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Kandregula S, Savardekar A, Beyl R, Caskey J, Terrell D, Adeeb N, Whipple SG, Newman WC, Toms J, Kosty J, Sharma P, Mayeaux EJ, Cuellar H, Guthikonda B. Health inequities and socioeconomic factors predicting the access to treatment for unruptured intracranial aneurysms in the USA in the last 20 years: interaction effect of race, gender, and insurance. J Neurointerv Surg 2023; 15:1251-1256. [PMID: 36863863 DOI: 10.1136/jnis-2022-019767] [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: 10/17/2022] [Accepted: 02/12/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The literature suggests that minority racial and ethnic groups have lower treatment rates for unruptured intracranial aneurysms (UIA). It is uncertain how these disparities have changed over time. METHODS A cross-sectional study using the National Inpatient Sample database covering 97% of the USA population was carried out. RESULTS A total of 213 350 treated patients with UIA were included in the final analysis and compared with 173 375 treated patients with aneurysmal subarachnoid hemorrhage (aSAH) over the years 2000-2019. The mean (SD) age of the UIA and aSAH groups was 56.8 (12.6) years and 54.3 (14.1) years, respectively. In the UIA group, 60.7% were white patients, 10.2% were black patients, 8.6% were Hispanic, 2% were Asian or Pacific Islander, 0.5% were Native Americans, and 2.8% were others. The aSAH group comprised 48.5% white patients, 13.6% black patients, 11.2% Hispanics, 3.6% Asian or Pacific Islanders, 0.4% Native Americans, and 3.7% others. After adjusting for covariates, black patients (OR 0.637, 95% CI 0.625 to 0.648) and Hispanic patients (OR 0.654, 95% CI 0.641 to 0.667) had lower odds of treatment compared with white patients. Medicare patients had higher odds of treatment than private patients, while Medicaid and uninsured patients had lower odds. Interaction analysis showed that non-white/Hispanic patients with any insurance/no insurance had lower treatment odds than white patients. Multivariable regression analysis showed that the treatment odds of black patients has improved slightly over time, while the odds for Hispanic patients and other minorities have remained the same over time. CONCLUSION This study from 2000 to 2019 shows that disparities in the treatment of UIA have persisted but have slightly improved over time for black patients while remaining constant for Hispanic patients and other minority groups.
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Affiliation(s)
| | - Amey Savardekar
- Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Robbie Beyl
- Biostatistics, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Joshua Caskey
- Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | | | - Nimer Adeeb
- Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | | | | | - Jamie Toms
- Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Jennifer Kosty
- Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Pankaj Sharma
- Neurology, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Edward J Mayeaux
- Family Medicine, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Hugo Cuellar
- Radiology, LSU Health Shreveport, Shreveport, Louisiana, USA
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Laubach L, Sharma V, Alsumait A, Chiang B, Kuester V. Socioeconomic Factors Correlation With Idiopathic Scoliosis Curve Type and Cobb Angle Severity. Cureus 2023; 15:e34993. [PMID: 36938294 PMCID: PMC10019979 DOI: 10.7759/cureus.34993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Race and socioeconomic status correlate with disease outcomes and treatment in patients with idiopathic scoliosis (IS) to varying degrees, although there is no clear association with Cobb angle and curve type. The purpose of this study was to assess socioeconomic factors and their association with Cobb angles in patients with IS. METHODS A retrospective chart review was completed with the radiographic analysis of 89 patients diagnosed with IS and spinal curves >10° between the ages of six and 18. Associations between the Cobb angles and socioeconomic categorical variables were analyzed using a nonparametric Kruskal-Wallis test and continuous variables using a Spearman Rank correlation. Results: There were no significant associations between proximal thoracic, main thoracic, or thoracolumbar/lumbar Cobb angles and sex, insurance type, race, access to healthy food, financial difficulty, or income. BMI and proximal thoracic Cobb angle (ρ = 0.2375, p=0.0268) had a significant positive correlation, and BMI and income (ρ = -0.2468, p=0.0228) shared a significant negative correlation. CONCLUSIONS The severity of IS proximal thoracic Cobb angles was positively associated with BMI and income. Other socioeconomic factors such as age, race, sex, access to food, insurance, and financial difficulties related to scoliosis treatment were not correlated with Cobb angle severity. The data presented suggest that patients with IS have varying degrees of curve type and severity that overall do not correlate with various socioeconomic factors. Validating which factors are predictive of curve severity could lead to early intervention preventing further morbidity of IS.
