza, and heart recipients were least up-to-date on pneumococcal vaccines. CONCLUSIONS Rates of vaccination were below national goals. Rurality was associated with undervaccination. Further investigation is needed to understand and address barriers to vaccination among transplant recipients.
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Affiliation(s)
- Jamie R Felzer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lila J Finney Rutten
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Elena Beam
- Division of Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert M Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
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Cedeño B, Shimkin G, Lawson A, Cheng B, Patterson DG, Keys T. Positive yet problematic: Lived experiences of racial and ethnic minority medical students during rural and urban underserved clinical rotations. J Rural Health 2023. [PMID: 36702631 DOI: 10.1111/jrh.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF STUDY Medical students who identify as Black, Indigenous, and People of Color (BIPOC) regularly experience mistreatment and discrimination. This study sought to understand these student experiences during rotations in rural and urban underserved community teaching sites. METHODS Self-identified BIPOC medical students who completed the University of Washington School of Medicine's Rural Underserved Opportunities Program from 2019 through 2021 were invited to participate in a 60- to 90-minute focus group discussion via Zoom. From August to September 2021, 4 focus groups and 1 individual interview were conducted with a total of 12 participants. A current BIPOC medical student facilitated the sessions utilizing questions developed by the research team. Four study team members coded transcripts for key themes related to experiences of microaggressions. FINDINGS All participants reported having an overall positive experience, but everyone also witnessed and/or experienced at least 1 microaggression. Unlike those in urban placements, participants placed in rural sites expressed anxiety about being in predominantly White communities and experienced feelings of racial and/or ethnic isolation during the rotation. Participants recommended that rural preceptors identify themselves as trusted advocates and the program should prioritize placing BIPOC students at diverse clinical sites. CONCLUSIONS Medical schools must take action to address the mistreatment of BIPOC medical students in the clinical environment. Schools and rural training sites need to consider how to best support students to create an equitable learning environment and recruit more BIPOC physicians to rural practice.
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Affiliation(s)
- Brian Cedeño
- Medical Student, University of Washington School of Medicine, Seattle, Washington, USA
| | - Genya Shimkin
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexa Lawson
- Office of Rural Programs, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bopha Cheng
- Office of Rural Programs, University of Washington School of Medicine, Seattle, Washington, USA
| | - Davis G Patterson
- WWAMI Rural Health Research Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Toby Keys
- Office of Rural Programs, University of Washington School of Medicine, Seattle, Washington, USA
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Salerno EA, Gao R, Fanning J, Gothe NP, Peterson LL, Anbari AB, Kepper MM, Luo J, James AS, McAuley E, Colditz GA. Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences. Front Oncol 2023; 13:1061641. [PMID: 36761969 PMCID: PMC9907024 DOI: 10.3389/fonc.2023.1061641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Background While technology advances have increased the popularity of remote interventions in underserved and rural cancer communities, less is understood about technology access and preferences for home-based physical activity programs in this cancer survivor population. Purpose To determine access, preferences, and needs, for a home-based physical activity program in rural cancer survivors. Methods A Qualtrics Research Panel was recruited to survey adults with cancer across the United States. Participants self-reported demographics, cancer characteristics, technology access and usage, and preferences for a home-based physical activity program. The Godin Leisure Time Exercise Questionnaire (GLTEQ) assessed current levels of physical activity. Descriptive statistics included means and standard deviations for continuous variables, and frequencies for categorical variables. Independent samples t-tests explored differences between rural and non-rural participants. Results Participants (N=298; mean age=55.2 ± 16.5) had a history of cancer (mean age at diagnosis=46.5), with the most commonly reported cancer type being breast (25.5%), followed by prostate (16.1%). 74.2% resided in rural hometowns. 95% of participants reported accessing the internet daily. On a scale of 0-100, computer/laptop (M=63.4) and mobile phone (M=54.6) were the most preferred delivery modes for a home-based physical activity intervention, and most participants preferred balance/flexibility (72.2%) and aerobic (53.9%) exercises. Desired intervention elements included a frequency of 2-3 times a week (53.5%) for at least 20 minutes (75.7%). While there were notable rural disparities present (e.g., older age at diagnosis, lower levels of education; ps<.001), no differences emerged for technology access or environmental barriers (ps>.08). However, bias due to electronic delivery of the survey should not be discounted. Conclusion These findings provide insights into the preferred physical activity intervention (e.g., computer delivery, balance/flexibility exercises) in rural cancer survivors, while highlighting the need for personalization. Future efforts should consider these preferences when designing and delivering home-based interventions in this population.
