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Kibuchi E, Chumo I, Kabaria C, Elsey H, Phillips-Howard P, de Siqueira-Filha NT, Whittaker L, Leyland AH, Mberu B, Gray L. Health inequalities at the intersection of multiple social determinants among under five children residing Nairobi urban slums: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002931. [PMID: 38422055 PMCID: PMC10903897 DOI: 10.1371/journal.pgph.0002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
In this analysis we examine through an intersectionality lens how key social determinants of health (SDOH) are associated with health conditions among under-five children (<5y) residing in Nairobi slums, Kenya. We used cross-sectional data collected from Nairobi slums between June and November 2012 to explore how multiple interactions of SDoH shape health inequalities in slums. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. We constructed intersectional strata for each health condition from combinations of significant SDoH obtained using univariate analyses. We then estimated the intersectional effects of health condition in a series of MAIHDA logistic regression models distinguishing between additive and interaction effects. We quantified discriminatory accuracy (DA) of the intersectional strata by means of the variance partitioning coefficient (VPC) and the area under the receiver operating characteristic curve (AUC-ROC). The total participants were 2,199 <5y, with 120 records (5.5%) dropped because health conditions were recorded as "not applicable". The main outcome variables were three health conditions: 1) whether a child had diarrhea or not, 2) whether a child had fever or not, and 3) whether a child had cough or not in the previous two weeks. We found non-significant intersectional effects for each health condition. The head of household ethnic group was significantly associated with each health condition. We found good DA for diarrhea (VPC = 9.0%, AUC-ROC = 76.6%) an indication of large intersectional effects. However, fever (VPC = 1.9%, AUC-ROC = 66.3%) and cough (VPC = 0.5%, AUC-ROC = 61.8%) had weak DA indicating existence of small intersectional effects. Our study shows pathways for SDoH that affect diarrhea, cough, and fever for <5y living in slums are multiplicative and shared. The findings show that <5y from Luo and Luhya ethnic groups, recent migrants (less than 2 years), and households experiencing CHE are more likely to face worse health outcomes. We recommend relevant stakeholders to develop strategies aimed at identifying these groups for targeted proportionate universalism based on the level of their need.
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Affiliation(s)
- Eliud Kibuchi
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | - Lana Whittaker
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Alastair H. Leyland
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Linsay Gray
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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Senior R, Pickett L, Stirling A, Dash S, Gorgone P, Durst G, Jones D, Shannon R, Bhavsar NA, Bedoya A. Development of an interactive dashboard for gun violence pattern analysis and intervention design at the local level. JAMIA Open 2023; 6:ooad105. [PMID: 38088956 PMCID: PMC10712903 DOI: 10.1093/jamiaopen/ooad105] [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: 03/21/2023] [Revised: 08/09/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Gun violence remains a concerning and persistent issue in our country. Novel dashboards may integrate and summarize important clinical and non-clinical data that can inform targeted interventions to address the underlying causes of gun violence. Methods Data from various clinical and non-clinical sources were sourced, cleaned, and integrated into a customizable dashboard that summarizes and provides insight into the underlying factors that impact local gun violence episodes. Results The dashboards contained data from 7786 encounters and 1152 distinct patients from our Emergency Department's Trauma Registry with various patterns noted by the team. A multidisciplinary executive team, including subject matter experts in community-based interventions, epidemiology, and social sciences, was formed to design targeted interventions based on these observations. Conclusion Targeted interventions to reduce gun violence require a multimodal data sourcing and standardization approach, the inclusion of neighborhood-level data, and a dedicated multidisciplinary team to act on the generated insights.
