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Scaife JH, Iantorno SE, Bucher BT. Rates of Concurrent Computed Tomography Imaging Following Ultrasound for Pediatric Patients With Appendicitis. J Surg Res 2024; 302:134-143. [PMID: 39102772 DOI: 10.1016/j.jss.2024.06.048] [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: 12/16/2023] [Revised: 05/24/2024] [Accepted: 06/23/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Imaging guidelines recommend an ultrasound (US)-first approach to evaluate appendicitis to minimize radiation. However, the association between US and computed tomography (CT) utilization remains unclear. We aimed to determine how increased US utilization correlated with the rate of CT evaluation of pediatric acute appendicitis. METHODS We conducted a retrospective cohort study using the 2019 Nationwide Emergency Department Sample. Eligible patients were aged less than 18 y with a diagnosis of appendicitis. Imaging was determined by Current Procedural Terminology codes. Concurrent imaging was defined as US and CT use during the same encounter. We calculated the hospital rate of concurrent imaging and categorized hospitals into tertiles: low (< 20%), medium (20%-40%), and high (> 40%). We developed generalized ordinal logistic regression models with inverse probability weighting to assess patient characteristics and hospital rates of concurrent imaging associations. RESULTS Our analysis included 485 hospitals and 23,976 patients. Thirty four percent were treated at hospitals in the lowest, 35% at the middle, and 31% at the highest tertile hospitals. We observed a negative correlation (-0.27, P < 0.001) between increasing US use and concurrent imaging use. The odds of presenting to a higher concurrent imaging rate hospital were significantly lower for Blacks (adjusted odds ratio [aOR] [95% confidence interval {CI}]: 0.6, [0.4-0.9]) and Hispanics (aOR [95% CI]: 0.7 [0.5-0.9]) in comparison to Whites. The odds of presenting to a higher concurrent imaging rate hospital were higher for patients in the second (aOR [95% CI]: 1.9 [1.2-3.2]) and lowest income quartile (aOR [95% CI]: 3.7 [1.1-13.1]) compared to the highest income quartile. CONCLUSIONS Increased US use correlated with decreased CT utilization for diagnosing appendicitis. White children and those in lower socioeconomic neighborhoods are more likely to visit hospitals with high concurrent imaging use.
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Affiliation(s)
- Jack H Scaife
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Stephanie E Iantorno
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brian T Bucher
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Moore HG, Patibandla SD, McClung AM, Grauer JN, Sucato DJ, Wise CA, Johnson ME, Rathjen KE, McIntosh AL, Ramo BA, Brooks JT. Do Children With Medicaid Insurance Have Increased Revision Rates 5 Years After Posterior Spinal Fusions? J Pediatr Orthop 2023; 43:615-619. [PMID: 37694695 DOI: 10.1097/bpo.0000000000002504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Socioeconomic disparities in musculoskeletal care are increasingly recognized, however, no studies to date have investigated the role of the insurance carrier on outcomes after posterior spinal fusion (PSF) with segmental spinal instrumentation for adolescent idiopathic scoliosis (AIS). METHODS A US insurance dataset was queried using the PearlDiver Mariner software for all patients aged 10 to 18 undergoing PSF for a primary diagnosis of AIS between 2010 and 2020. Age, sex, geographic region, number of levels fused, and baseline medical comorbidities were queried. Complications occurring within 90 days of the index surgery were queried using the International Classification of Diseases, Ninth Revision (ICD-9) and International Classification of Diseases, 10th Revision (ICD-10) codes. Revision surgery was also queried up to 5 years after the index PSF. Categorical variables were compared using the Fisher χ 2 tests and continuous variables were compared using independent t tests. All-cause revision within 5 years was compared using the Kaplan-Meier analysis and a log-rank test. Significance was set at P -value <0.05. RESULTS A total of 10,794 patients were identified with 9006 (83.4%) patients with private insurance and 1788 (16.6%) patients insured by Medicaid. The mean follow-up in the database was 5.36±3 years for patients with private insurance and 4.78±2.9 years for patients with Medicaid insurance ( P <0.001). Children with AIS and Medicaid insurance had a significantly higher prevalence of asthma, hypertension, and obesity. A larger percentage of children with Medicaid insurance (41.3%) underwent a ≥13-level PSF compared with privately insured children (34.5%) ( P <0.001). Medicaid patients did not experience higher odds of postoperative complications; in addition, revision surgeries occurred in 1.1% and 1.8% of patients with private insurance and Medicaid insurance, respectively at 5 years postoperatively ( P =0.223). CONCLUSION Despite worse baseline comorbidities and longer fusion constructs, AIS patients insured with Medicaid did not have higher rates of complications or revisions at 5-year follow-up versus privately insured patients. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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3
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Sawhney R, Ahsanuddin S, Sheorey L, Wassef DW, Baredes S, Park RCW. Understanding giant cell sarcoma of the head and neck: A population-based study. Head Neck 2021; 43:2786-2794. [PMID: 34121252 DOI: 10.1002/hed.26765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/24/2021] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant cell sarcomas (GCS) are rare head and neck neoplasms. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was analyzed for all patients who have been diagnosed with GCS from 1973 to 2014. RESULTS Four hundred and forty cases of GCS of the head and neck were identified. The average age at diagnosis was 74.4 years, 86.8% were white, 82.5% were male, 70.7% were insured, and 88.2% lived in an urban metropolitan region. Connective tissue was the most frequent primary site (42.5%). The 5Y-DSS rate was 91.1%, while the 5Y-OS was 54.6% for all cases. Patients treated with surgery alone had the highest 5Y-DSS rate of 94.5. T-classification odds ratio was a significant predictor of survival accounting for confounding variables on multivariate analysis. CONCLUSIONS GCS presents most frequently in connective tissue of the head and neck with overall high probability of survival. The treatment of choice is surgery alone.