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Affiliation(s)
- Logan Laubach
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Viraj Sharma
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Abdulaziz Alsumait
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Benjamin Chiang
- General Surgery, Riverside University Health System Medical Center, Riverside, USA
| | - Victoria Kuester
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
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Abstract
Mentorship and sponsorship are part of academia because they are vital for professional and personal development. Inclusive mentorship is defined as mentoring across differences. It highlights the need of all mentors to be well-versed culturally and to recognize and circumvent bias and microaggressions. Inclusive mentorship can also elevate underrepresented populations in medicine and create intercultural relationships that also benefit the relationships we have with our diversifying patient populations. There are still several barriers prohibiting inclusive mentorship from being widely understood and employed. This article discusses the importance of and techniques for improving inclusive mentorship.
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Affiliation(s)
| | - Erica Taylor
- Duke University School of Medicine, PO Box 1726, Wake Forest, NC 27587, USA.
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Racial Disparities in Cardiovascular Risk and Cardiovascular Care in Women. Curr Cardiol Rep 2022; 24:1197-1208. [PMID: 35802234 DOI: 10.1007/s11886-022-01738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Research on sex and gender aspects cardiovascular disease has contributed to a reduction in cardiovascular mortality in women. However, cardiovascular disease remains the leading cause of death of women in the United States. Disparities in cardiovascular risk and outcomes among women overall persist and are amplified for women of certain ethnic and racial subgroups. We review the evidence of racial and ethnic differences in cardiovascular risk and care among women and describe a path forward to achieve equitable cardiovascular care for women of racial and ethnic minority groups. RECENT FINDINGS There is a disproportionate effect on cardiovascular outcomes in women and certain racial and ethnic groups in part due to disparities in triage, diagnosis, treatment, which lead to amplification of inequalities in women of minority racial and ethnic background. Data suggest gender and racial bias, underappreciation of nontraditional risk factors, underrepresentation of women in clinical trials and undertreatment of disease contributes to persistent differences in cardiovascular disease outcomes in women of color. Understanding the myriad of factors that contribute to increased cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds is imperative to improving cardiovascular care for this patient population.
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Towner M, Kim JJ, Simon MA, Matei D, Roque D. Disparities in gynecologic cancer incidence, treatment, and survival: a narrative review of outcomes among black and white women in the United States. Int J Gynecol Cancer 2022; 32:931-938. [PMID: 35523443 PMCID: PMC9509411 DOI: 10.1136/ijgc-2022-003476] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
For patients diagnosed with ovarian, uterine, or cervical cancer, race impacts expected outcome, with black women suffering worse survival than white women for all three malignancies. Moreover, outcomes for black women have largely worsened since the 1970s. In this narrative review, we first provide an updated summary of the incidence and survival of ovarian, uterine, and cervical cancer, with attention paid to differences between white and black patients. We then offer a theoretical framework detailing how racial disparities in outcomes for each of the gynecologic malignancies can be explained as the sum result of smaller white-black differences in experience of preventive strategies, implementation of screening efforts, early detection of symptomatic disease, and appropriate treatment. Much research has been published regarding racial disparities in each of these domains, and with this review, we seek to curate the relevant literature and present an updated understanding of disparities between black and white women with gynecologic malignancies.
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Affiliation(s)
- Mary Towner
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J Julie Kim
- Obstetrics and Gynecology, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Melissa A Simon
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniela Matei
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dario Roque
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Improving Surgical Quality for Patients with Mental Health Illnesses: A Narrative Review. Ann Surg 2021; 275:477-481. [PMID: 34417360 DOI: 10.1097/sla.0000000000005174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To establish and define disparities in care for patients presenting with surgical disease who have pre-existing mental health diagnoses. SUMMARY BACKGROUND DATA Mental illness affects approximately 6.7 million Canadians. For them, stigma, comorbid disorders, and sequelae of psychiatric diagnoses can be barriers patients face to receive equitable healthcare. The goal of this review is to define inequities in surgical care for patients with pre-existing mental illness. METHODS We search OVID Medline, Pubmed, EMBASE, and the Cochrane review files using a combination of search terms using a PICO (population, intervention, comparison, outcome) model focusing on surgical care for patients with mental illness. RESULTS The literature on mental illness in surgical patients focused primarily on preoperative and postoperative disparities in surgical care between patients with and without a diagnosis of mental illness. Preoperatively, patients were 7.5-40% less likely to be deemed surgical candidates, were less likely to receive testing, and were more likely to present at later stages of their disease or have delayed surgical care. Similar themes arose in the postoperative period: patients with mental illness were more likely to require ICU admission, were up to 3 times more likely to have a prolonged length of hospital stay, had a 14-270% increased likelihood of having postoperative complications, and had significantly higher healthcare costs. CONCLUSIONS Surgical patients with preexisting psychiatric diagnoses have a propensity for worse perioperative outcomes compared to patients without reported mental illness. Taking a thorough psychiatric history can potentially help surgical teams address disparities and access to care as well as anticipate and prevent adverse outcomes.