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Affiliation(s)
- Elizabeth A. Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Rohana Gao
- Academic Program of Medical Education, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jason Fanning
- Department of Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Neha P. Gothe
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Lindsay L. Peterson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Allison B. Anbari
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Zimmermann K, Muramatsu N, Molina Y, Carnahan LR, Geller SE. Application of the consolidated framework for implementation research to understand implementation context of a cardiovascular disease risk-reduction intervention in rural churches. Transl Behav Med 2023; 13:236-244. [PMID: 36694377 DOI: 10.1093/tbm/ibac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Rural populations in the USA face higher rates of cardiovascular disease (CVD) incidence and mortality relative to non-rural and often lack access to health-promoting evidence-based interventions (EBIs) to support CVD prevention and management. Partnerships with faith organizations offer promise for translating preventative EBIs in rural communities; however, studies demonstrating effective translation of EBIs in these settings are limited. We used the Consolidated Framework for Implementation Research (CFIR) and a multiple case study approach to understand the role of internal organizational context within 12 rural churches in the implementation of a 12-week CVD risk-reduction intervention followed by a 24-month maintenance program implemented in southernmost Illinois. The study involved qualitative analysis of key informant interviews collected before (n = 26) and after (n = 15) the intervention and monthly implementation reports (n = 238) from participating churches using a deductive analysis approach based on the CFIR. Internal context across participating churches varied around organizational climate and culture in four thematic areas: (i) religious basis for health promotion, (ii) history of health activities within the church, (iii) perceived need for the intervention, and (iv) church leader engagement. Faith organizations may be ideal partners in rural health promotion research but may vary in their interest and capacity to collaborate. Identifying contextual factors within community organizations is a first step to facilitating rural, community-based EBI implementation and outcomes.
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Affiliation(s)
- Kristine Zimmermann
- Department of Family and Community Medicine, Division of Health Research and Evaluation, University of Illinois College of Medicine Rockford, Rockford, IL, USA.,Division of Community Health Sciences, School of Public Health, University of Illinois, Chicago, USA
| | - Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois, Chicago, USA
| | - Yamilé Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois, Chicago, USA.,University of Illinois Cancer Center, Chicago, IL, USA
| | - Leslie R Carnahan
- Division of Community Health Sciences, School of Public Health, University of Illinois, Chicago, USA.,University of Illinois Cancer Center, Chicago, IL, USA
| | - Stacie E Geller
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois, Chicago, USA.,Center for Research on Women and Gender, College of Medicine, University of Illinois, Chicago, USA
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Kim NE, Kang EH, Ha E, Lee JY, Lee JH. Association of type 2 diabetes mellitus with lung cancer in patients with chronic obstructive pulmonary disease. Front Med (Lausanne) 2023; 10:1118863. [PMID: 37181380 PMCID: PMC10172489 DOI: 10.3389/fmed.2023.1118863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of developing lung cancer. Some studies have also suggested that diabetes mellitus (DM) may increase the risk of developing lung cancer. This study aimed to investigate whether type 2 DM (T2DM) is associated with an increased risk of lung cancer in patients with COPD. Materials and methods We conducted a retrospective analysis on two cohorts: the National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea and the Common Data Model (CDM) database of a university hospital. Among patients newly diagnosed with COPD in each cohort, those with a lung cancer diagnosis were included, and a control group was selected through propensity score matching. We used the Kaplan-Meier analysis and Cox proportional hazard models to compare lung cancer incidence between patients with COPD and T2DM and those without T2DM. Results In the NHIS-NSC and CDM cohorts, we enrolled 3,474 and 858 patients with COPD, respectively. In both cohorts, T2DM was associated with an increased risk of lung cancer [NHIS-NSC: adjusted hazard ratio (aHR), 1.20; 95% confidence interval (CI), 1.02-1.41; and CDM: aHR, 1.45; 95% CI, 1.02-2.07). Furthermore, in the NHIS-NSC, among patients with COPD and T2DM, the risk of lung cancer was higher in current smokers than in never-smokers (aHR, 1.45; 95% CI, 1.09-1.91); in smokers with ≥30 pack-years than in never-smokers (aHR, 1.82; 95% CI, 1.49-2.25); and in rural residents than in metropolitan residents (aHR, 1.33; 95% CI, 1.06-1.68). Conclusion Our findings suggest that patients with COPD and T2DM may have an increased risk of developing lung cancer compared to those without T2DM.