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Affiliation(s)
- Rohan Sawhney
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Salma Ahsanuddin
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Lena Sheorey
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David W Wassef
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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4
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Lind KE, Flug JA. Sociodemographic Variation in the Use of Conservative Therapy Before MRI of the Lumbar Spine for Low Back Pain in the Era of Public Reporting. J Am Coll Radiol 2019; 16:560-569. [PMID: 30947888 DOI: 10.1016/j.jacr.2018.12.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the relationship between use of MRI of the lumbar spine for low back pain without prior conservative therapy and sociodemographic factors after the implementation of public reporting for Medicare's Hospital Outpatient Imaging Efficiency Measure for MRI Lumbar Spine for Low Back Pain (OP-8) metric. MATERIALS AND METHODS We conducted a secondary data analysis using a nationally representative sample of 2009 to 2014 Medicare claims to evaluate trends in use of conservative therapy before MRI of the lumbar spine. Continuously enrolled fee-for-service Medicare beneficiaries were included. We applied the same criteria used by Medicare to generate a measure consistent with OP-8. Regression was used to evaluate trends in OP-8 by reporting status (outpatient hospital or clinic) and beneficiary characteristics. Age, sex, and race from the Medicare denominator and area-level socioeconomic measures from the Area Health Resource File were used as covariates. RESULTS Use of conservative therapy before MRI increased regardless of OP-8 reporting status. Several sociodemographic characteristics were associated with the likelihood of receiving conservative therapy before MRI; beneficiaries were less likely to receive conservative therapy before MRI if they were male, older, black, Hispanic or Latino; if they lived in the West or in an area with more college graduates; or if they had low incomes. Beneficiaries were more likely to receive conservative therapy before MRI if they had poorer health or lived in areas with higher home values. CONCLUSION Variations in use of conservative therapy according to factors other than clinically relevant factors, such as health status, are worrying. Further strategies are needed to improve appropriateness and equity in the provision of diagnostic imaging.
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Affiliation(s)
- Kimberly E Lind
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Jonathan A Flug
- Mayo Clinic Arizona, Department of Radiology, Phoenix, Arizona
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Golembiewski E, Allen KS, Blackmon AM, Hinrichs RJ, Vest JR. Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review. JMIR Public Health Surveill 2019; 5:e12846. [PMID: 31593550 PMCID: PMC6803891 DOI: 10.2196/12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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Affiliation(s)
| | - Katie S Allen
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Amber M Blackmon
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | - Joshua R Vest
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
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Cote DJ, Ostrom QT, Gittleman H, Duncan KR, CreveCoeur TS, Kruchko C, Smith TR, Stampfer MJ, Barnholtz-Sloan JS. Glioma incidence and survival variations by county-level socioeconomic measures. Cancer 2019; 125:3390-3400. [PMID: 31206646 DOI: 10.1002/cncr.32328] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple studies have reported higher rates of glioma in areas with higher socioeconomic status (SES) but to the authors' knowledge have not stratified by other factors, including race/ethnicity or urban versus rural location. METHODS The authors identified the average annual age-adjusted incidence rates and calculated hazard ratios for death for gliomas of various subtypes, stratified by a county-level index for SES, race/ethnicity, US region, and rural versus urban status. RESULTS Rates of glioma were highest in counties with higher SES (rate ratio, 1.18; 95% CI, 1.15-1.22 comparing the highest with the lowest quintiles [P < .001]). Stratified by race/ethnicity, higher rates in high SES counties persisted for white non-Hispanic individuals. Stratified by rural versus urban status, differences in incidence by SES were more pronounced among urban counties. Survival was higher for residents of high SES counties after adjustment for age and extent of surgical resection (hazard ratio, 0.82; 95% CI, 0.76-0.87 comparing the highest with the lowest quintile of SES [P < .001]). Survival was higher among white Hispanic, black, and Asian/Pacific Islander individuals compared with white non-Hispanic individuals, after adjustment for age, SES, and extent of surgical resection, and when restricted to those individuals with glioblastoma who received radiation and chemotherapy. CONCLUSIONS The incidence of glioma was higher in US counties of high compared with low SES. These differences were most pronounced among white non-Hispanic individuals and white Hispanic individuals residing in urban areas. Better survival was observed in high SES counties, even when adjusting for extent of surgical resection, and when restricted to those who received radiation and chemotherapy for glioblastoma. Differences in incidence and survival were associated with SES and race, rather than rural versus urban status.