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Affiliation(s)
- Rashaud Senior
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Lisa Pickett
- Duke University Health System, Durham, NC 27710, United States
| | - Andrew Stirling
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Shwetha Dash
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Patti Gorgone
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
| | - Georgina Durst
- Duke University Health System, Durham, NC 27710, United States
| | - Debra Jones
- Duke University Health System, Durham, NC 27710, United States
| | - Richard Shannon
- Duke University Health System, Durham, NC 27710, United States
| | - Nrupen A Bhavsar
- Department of Medicine, Duke University Hospital, Durham, NC, United States
| | - Armando Bedoya
- Duke University Health System, Durham, NC 27710, United States
- Duke Health Technology Services, Durham, NC 27710, United States
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Lindenfeld Z, Pagán JA, Silver D, McNeill E, Mostafa L, Zein D, Chang JE. Stakeholder Perspectives on Data-Driven Solutions to Address Cardiovascular Disease and Health Equity in New York City. AJPM FOCUS 2023; 2:100093. [PMID: 37790665 PMCID: PMC10546603 DOI: 10.1016/j.focus.2023.100093] [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 There is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g., cardiovascular disease) closely mimic inequities in social factors such as income, education, and housing. Although there is a wealth of data on these social factors in New York City, little is known about how to rapidly use available data sources to address health disparities. Methods Semistructured interviews were conducted with key stakeholders (N=11) from across the public health landscape in New York City (health departments, healthcare delivery systems, and community-based organizations) to assess perspectives on how social determinants of health data can be used to address cardiovascular disease and health equity, what data-driven tools would be useful, and challenges to using these data sources and developing tools. A matrix analysis approach was used to analyze the interview data. Results Stakeholders were optimistic about using social determinants of health data to address health equity by delivering holistic care, connecting people with additional resources, and increasing investments in under-resourced communities. However, interviewees noted challenges related to the quality and timeliness of social determinants of health data, interoperability between data systems, and lack of consistent metrics related to cardiovascular disease and health equity. Conclusions Future research on this topic should focus on mitigating the barriers to using social determinants of health data, which includes incorporating social determinants of health data from other sectors. There is also a need to assess how data-driven solutions can be implemented within and across communities and organizations.
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Affiliation(s)
- Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - José A. Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Diana Silver
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Elizabeth McNeill
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Logina Mostafa
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Dina Zein
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Ji Eun Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
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Carlson SA, Watson KB, Rockhill S, Wang Y, Pankowska MM, Greenlund KJ. Linking Local-Level Chronic Disease and Social Vulnerability Measures to Inform Planning Efforts: A COPD Example. Prev Chronic Dis 2023; 20:E76. [PMID: 37651645 PMCID: PMC10487786 DOI: 10.5888/pcd20.230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Data are publicly available to identify geographic differences in health outcomes, including chronic obstructive pulmonary disease (COPD), and social vulnerability; however, examples of combining data across sources to understand disease burden in the context of community vulnerability are lacking. METHODS We merged county and census tract model-based estimates of COPD prevalence from PLACES (www.cdc.gov/PLACES) with social vulnerability measures from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (https://www.atsdr.cdc.gov/placeandhealth/svi), including 4 themes (socioeconomic, household composition and disability, minority status and language, and housing type and transportation), and the overall Social Vulnerability Index (SVI). We used the merged data set to create vulnerability profiles by COPD prevalence, explore joint geographic patterns, and calculate COPD population estimates by vulnerability levels. RESULTS Counties and census tracts with high COPD prevalence (quartile 4) had high median vulnerability rankings (range: 0-1) for 2 themes: socioeconomic (county, 0.81; tract, 0.77) and household composition and disability (county, 0.75; tract, 0.81). Concordant high COPD prevalence and vulnerability for these themes were clustered along the Ohio and lower Mississippi rivers. The estimated number of adults with COPD residing in counties with high vulnerability was 2.5 million (tract: 4.7 million) for the socioeconomic theme and 2.3 million (tract: 5.0 million) for the household composition and disability theme (high overall SVI: county, 4.5 million; tract, 4.7 million). CONCLUSION Data from 2 publicly available tools can be combined, analyzed, and visualized to jointly examine local COPD estimates and social vulnerability. These analyses can be replicated with other measures to expand the use of these cross-cutting tools for public health planning.
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Affiliation(s)
- Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Kathleen B Watson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Rockhill
- Geospatial Research, Analysis, and Services Program, Office of Innovation and Analytics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Magdalena M Pankowska
- Oak Ridge Institute for Science and Education, Research Participation Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Enard KR, Coleman AM, Yakubu RA, Butcher BC, Tao D, Hauptman PJ. Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review. J Am Heart Assoc 2023; 12:e026590. [PMID: 36695317 PMCID: PMC9973629 DOI: 10.1161/jaha.122.026590] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full-text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross-sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence-based interventions that can ameliorate significant HF morbidity and societal costs.