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Affiliation(s)
- Nam Eun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Eun-Hwa Kang
- Informatization Department, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Eunhee Ha
- Graduate Program in System Health Science and Engineering, Department of Environmental Medicine, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Republic of Korea
| | - Ji-Young Lee
- Inflammation-Cancer Microenvironment Research Center, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- *Correspondence: Ji-Young Lee,
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Jin Hwa Lee,
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Norman-Burgdolf H, DeWitt E, Gillespie R, Cardarelli KM, Slone S, Gustafson A. Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019-2022. Front Public Health 2023; 11:1142478. [PMID: 37124781 PMCID: PMC10140309 DOI: 10.3389/fpubh.2023.1142478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.
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Affiliation(s)
- Heather Norman-Burgdolf
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
- *Correspondence: Heather Norman-Burgdolf,
| | - Emily DeWitt
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
| | - Rachel Gillespie
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Kathryn M. Cardarelli
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Stacey Slone
- Dr. Bing Zhang Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, KY, United States
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
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Bush K, Patrick C, Elliott K, Morris M, Tiruneh Y, McGaha P. Unsung heroes in health education and promotion: How Community Health Workers contribute to hypertension management. Front Public Health 2023; 11:1088236. [PMID: 36908415 PMCID: PMC9996176 DOI: 10.3389/fpubh.2023.1088236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023] Open
Abstract
Rural communities are noted as having poor health outcomes. Rural areas experience barriers to care primarily due to a lack of resources, including education, health insurance, transportation, and social support. Additionally, poor health outcomes are a consequence of poor health literacy skills. Community Health Workers (CHWs) are utilized as a resource to combat these issues. This study focused on a CHW led Self-Management Blood Pressure (SMBP) program offered through the University of Texas at Tyler Health Science Center. The goal of the program was to improve management of hypertension through awareness, education, navigation, advocacy, and resource assistance. The SMBP program included structured workshops and regular follow-up with participants including connections to community resources and social support. CHWs worked closely with physicians providing bi-directional feedback on referrals and engagement of communities through outreach events. Furthermore, CHWs aided to bridge cultural or linguistic gaps between service providers and community members. Data is provided indicating this CHW-led intervention played a significant role in improving hypertension through education of how to make lifestyle changes that impact overall health and quality of life. Participants gained knowledge encouraging them to create lifelong healthy habits, coping skills, stress management, self-care, and accountability. Through this innovative approach, participants thrived in the supportive and encouraging environment led by CHWs as well as improved their blood pressure management.
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Affiliation(s)
- Kim Bush
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Carlea Patrick
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Kimberly Elliott
- Department of Health Policy, Economics, and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Michael Morris
- Department of Health Policy, Economics, and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Yordanos Tiruneh
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Paul McGaha
- Department of Preventive Medicine and Population Health, University of Texas at Tyler Health Science Center, Tyler, TX, United States
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Totten AM, Womack DM, Griffin JC, McDonagh MS, Davis-O'Reilly C, Blazina I, Grusing S, Elder N. Telehealth-guided provider-to-provider communication to improve rural health: A systematic review. J Telemed Telecare 2022:1357633X221139892. [PMID: 36567431 DOI: 10.1177/1357633x221139892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Telehealth may address healthcare disparities for rural populations. This systematic review assesses the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare. METHODS We searched Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL from 1 January 2010 to 12 October 2021 for trials and observational studies of rural provider-to-provider telehealth. Abstracts and full text were dual-reviewed. We assessed the risk of bias for individual studies and strength of evidence for studies with similar outcomes. RESULTS Seven studies of rural uptake of provider-to-provider telehealth documented increases over time but variability across geographic regions. In 97 effectiveness studies, outcomes were similar with rural provider-to-provider telehealth versus without for inpatient consultations, neonatal care, outpatient depression and diabetes, and emergency care. Better or similar results were reported for changes in rural clinician behavior, knowledge, confidence, and self-efficacy. Evidence was insufficient for other clinical uses and outcomes. Sixty-seven (67) evaluation and qualitative studies identified barriers and facilitators to implementing rural provider-to-provider telehealth. Success was linked to well-functioning technology, sufficient resources, and adequate payment. Barriers included lack of understanding of rural context and resources. Methodologic weaknesses of studies included less rigorous study designs and small samples. DISCUSSION Rural provider-to-provider telehealth produces similar or better results versus care without telehealth. Barriers to rural provider-to-provider telehealth implementation are common to practice change but include some specific to rural adaptation and adoption. Evidence gaps are partially due to studies that do not address differences in the groups compared or do not include sufficient sample sizes.