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Affiliation(s)
- David J Cote
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.,Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois.,Section of Epidemiology and Population Sciences, Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Haley Gittleman
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois.,Bioinformatics, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kelsey R Duncan
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio
| | - Travis S CreveCoeur
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Timothy R Smith
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Meir J Stampfer
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois.,Bioinformatics, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Perry H, Eisenberg RL, Swedeen ST, Snell AM, Siewert B, Kruskal JB. Improving Imaging Care for Diverse, Marginalized, and Vulnerable Patient Populations. Radiographics 2018; 38:1833-1844. [DOI: 10.1148/rg.2018180034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hannah Perry
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Ronald L. Eisenberg
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Suzanne T. Swedeen
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Aideen M. Snell
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Bettina Siewert
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Jonathan B. Kruskal
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
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Tamariz L, Medina H, Suarez M, Seo D, Palacio A. Linking census data with electronic medical records for clinical research: A systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.3233/jem-180454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Leonardo Tamariz
- Division of Population Health and Computational Medicine , Miller School of Medicine at the University of Miami, Miami, FL, USA
- GRECC, Veterans Affairs Medical Center, Miami, FL, USA
| | - Heidy Medina
- Division of Population Health and Computational Medicine , Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Maritza Suarez
- Division of General Medicine, Department of Medicine, University of Miami Leonard Miller School of Medicine, Miami, FL, USA
| | - David Seo
- Division of Population Health and Computational Medicine , Miller School of Medicine at the University of Miami, Miami, FL, USA
- Division of Cardiology, Department of Medicine, University of Miami Leonard Miller School of Medicine, Miami, FL, USA
| | - Ana Palacio
- Division of Population Health and Computational Medicine , Miller School of Medicine at the University of Miami, Miami, FL, USA
- GRECC, Veterans Affairs Medical Center, Miami, FL, USA
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Bosch de Basea M, Espinosa A, Gil M, Figuerola J, Pardina M, Vilar J, Cardis E. CT scan exposure in Spanish children and young adults by socioeconomic status: Cross-sectional analysis of cohort data. PLoS One 2018; 13:e0196449. [PMID: 29723272 PMCID: PMC5933709 DOI: 10.1371/journal.pone.0196449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/15/2018] [Indexed: 11/30/2022] Open
Abstract
Recent publications reported that children in disadvantaged areas undergo more CT scanning than others. The present study is aimed to assess the potential differences in CT imaging by socioeconomic status (SES) in Spanish young scanned subjects and if such differences vary with different indicators or different time point SES measurements. The associations between CT scanning and SES, and between the CT scan rate per patient and SES were investigated in the Spanish EPI-CT subcohort. Various SES indicators were studied to determine whether particular SES dimensions were more closely related to the probability of undergoing one or multiple CTs. Comparisons were made with indices based on 2001 and 2011 censuses. We found evidence of socio-economic variation among young people, mainly related to autonomous communities of residence. A slightly higher rate of scans per patient of multiple body parts in the less affluent categories was observed, possibly reflecting a higher rate of accidents and violence in these groups. The number of CT scans per patient was higher both in the most affluent and the most deprived categories and somewhat lower in the intermediate groups. This relation varied with the SES indicator used, with lower CT scans per patients in categories of high unemployment and temporary work, but not depending on categories of unskilled work or illiteracy. The relationship between these indicators and number of CTs in 2011 was different than that seen with the 2001 census, with the number of CTs increasing with higher unemployment. Overall we observed some differences in the SES distribution of scanned patients by Autonomous Community in Spain. There was, however, no major differences in the frequency of CT scans per patient by SES overall, based on the 2001 census. The use of different indicators and of SES data collected at different time points led to different relations between SES and frequency of CT scans, outlining the difficulty of adequately capturing the social and economic dimensions which may affect health and health service utilisation.
