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Lord J, Odoi A. Determinants of disparities of diabetes-related hospitalization rates in Florida: a retrospective ecological study using a multiscale geographically weighted regression approach. Int J Health Geogr 2024; 23:1. [PMID: 38184599 PMCID: PMC10771651 DOI: 10.1186/s12942-023-00360-5] [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: 06/03/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Early diagnosis, control of blood glucose levels and cardiovascular risk factors, and regular screening are essential to prevent or delay complications of diabetes. However, most adults with diabetes do not meet recommended targets, and some populations have disproportionately high rates of potentially preventable diabetes-related hospitalizations. Understanding the factors that contribute to geographic disparities can guide resource allocation and help ensure that future interventions are designed to meet the specific needs of these communities. Therefore, the objectives of this study were (1) to identify determinants of diabetes-related hospitalization rates at the ZIP code tabulation area (ZCTA) level in Florida, and (2) assess if the strengths of these relationships vary by geographic location and at different spatial scales. METHODS Diabetes-related hospitalization (DRH) rates were computed at the ZCTA level using data from 2016 to 2019. A global ordinary least squares regression model was fit to identify socioeconomic, demographic, healthcare-related, and built environment characteristics associated with log-transformed DRH rates. A multiscale geographically weighted regression (MGWR) model was then fit to investigate and describe spatial heterogeneity of regression coefficients. RESULTS Populations of ZCTAs with high rates of diabetes-related hospitalizations tended to have higher proportions of older adults (p < 0.0001) and non-Hispanic Black residents (p = 0.003). In addition, DRH rates were associated with higher levels of unemployment (p = 0.001), uninsurance (p < 0.0001), and lack of access to a vehicle (p = 0.002). Population density and median household income had significant (p < 0.0001) negative associations with DRH rates. Non-stationary variables exhibited spatial heterogeneity at local (percent non-Hispanic Black, educational attainment), regional (age composition, unemployment, health insurance coverage), and statewide scales (population density, income, vehicle access). CONCLUSIONS The findings of this study underscore the importance of socioeconomic resources and rurality in shaping population health. Understanding the spatial context of the observed relationships provides valuable insights to guide needs-based, locally-focused health planning to reduce disparities in the burden of potentially avoidable hospitalizations.
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Affiliation(s)
- Jennifer Lord
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.
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Gomez-Peralta F, Abreu C, Benito M, Barranco RJ. Geographical clustering and socioeconomic factors associated with hypoglycemic events requiring emergency assistance in Andalusia (Spain). BMJ Open Diabetes Res Care 2021; 9:9/1/e001731. [PMID: 33397670 PMCID: PMC7783525 DOI: 10.1136/bmjdrc-2020-001731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/26/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The geographical distribution of hypoglycemic events requiring emergency assistance was explored in Andalusia (Spain), and potentially associated societal factors were determined. RESEARCH DESIGN AND METHODS This was a database analysis of hypoglycemia requiring prehospital emergency assistance from the Public Company for Health Emergencies (Empresa Pública de Emergencias Sanitarias (EPES)) in Andalusia during 2012, which served 8 393 159 people. Databases of the National Statistics Institute, Basic Spatial Data of Andalusia and System of Multiterritorial Information of Andalusia were used to retrieve spatial data and population characteristics. Geographic Information System software (QGIS and GeoDA) was used for analysis and linkage across databases. Spatial analyses of geographical location influence in hypoglycemic events were assessed using Moran's I statistics, and linear regressions were used to determine their association with population characteristics. RESULTS The EPES attended 1 137 738 calls requesting medical assistance, with a mean hypoglycemia incidence of 95.0±61.6 cases per 100 000 inhabitants. There were significant differences in hypoglycemia incidence between basic healthcare zones attributable to their geographical location in the overall population (Moran's I index 0.122, z-score 7.870, p=0.001), women (Moran's I index 0.088, z-score 6.285, p=0.001), men (Moran's I index 0.076, z-score 4.914, p=0.001) and aged >64 years (Moran's I index 0.147, z-score 9.753, p=0.001). Hypoglycemia incidence was higher within unemployed individuals (β=0.003, p=0.001) and unemployed women (β=0.005, p=0.001), while lower within individuals aged <16 years (β=-0.004, p=0.040), higher academic level (secondary studies) (β=-0.003, p=0.004) and women with secondary studies (β=-0.005, p<0.001). In subjects aged >64 years, lower rate of hypoglycemia was associated with more single-person homes (β=-0.008, p=0.022) and sports facilities (β=-0.342, p=0.012). CONCLUSIONS This analysis supports the geographical distribution of hypoglycemia in the overall population, both genders and subjects aged >64 years, which was affected by societal factors such as unemployment, literacy/education, housing and sports facilities. These data can be useful to design specific prevention programs.