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Affiliation(s)
| | - Dana M Womack
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Ian Blazina
- Oregon Health & Science University, Portland, OR, USA
| | - Sara Grusing
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy Elder
- Oregon Health & Science University, Portland, OR, USA
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Ondusko DS, Liu J, Hatch B, Profit J, Carter EH. Associations between maternal residential rurality and maternal health, access to care, and very low birthweight infant outcomes. J Perinatol 2022; 42:1592-1599. [PMID: 35821103 DOI: 10.1038/s41372-022-01456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Infant mortality is increased in isolated rural areas. This study compares prenatal factors, access to care, and health outcomes for very-low birthweight (VLBW) infants by degree of maternal residential rurality. METHODS This descriptive population-based retrospective cohort study used the California Perinatal Quality Care Collaborative registry to study VLBW infants. Rurality was assigned as urban, large rural, and small rural/isolated using the Rural Urban Commuting Area codes. We used hierarchical random effect models to test the association of rurality with survival without major morbidity. RESULTS The study included 38 614 dyads. VLBW survival without major morbidity decreased with increasing rurality and the relationship remained significant for small rural/isolated areas (OR 0.79, p = 0.03) after adjustment. Birth weight, gestational age, and infant sex were similar across geographic groups. CONCLUSION A rural urban disparity exists for VLBW survival without major morbidity. Our findings generate hypotheses about factors that may be driving these disparities.
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Affiliation(s)
- Devlynne S Ondusko
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
| | - Jessica Liu
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Brigit Hatch
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Emily Hawkins Carter
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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James WL, Brindley C, Purser C, Topping M. Conceptualizing rurality: The impact of definitions on the rural mortality penalty. Front Public Health 2022; 10:1029196. [PMID: 36408010 PMCID: PMC9669957 DOI: 10.3389/fpubh.2022.1029196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background In the U.S., inequality is widespread and still growing at nearly every level conceivable. This is vividly illustrated in the long-standing, well-documented inequalities in outcomes between rural and urban places in the U.S.; namely, the rural mortality penalty of disproportionately higher mortality rates in these areas. But what does the concept of "rural" capture and conjure? How we explain these geographic differences has spanned modes of place measurement and definitions. We employ three county-level rural-urban definitions to (1) analyze how spatially specific and robust rural disparities in mortality are and (2) identify whether mortality outcomes are dependent on different definitions. Methods We compare place-based all-cause mortality rates using three typologies of "rural" from the literature to assess robustness of mortality rates across these rural and urban distinctions. Results show longitudinal all-cause mortality rate trends from 1968 to 2020 for various categories of urban and rural areas. We then apply this data to rural and urban geography to analyze the similarity in the distribution of spatial clusters and outliers in mortality using spatial autocorrelation methodologies. Results The rural disadvantage in mortality is remarkably consistent regardless of which rural-urban classification scheme is utilized, suggesting the overall pattern of rural disadvantage is robust to any definition. Further, the spatial association between rurality and high rates of mortality is statistically significant. Conclusion Different definitions yielding strongly similar results suggests robustness of rurality and consequential insights for actionable policy development and implementation.