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Affiliation(s)
- Magda Bosch de Basea
- Radiation epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - Ana Espinosa
- Radiation epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mariona Gil
- Radiation epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Figuerola
- Radiation epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - José Vilar
- Hospital Universitario Doctor Peset, Valencia, Spain
| | - Elisabeth Cardis
- Radiation epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol 2018; 28:493-502. [PMID: 29628285 DOI: 10.1016/j.annepidem.2018.03.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research. METHODS We abstracted information on the environmental and health outcome variables and the methods and data sources used. RESULTS The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas. CONCLUSIONS Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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11
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Derakhshan A, Miller J, Lubelski D, Nowacki AS, Wells BJ, Milinovich A, Benzel EC, Mroz TE, Steinmetz MP. The Impact of Socioeconomic Status on the Utilization of Spinal Imaging. Neurosurgery 2016. [PMID: 26214318 DOI: 10.1227/neu.0000000000000914] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Few studies have examined the general correlation between socioeconomic status and imaging. This study is the first to analyze this relationship in the spine patient population. OBJECTIVE To assess the effect of socioeconomic status on the frequency with which imaging studies of the lumbar spine are ordered and completed. METHODS Patients that were diagnosed with lumbar radiculopathy and/or myelopathy and had at least 1 subsequent lumbar magnetic resonance imaging (MRI), computed tomography (CT), or X-ray ordered were retrospectively identified. Demographic information and the number of ordered and completed imaging studies were among the data collected. Patient insurance status and income level (estimated based on zip code) served as representations of socioeconomic status. RESULTS A total of 24,105 patients met the inclusion criteria for this study. Regression analyses demonstrated that uninsured patients were significantly less likely to have an MRI, CT, or X-ray study ordered (P < .001 for all modalities) and completed (P < .001 for MRI and X-ray, P = .03 for CT). Patients with lower income had higher rates of MRI, CT, and X-ray (P < .001 for all) imaging ordered but were less likely to have an ordered X-ray be completed (P = .009). There was no significant difference in the completion rate of ordered MRIs or CTs. CONCLUSION Disparities in image utilization based on socioeconomic characteristics such as insurance status and income level highlight a critical gap in access to health care. Physicians should work to mitigate the influence of such factors when deciding whether to order imaging studies, especially in light of the ongoing shift in health policy in the United States.
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Affiliation(s)
- Adeeb Derakhshan
- *Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Center for Spine Health, and Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio; ‡Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio
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12
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Shan J, Zhang L, Holmes AA, Taub CC. The Impact of Race on the Prognosis of Preclinical Diastolic Dysfunction: A Large Multiracial Urban Population Study. Am J Med 2016; 129:222.e1-10. [PMID: 26475254 DOI: 10.1016/j.amjmed.2015.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study was performed to assess the impact of race on the incidence of heart failure and survival in patients with preclinical diastolic dysfunction. METHODS All adults during a 5-year period with grade 1 diastolic dysfunction on echocardiogram, left ventricular ejection fraction ≥ 50%, and no diagnosis of heart failure were included in this study. Clinical endpoints were new diagnosis of heart failure (International Classification of Diseases-Ninth Revision code 428.0) and all-cause mortality. A total of 7878 patients: 20.8% non-Hispanic White, 35.8% non-Hispanic Black, and 31.0% Hispanic individuals (mean age was 68 ± 12 years, 37% men) were included in the study. Non-Hispanic Whites were older, more frequently male, and had a higher mean socioeconomic status and more antecedent myocardial infarction. RESULTS Non-Hispanic Blacks and Hispanics had more hypertension, diabetes, renal disease, and cerebrovascular disease. After a median follow-up time of 6 years, 1356 patients developed heart failure and 2078 patients died. The 10-year cumulative probabilities of heart failure and all-cause mortality were 23.9% and 32.6%, respectively. Time to incident heart failure was similar among the 3 racial groups. However, non-Hispanic Blacks (hazard ratio 0.80, P = .002) and Hispanics (hazard ratio 0.67, P < .001) experienced lower mortality compared with non-Hispanic Whites, which was confirmed on a propensity-scored sensitivity analysis. CONCLUSIONS Time to heart failure was similar among the 3 racial groups, however, non-Hispanic Whites experienced worse survival compared with non-Hispanic Blacks and Hispanics, despite their higher burden of risk factors. The reasons for worse survival in the non-Hispanic white population need to be further explored.
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Affiliation(s)
- Jian Shan
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Lili Zhang
- Department of Medicine, Jacobi Medical Center, Bronx, NY
| | | | - Cynthia C Taub
- Division of Cardiology, Montefiore Medical Center, Bronx, NY.
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