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Affiliation(s)
- Kimberly R. Enard
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - Alyssa M. Coleman
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - R. Aver Yakubu
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | | | - Donghua Tao
- Medical Center LibrarySaint Louis UniversitySaint LouisMO
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Barua P, Kibuchi E, Aktar B, Chowdhury SF, Mithu IH, Quayyum Z, Filha NTDS, Leyland AH, Rashid SF, Gray L. The effects of social determinants on children's health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001588. [PMID: 36963045 PMCID: PMC10022045 DOI: 10.1371/journal.pgph.0001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefore, we aim to investigate how SDoH collectively affects health outcomes of U5y living in Bangladesh slums through an intersectionality lens. We used data from the most recent national Urban Health Survey (UHS) 2013 covering urban populations in Dhaka, Chittagong, Khulna, Rajshahi, Barisal, Sylhet, and Rangpur divisions. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the Discriminatory Accuracy (DA) of the intersectional effects estimates using Variance Partition Coefficient (VPC) and the Area Under the Receiver Operating Characteristic Curve (AUC-ROC). We also assessed the Proportional Change in Variance (PCV) to calculate intersectional effects. We considered three health outcomes: cough, fever, and acute respiratory infections (ARI) in U5y.We found a low DA for cough (VPC = 0.77%, AUC-ROC = 61.90%), fever (VPC = 0.87%, AUC-ROC = 61.89%) and ARI (VPC = 1.32%, AUC-ROC = 66.36%) of intersectional strata suggesting that SDoH considered do not collectively differentiate U5y with a health outcome from those with and without a health outcome. The PCV for cough (85.90%), fever (78.42%) and ARI (69.77%) indicates the existence of moderate intersectional effects. We also found that SDoH factors such as slum location, mother's employment, age of household head, and household's garbage disposal system are associated with U5y health outcomes. The variables used in this analysis have low ability to distinguish between those with and without health outcomes. However, the existence of moderate intersectional effect estimates indicates that U5y in some social groups have worse health outcomes compared to others. Therefore, policymakers need to consider different social groups when designing intervention policies aimed to improve U5y health outcomes in Bangladesh slums.
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Affiliation(s)
- Proloy Barua
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Imran Hossain Mithu
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Zahidul Quayyum
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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Shao S, Che T, Zhou D. Effects of social assistance on self-rated health. Front Public Health 2022; 10:918323. [PMID: 36339138 PMCID: PMC9632987 DOI: 10.3389/fpubh.2022.918323] [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: 04/12/2022] [Accepted: 09/27/2022] [Indexed: 01/22/2023] Open
Abstract
Based on the China Health and Retirement Longitudinal Study (CHARLS) data in 2018, medical assistance and life assistance have significant negative influences on self-rated health, found via an empirical analysis based on the Oprobit model. Such negative influences are robust based on the substitution of explained variables and propensity score matching. It can be found from a heterogeneity analysis that the negative influences of medical assistance on self-rated health are more significant in urban residents and residents in Central China and East China. Meanwhile, negative influences of life assistance on self-rated health are more significant in urban residents, and residents in Central China, East China, and Northeast China. This study provides empirical evidence to improve the health of residents by using medical assistance and life assistance accurately and offers important policy enlightenments to formulate appropriate social assistance policies.
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Affiliation(s)
- Siqi Shao
- Liaoning Police College, Department of Public Security Management, Dalian, China
| | - Tiantian Che
- Dongbei University of Finance and Economics, Dalian, China
| | - Deshui Zhou
- Institute of Finance and Public Management, Anhui University of Finance & Economics, Bengbu, China,*Correspondence: Deshui Zhou
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Abdalla SM, Galea S. The 3-D Commission: Forging a Transdisciplinary Synthesis at the Intersection of Social Determinants of Health, Data, and Decision-making. J Urban Health 2021; 98:1-3. [PMID: 34414513 PMCID: PMC8440695 DOI: 10.1007/s11524-021-00555-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA United States
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA United States
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