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Affiliation(s)
- Wesley L. James
- Department of Sociology, Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States,*Correspondence: Wesley L. James
| | - Claire Brindley
- Department of Sociology, Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States
| | - Christopher Purser
- Department of Politics, Justice, Law, and Philosophy, University of North Alabama, Florence, AL, United States
| | - Michael Topping
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, United States
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Crengle S, Davie G, Whitehead J, de Graaf B, Lawrenson R, Nixon G. Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 28:100570. [PMID: 36042896 PMCID: PMC9420525 DOI: 10.1016/j.lanwpc.2022.100570] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Previous research identified inequities in all-cause mortality between Māori and non-Māori populations. Unlike comparable jurisdictions, mortality rates in rural areas have not been shown to be higher than those in urban areas for either population. This paper uses contemporary mortality data to examine Māori and non-Māori mortality rates in rural and urban areas. METHODS A population-level observational study using deidentified routinely collected all-cause mortality, amenable mortality and census data. For each level of the Geographic Classification for Health (GCH), Māori and non-Māori age-sex standardised all-cause mortality and amenable mortality incident rates, Māori:Non-Māori standardised incident rate ratios and Māori rural:urban standardised incident rate ratios were calculated. Age and deprivation stratified rates and rate ratios were also calculated. FINDINGS Compared to non-Māori, Māori experience excess all-cause (SIRR 1.87 urban; 1.95 rural) and amenable mortality (SIRR 2.45 urban; 2.34 rural) and in all five levels of the GCH. Rural Māori experience greater all-cause (SIRR 1.07) and amenable (SIRR 1.13) mortality than their urban peers. Māori and non-Māori all-cause and amenable mortality rates increased as rurality increased. INTERPRETATION The excess Māori all-cause mortality across the rural: urban spectrum is consistent with existing literature documenting other Māori health inequities. A similar but more pronounced pattern of inequities is observed for amenable mortality that reflects ethnic differences in access to, and quality of, health care. The excess all-cause and amenable mortality experienced by rural Māori, compared to their urban counterparts, suggests that there are additional challenges associated with living rurally. FUNDING This work was funded by the Health Research Council of New Zealand (HRC19/488).
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Affiliation(s)
- Sue Crengle
- (Kāi Tahu, Kāti Māmoe, Waitaha) PhD. Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Gabrielle Davie
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Jesse Whitehead
- Te Ngira Institute for Population Research, Waikato University, Private Bag 3105, Hamilton 3240, New Zealand
| | - Brandon de Graaf
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, Waikato University, Private Bag 3105, Hamilton 3240, New Zealand
| | - Garry Nixon
- Department of General Practice and Rural Health, University of Otago, PO Box 56, Dunedin 9054, New Zealand
- Dunstan Hospital, PO Box 30, Clyde 9341, New Zealand
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Yang X, Zhao X, Chen X, Tong R. Proportions distribution of pneumoconiosis stages in China: a study based on a meta-analysis and field investigation. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2022; 57:1024-1036. [PMID: 36285421 DOI: 10.1080/10934529.2022.2138316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Occupational pneumoconiosis is the most serious work-related disease in China. In this paper, pneumoconiosis stages distribution was obtained to study the stages severity of occupational pneumoconiosis patients in China. A meta-analysis was conducted among screening the published literature on the pneumoconiosis epidemiology in China by Stata 15.0. Moreover, a field survey was conducted on 510 migrant workers suffering from pneumoconiosis in four provinces of China, and the results were analyzed by simple linear analysis and ordinal logistic regression analysis. The stage I, II and III pneumoconiosis accounted for 0.71, 0.21, 0.08, respectively, by the results of meta-analysis. The publication bias of these articles is not obvious based on the Egger's test and funnel plots. There was no significant linear correlation between the distribution of pneumoconiosis stages and the economic status and medical conditions in this study. Migrant workers pneumoconiosis stage I, II and III accounted for 0.14, 0.2, 0.66 respectively, which was significantly correlated with length of work and provinces. In China, migrant workers lack effective occupational health protection so that they have higher occupational health risks than urban workers. Therefore, occupational health protection for migrant workers in the occupational health management system needs to be strengthened.