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Affiliation(s)
| | - Cristina Abreu
- Endocrinology and Nutrition Unit, Hospital General de Segovia, Segovia, Spain
| | - Manuel Benito
- Department of Urbanism, School of Architecture, Polytechnic University of Madrid, Madrid, Spain
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Lee DC, McGraw NA, Doran KM, Mengotto AK, Wiener SL, Vinson AJ, Thorpe LE. Comparing methods of performing geographically targeted rural health surveillance. Emerg Themes Epidemiol 2020; 17:3. [PMID: 33292290 PMCID: PMC7686693 DOI: 10.1186/s12982-020-00090-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 11/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background Worsening socioeconomic conditions in rural America have been fueling increases in chronic disease and poor health. The goal of this study was to identify cost-effective methods of deploying geographically targeted health surveys in rural areas, which often have limited resources. These health surveys were administered in New York’s rural Sullivan County, which has some of the poorest health outcomes in the entire state. Methods Comparisons were made for response rates, estimated costs, respondent demographics, and prevalence estimates of a brief health survey delivered by mail and phone using address-based sampling, and in-person using convenience sampling at a sub-county level in New York’s rural Sullivan County during 2017. Results Overall response rates were 27.0% by mail, 8.2% by phone, and 71.4% for convenience in-person surveys. Costs to perform phone surveys were substantially higher than mailed or convenience in-person surveys. All modalities had lower proportions of Hispanic respondents compared to Census estimates. Unadjusted and age-adjusted prevalence estimates were similar between mailed and in-person surveys, but not for phone surveys. Conclusions These findings are consistent with declining response rates of phone surveys, which obtained an inadequate sample of rural residents. Though in-person surveys had higher response rates, convenience sampling failed to obtain a geographically distributed sample of rural residents. Of modalities tested, mailed surveys provided the best opportunity to perform geographically targeted rural health surveillance.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA. .,Department of Population Health, NYU School of Medicine, New York, NY, USA.
| | - Nancy A McGraw
- Sullivan County Public Health Services, Liberty, NY, USA
| | - Kelly M Doran
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA.,Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Amanda K Mengotto
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA
| | - Sara L Wiener
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA
| | - Andrew J Vinson
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA
| | - Lorna E Thorpe
- Department of Population Health, NYU School of Medicine, New York, NY, USA
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Osorio M, Ravenell JE, Sevick MA, Ararso Y, Young T, Wall SP, Lee DC. Community-Based Hemoglobin A1C Testing in Barbershops to Identify Black Men With Undiagnosed Diabetes. JAMA Intern Med 2020; 180:596-597. [PMID: 31985740 PMCID: PMC6990850 DOI: 10.1001/jamainternmed.2019.6867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional study evaluates the use of hemoglobin A1c testing at barbershops owned by black individuals for timely diagnosis of diabetes among black men and suggests appropriate methods for care.