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Affiliation(s)
- Xuesong Yang
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Xu Zhao
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Xingbang Chen
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Ruipeng Tong
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
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Wang D, Zhang E, Qiu P, Hong X. Does increasing public expenditure on sports promote regional sustainable development: Evidence from China. Front Public Health 2022; 10:976188. [PMID: 36211699 PMCID: PMC9533120 DOI: 10.3389/fpubh.2022.976188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
In the post-COVID era, how to improve the level of regional sustainable development has attracted much attention. And the vigorous development of the sports economy may be closely related to the regional sustainable development. This paper explores the impact and mechanism analysis of government sports public expenditure on regional sustainable development from the perspective of sports economic development. The study found that China's sustainable development presents obvious ladder-like characteristics and highlights the regional imbalance and inadequacy of regional green and coordinated development. And the government's increase in public expenditure on sports can significantly promote regional sustainable development and improve the level of regional green and coordinated development. With the continuous improvement of the regional economic development, the effect of sports public expenditure continues to increase. It can be seen from this that implementing the strategy of strengthening the country through sports under the government's guidance is an essential guarantee for the public health and quality of life and the sustainable development of the economy and society. Additionally, the development level of market finance is also an important driving factor for the government's public expenditure on sports to improve the level of sustainable development in the region. From the mechanism analysis, the government activates the local residents' consumption level by increasing the public expenditure on sports, thus promoting regional sustainable development.
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Affiliation(s)
- Dingqing Wang
- School of Economics, Jilin University, Changchun, China
| | - Enqi Zhang
- Krieger School of Arts and Sciences, Johns Hopkins University, Washington, DC, United States
| | - Peng Qiu
- Physical Education College, Jilin University, Changchun, China,*Correspondence: Peng Qiu
| | - Xiaoyu Hong
- Business School, Nanjing University, Nanjing, China
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Rees-Punia E, Deubler E, Patel AV, Diver WR, Hodge J, Islami F, Lee MJ, McCullough ML, Teras LR. The Role of Individual-Level Factors in Rural Mortality Disparities. AJPM FOCUS 2022; 1:100013. [PMID: 37791015 PMCID: PMC10546552 DOI: 10.1016/j.focus.2022.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The role of individual risk factors in the rural‒urban mortality disparity is poorly understood. The purpose of this study was to explore the role of individual-level demographics and health behaviors on the association between rural residence and the risk of mortality. Methods Cancer Prevention Study-II participants provided updated addresses throughout the study period. Rural‒Urban Commuting Area codes were assigned to participants' geocoded addresses as a time-varying exposure. Cox proportional hazards regression was used to estimate hazard ratios and 95% CIs for mortality associated with Rural‒Urban Commuting Area groups. Results After adjustment for age and sex, residents of rural areas/small towns had a small but statistically significant elevated risk of all-cause mortality compared with metropolitan residents (hazard ratio=1.04; 95% CI=1.01, 1.06). Adjustment for additional covariates attenuated the association entirely (hazard ratio=0.99; 95% CI=0.97, 1.01). Individually, adjustment for education (hazard ratio=0.99; 95% CI=0.97, 1.01), alcohol use (hazard ratio=1.01; 95% CI=0.99, 1.04), and moderate-to-vigorous intensity aerobic physical activity (hazard ratio=1.00; 95% CI=0.97, 1.02) eliminated the elevated risk. Conclusions The elevated risk of death for rural compared with that for metropolitan residents appeared to be largely explained by individual-level demographics and health behaviors. If replicated in other subpopulations, these results suggest that modifiable factors may play an important role in reducing the rural mortality disparity.
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Affiliation(s)
- Erika Rees-Punia
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Emily Deubler
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Alpa V. Patel
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - W. Ryan Diver
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - James Hodge
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Farhad Islami
- Department of Surveillance & Health Equity Science, American Cancer Society, Kennesaw, Georgia
| | - Min Jee Lee
- Department of Population Science & Policy, Southern Illinois University School of Medicine, Kennesaw, Georgia
| | | | - Lauren R. Teras
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
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Job attributes valued by physicians, PAs, and NPs. JAAPA 2022; 35:46-50. [DOI: 10.1097/01.jaa.0000854532.13833.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Disparities in COVID-19 Mortality Rates: Implications for Rural Health Policy and Preparedness. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:478-485. [PMID: 35389953 PMCID: PMC9307261 DOI: 10.1097/phh.0000000000001507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT It is well established that rural communities face geographic and socioeconomic challenges linked to higher rates of health disparities across the United States, though the coronavirus disease 2019 (COVID-19) impact on rural communities is less certain. OBJECTIVE To understand the COVID-19 pandemic's impact on rural communities in Tennessee, investigate differences in rural-urban mortality rates after controlling for confounding variables, and inform state pandemic response policy. DESIGN A cross-sectional analysis of cumulative COVID-19 morality rates. SETTING/PARTICIPANTS Tennessee county-level COVID-19 mortality data from March 1, 2020, to January 31, 2021, were matched with county-level sociodemographic and health data from public datasets: Agency for Healthcare Research and Quality Social Determinants of Health, PLACES: Local Data for Better Health County Data, and the US Census Bureau. County status was defined using the 2013 National Center for Health Statistics Urban-Rural Classification. MAIN OUTCOME MEASURES A negative binomial regression model estimated adjusted incidence rate ratio and 95% confidence intervals (CI) for rural compared with urban mortality. Unadjusted rate ratios and rate differences for COVID-19 mortality in rural versus urban counties were compared with those for influenza and pneumonia and all-cause mortality over the past 5 years. RESULTS During the study period, 9650 COVID-19 deaths occurred across 42 urban and 53 rural counties. Controlling for county-level sociodemographic characteristics, health care access, and comorbidities, incidence rate ratio was 1.13 (95% CI, 1.00-1.28, P < .05) for rural as compared with urban deaths. Unadjusted COVID-19 mortality risk difference between rural and urban counties was greater (61.85, 95% CI, 54.31-69.31) than 5-year influenza and pneumonia rural-urban risk difference (12.57, 95% CI, 11.16-13.00) during 2015-2019. CONCLUSIONS COVID-19 mortality rates were greater for populations living in Tennessee's rural as compared with urban counties during the study period. This differential impact must be considered in public health decision making to mitigate COVID-19.
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Abbott L, Graven L, Schluck G, Lemacks J. A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample. Healthcare (Basel) 2022; 10:1536. [PMID: 36011193 PMCID: PMC9407851 DOI: 10.3390/healthcare10081536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information-Motivation-Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.
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Affiliation(s)
- Laurie Abbott
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Lucinda Graven
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Glenna Schluck
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Jennifer Lemacks
- College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
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Shaw JL, Beans JA, Noonan C, Smith JJ, Mosley M, Lillie KM, Avey JP, Ziebell R, Simon G. Validating a predictive algorithm for suicide risk with Alaska Native populations. Suicide Life Threat Behav 2022; 52:696-704. [PMID: 35293010 PMCID: PMC9378560 DOI: 10.1111/sltb.12853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The American Indian/Alaska Native (AI/AN) suicide rate in Alaska is twice the state rate and four times the U.S. rate. Healthcare systems need innovative methods of suicide risk detection. The Mental Health Research Network (MHRN) developed suicide risk prediction algorithms in a general U.S. PATIENT POPULATION METHODS We applied MHRN predictors and regression coefficients to electronic health records of AI/AN patients aged ≥13 years with behavioral health diagnoses and primary care visits between October 1, 2016, and March 30, 2018. Logistic regression assessed model accuracy for predicting and stratifying risk for suicide attempt within 90 days after a visit. We compared expected to observed risk and assessed model performance characteristics. RESULTS 10,864 patients made 47,413 primary care visits. Suicide attempt occurred after 589 (1.2%) visits. Visits in the top 5% of predicted risk accounted for 40% of actual attempts. Among visits in the top 0.5% of predicted risk, 25.1% were followed by suicide attempt. The best fitting model had an AUC of 0.826 (95% CI: 0.809-0.843). CONCLUSIONS The MHRN model accurately predicted suicide attempts among AI/AN patients. Future work should develop clinical and operational guidance for effective implementation of the model with this population.