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Affiliation(s)
- Marcela Osorio
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Joseph E Ravenell
- Department of Population Health, New York University School of Medicine, New York
| | - Mary A Sevick
- Department of Population Health, New York University School of Medicine, New York
| | - Yonathan Ararso
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Ta'Loria Young
- Touro College of Osteopathic Medicine, New York, New York
| | - Stephen P Wall
- Department of Population Health, New York University School of Medicine, New York
| | - David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York.,Department of Population Health, New York University School of Medicine, New York
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Lee DC, Young T, Koziatek CA, Shim CJ, Osorio M, Vinson AJ, Ravenell JE, Wall SP. Age Disparities Among Patients With Type 2 Diabetes and Associated Rates of Hospital Use and Diabetic Complications. Prev Chronic Dis 2019; 16:E101. [PMID: 31370917 PMCID: PMC6716392 DOI: 10.5888/pcd16.180681] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Although screening for diabetes is recommended at age 45, some populations may be at greater risk at earlier ages. Our objective was to quantify age disparities among patients with type 2 diabetes in New York City. Methods Using all-payer hospital claims data for New York City, we performed a cross-sectional analysis of patients with type 2 diabetes identified from emergency department visits during the 5-year period 2011–2015. We estimated type 2 diabetes prevalence at each year of life, the age distribution of patients stratified by decade, and the average age of patients by sex, race/ethnicity, and geographic location. Results We identified 576,306 unique patients with type 2 diabetes. These patients represented more than half of all people with type 2 diabetes in New York City. Patients in racial/ethnic minority groups were on average 5.5 to 8.4 years younger than non-Hispanic white patients. At age 45, type 2 diabetes prevalence was 10.9% among non-Hispanic black patients and 5.2% among non-Hispanic white patients. In our geospatial analyses, patients with type 2 diabetes were on average 6 years younger in hotspots of diabetes-related emergency department use and inpatient hospitalizations. The average age of patients with type 2 diabetes was also 1 to 2 years younger in hotspots of microvascular diabetic complications. Conclusion We identified profound age disparities among patients with type 2 diabetes in racial/ethnic minority groups and in neighborhoods with poor health outcomes. The younger age of these patients may be due to earlier onset of diabetes and/or earlier death from diabetic complications. Our findings demonstrate the need for geographically targeted interventions that promote earlier diagnosis and better glycemic control.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th St, 1st Floor, New York, New York 10016. .,Department of Population Health, New York University School of Medicine, New York, New York
| | - Ta'Loria Young
- Touro College of Osteopathic Medicine, New York, New York
| | - Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Christopher J Shim
- California Northstate University College of Medicine, Elk Grove, California
| | - Marcela Osorio
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Andrew J Vinson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Joseph E Ravenell
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York.,Department of Population Health, New York University School of Medicine, New York, New York
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Lee DC, Yi SS, Athens JK, Vinson AJ, Wall SP, Ravenell JE. Using Geospatial Analysis and Emergency Claims Data to Improve Minority Health Surveillance. J Racial Ethn Health Disparities 2018; 5:712-720. [PMID: 28791583 PMCID: PMC5803484 DOI: 10.1007/s40615-017-0415-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/16/2017] [Accepted: 07/20/2017] [Indexed: 11/24/2022]
Abstract
Traditional methods of health surveillance often under-represent racial and ethnic minorities. Our objective was to use geospatial analysis and emergency claims data to estimate local chronic disease prevalence separately for specific racial and ethnic groups. We also performed a regression analysis to identify associations between median household income and local disease prevalence among Black, Hispanic, Asian, and White adults in New York City. The study population included individuals who visited an emergency department at least once from 2009 to 2013. Our main outcomes were geospatial estimates of diabetes, hypertension, and asthma prevalence by Census tract as stratified by race and ethnicity. Using emergency claims data, we identified 4.9 million unique New York City adults with 28.5% of identifying as Black, 25.2% Hispanic, and 6.1% Asian. Age-adjusted disease prevalence was highest among Black and Hispanic adults for diabetes (13.4 and 13.1%), hypertension (28.7 and 24.1%), and asthma (9.9 and 10.1%). Correlation between disease prevalence maps demonstrated moderate overlap between Black and Hispanic adults for diabetes (0.49), hypertension (0.57), and asthma (0.58). In our regression analysis, we found that the association between low income and high disease prevalence was strongest for Hispanic adults, whereas increases in income had more modest reductions in disease prevalence for Black adults, especially for diabetes. Our geographically detailed maps of disease prevalence generate actionable evidence that can help direct health interventions to those communities with the highest health disparities. Using these novel geographic approaches, we reveal the underlying epidemiology of chronic disease for a racially and culturally diverse population.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA.