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Affiliation(s)
- Jennifer L Shaw
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Julie A Beans
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | - Julia J Smith
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Mike Mosley
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Kate M Lillie
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Jaedon P Avey
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Rebecca Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Gregory Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Ouyang F, Cheng X, Zhou W, He J, Xiao S. Increased Mortality Trends in Patients With Chronic Non-communicable Diseases and Comorbid Hypertension in the United States, 2000–2019. Front Public Health 2022; 10:753861. [PMID: 35899158 PMCID: PMC9309719 DOI: 10.3389/fpubh.2022.753861] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background According to the Sustainable Development Goals (SDGs), countries are required to reduce the mortality rates of four main non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs), and cancer (CA), by one-third in 2030 from the 2015 level. However, progress fell short of expectations, partly attributed to the high rates of hypertension-related NCD mortality. This study aimed to investigate the mortality trends of SDG-targeted NCDs with comorbid hypertension. In addition, the disparities in mortality rates among different demographic subgroups were further explored. Methods Mortality data from 2000 to 2019 were acquired from the Centers for Disease Control and Prevention in the United States. SDG-targeted NCDs were considered the underlying causes of death, and hypertension was considered a multiple cause of death. Permutation tests were performed to determine the time points of Joinpoints for mortality trends. The annual percent changes and average annual percent changes (AAPCs), as well as 95% confidence intervals (CIs), were calculated to demonstrate the temporary trend of mortality rates overall and by age, sex, ethnicity, and region. Results The hypertension-related DM, CRD, and CA mortality rates increased over the 20 years, of which the AAPCs were 2.0% (95% CI: 1.4%, 2.6%), 3.2% (95% CI: 2.8%, 3.6%), and 2.1% (95% CI: 1.6%, 2.6%), respectively. Moreover, despite decreasing between 2005 and 2015, the hypertension-related CVD mortality rate increased from 2015 to 2019 [APC: 1.3% (95% CI: 0.7%, 1.9%)]. The increased trends were consistent across most age groups. Mortality rates among men were higher and increased faster than those among women. The hypertension-related CVD, DM, and CA mortality rates among African American people were higher than those among White people. The increased mortality rates in rural areas, especially in rural south, were higher than those in urban areas. Conclusion In the United States, the hypertension-related DM, CRD, and CA mortality rates increased between 2000 and 2019, as well as hypertension-related CVD mortality between 2015 and 2019. Disparities existed among different sexes, ethnicities, and areas. Actions to prevent and manage hypertension among patients with NCDs are required to reduce the high mortality rates and minimize disparities.
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Affiliation(s)
- Feiyun Ouyang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Jun He
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
- *Correspondence: Shuiyuan Xiao
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Interventions for Increasing Digital Equity and Access (IDEA) among rural patients who smoke: Study protocol for a pragmatic randomized pilot trial. Contemp Clin Trials 2022; 119:106838. [PMID: 35760340 DOI: 10.1016/j.cct.2022.106838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cigarette smoking prevalence is higher among rural compared with urban adults, yet access to cessation programming is reduced. The Increasing Digital Equity and Access (IDEA) study aims to evaluate three digital access and literacy interventions for promoting engagement with an online evidence-based smoking cessation treatment (EBCT) program among rural adults. METHODS The pilot trial will use a pragmatic, three-arm, randomized, parallel-group design with participants recruited from a Midwest community-based health system in Minnesota, Wisconsin, and Iowa. All participants will receive an online, 12-week, EBCT program, and written materials on digital access resources. Participants will be stratified based on state of residence and randomly assigned with 1:1:1 allocation to one of three study groups: (1) Control Condition-no additional study intervention (n = 30); (2) Loaner Digital Device-Bluetooth enabled iPad with data plan coverage loaned for the study duration (n = 30); (3) Loaner Digital Device + Coaching Support-loaner device plus up to six, 15-20 min motivational interviewing-based coaching calls to enhance participants' digital access and literacy (n = 30). All participants will complete study assessments at baseline and 4- and 12-weeks post-randomization. Outcomes are cessation program and trial engagement, biochemically confirmed smoking abstinence, and patient experience. RESULTS A rural community advisory committee was formed that fostered co-design of the study protocol for relevance to rural populations, including the trial design and interventions. CONCLUSION Study findings, processes, and resources may have relevance to other health systems aiming to foster digital inclusion in smoking cessation and chronic disease management programs and clinical trials in rural communities.
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