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
| | - Stella S Yi
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Jessica K Athens
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Andrew J Vinson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 462 First Avenue, Room A345, New York, NY, 10016, USA
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Joseph E Ravenell
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
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Lee DC, Jiang Q, Tabaei BP, Elbel B, Koziatek CA, Konty KJ, Wu WY. Using Indirect Measures to Identify Geographic Hot Spots of Poor Glycemic Control: Cross-sectional Comparisons With an A1C Registry. Diabetes Care 2018; 41:1438-1447. [PMID: 29691230 PMCID: PMC6014542 DOI: 10.2337/dc18-0181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/27/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Focusing health interventions in places with suboptimal glycemic control can help direct resources to neighborhoods with poor diabetes-related outcomes, but finding these areas can be difficult. Our objective was to use indirect measures versus a gold standard, population-based A1C registry to identify areas of poor glycemic control. RESEARCH DESIGN AND METHODS Census tracts in New York City (NYC) were characterized by race, ethnicity, income, poverty, education, diabetes-related emergency visits, inpatient hospitalizations, and proportion of adults with diabetes having poor glycemic control, based on A1C >9.0% (75 mmol/mol). Hot spot analyses were then performed, using the Getis-Ord Gi* statistic for all measures. We then calculated the sensitivity, specificity, positive and negative predictive values, and accuracy of using the indirect measures to identify hot spots of poor glycemic control found using the NYC A1C Registry data. RESULTS Using A1C Registry data, we identified hot spots in 42.8% of 2,085 NYC census tracts analyzed. Hot spots of diabetes-specific inpatient hospitalizations, diabetes-specific emergency visits, and age-adjusted diabetes prevalence estimated from emergency department data, respectively, had 88.9%, 89.6%, and 89.5% accuracy for identifying the same hot spots of poor glycemic control found using A1C Registry data. No other indirect measure tested had accuracy >80% except for the proportion of minority residents, which had 86.2% accuracy. CONCLUSIONS Compared with demographic and socioeconomic factors, health care utilization measures more accurately identified hot spots of poor glycemic control. In places without a population-based A1C registry, mapping diabetes-specific health care utilization may provide actionable evidence for targeting health interventions in areas with the highest burden of uncontrolled diabetes.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY .,Department of Population Health, New York University School of Medicine, New York, NY
| | - Qun Jiang
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Bahman P Tabaei
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Brian Elbel
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY.,Wagner Graduate School of Public Service, New York University, New York, NY
| | - Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Winfred Y Wu
- New York City Department of Health and Mental Hygiene, New York, NY
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Geographical variation of diabetic emergencies attended by prehospital Emergency Medical Services is associated with measures of ethnicity and socioeconomic status. Sci Rep 2018; 8:5122. [PMID: 29572530 PMCID: PMC5865134 DOI: 10.1038/s41598-018-23457-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/13/2018] [Indexed: 12/05/2022] Open
Abstract
Geographical variation of diabetic emergencies attended by prehospital emergency medical services (EMS) and the relationship between area-level social and demographic factors and risk of a diabetic emergency were examined. All cases of hypoglycaemia and hyperglycaemia attended by Ambulance Victoria between 1/01/2009 and 31/12/2015 were tabulated by Local Government Area (LGA). Conditional autoregressive models were used to create smoothed maps of age and gender standardised incidence ratio (SIR) of prehospital EMS attendance for a diabetic emergency. Spatial regression models were used to examine the relationship between risk of a diabetic emergency and area-level factors. The areas with the greatest risk of prehospital EMS attendance for a diabetic emergency were disperse. Area-level factors associated with risk of a prehospital EMS-attended diabetic emergency were socioeconomic status (SIR 0.70 95% CrI [0.51, 0.96]), proportion of overseas-born residents (SIR 2.02 95% CrI [1.37, 2.91]) and motor vehicle access (SIR 1.47 95% CrI [1.08, 1.99]). Recognition of areas of increased risk of prehospital EMS-attended diabetic emergencies may be used to assist prehospital EMS resource planning to meet increased need. In addition, identification of associated factors can be used to target preventative interventions tailored to individual regions to reduce demand.
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