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Haddad A, Bocchese M, Garber R, O'Neill B, Yesenosky GA, Patil P, Keane MG, Islam S, Sherrer JM, Basil A, Gangireddy C, Cooper JM, Cronin EM, Whitman IR. Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1143-1150. [PMID: 33959994 DOI: 10.1111/pace.14255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/01/2021] [Accepted: 04/11/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Non-white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown. METHODS We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 and 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post-procedure oral anticoagulation (OAC) use in whites versus non-whites. RESULTS Among 109 patients undergoing LAAO (45% white), whites had lower CHA2 DS2 VASc scores, on average, than non-whites (4.0 vs. 4.8, p = .006). There was no difference in median time from index event (IE) or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non-whites 13.7 months, p = .9; 1.9 vs. 1.8 months, p = .6, respectively), and there was no difference in procedural complications (whites 4% vs. non-whites 5%, p = .33). After adjusting for CHA2 DS2 VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95% CI [0.9-6.0], p = .07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA2 DS2 VASc score and GI bleed severity, whites had a nearly five-fold odds of being discharged on OAC (OR 4.6, 95% CI [1-21.8], p = 0.05). The association between race and discharge OAC was not mediated through income category (total mediation effect 19% 95% CI [-.04-0.11], p = .38). CONCLUSION Despite an increased prevalence of comorbidities amongst non-whites, wait time for LAAO and procedural complications were similar in whites versus non-whites. Among those with prior GI bleed, whites were nearly five-fold more likely to be discharged on OAC than non-whites, independent of income.
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Affiliation(s)
- Abdullah Haddad
- Sections of Cardiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Matthew Bocchese
- Department of Medicine, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca Garber
- Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Brian O'Neill
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - George A Yesenosky
- Cardiac Electrophysiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Pravin Patil
- Sections of Cardiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Martin G Keane
- Sections of Cardiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Sabrina Islam
- Sections of Cardiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Jacqueline M Sherrer
- Sections of Cardiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Anuj Basil
- Cardiac Electrophysiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Chethan Gangireddy
- Cardiac Electrophysiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Joshua M Cooper
- Cardiac Electrophysiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Edmond M Cronin
- Cardiac Electrophysiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Isaac R Whitman
- Cardiac Electrophysiology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Kim EJ, Parker VA, Liebschutz JM, Conigliaro J, DeGeorge J, Hanchate AD. Association Between Ambulatory Care Utilization and Coronary Artery Disease Outcomes by Race/Ethnicity. J Am Heart Assoc 2019; 8:e013372. [PMID: 31779562 PMCID: PMC6912984 DOI: 10.1161/jaha.119.013372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Coronary artery disease is common, and there exist disparities in management and outcomes. The purpose of this study is to examine the association between ambulatory care utilizations and inpatient acute myocardial infarction (AMI) mortality. Methods and Results This is a retrospective analysis of a stratified national sample of Medicare fee‐for‐service enrollees aged 66 years and older from January 1, 2010 to December 31, 2011. We measured both number of ambulatory visits and presence of ambulatory cardiac tests. The primary outcome was inpatient AMI mortality. Using multivariate logistic regression models, we estimated the association between ambulatory care utilization and the main patient outcomes, adjusting for patient‐ and area‐level demographic, geographical, and clinical characteristics. We found that a significantly lower percentage of Hispanics and Asians, relative to whites, had frequent ambulatory care visits. Among the largest 4 race/ethnic groups, Asians had the highest observed inpatient mortality rate (15.9%). Overall, low ambulatory utilization was associated with higher odds (odds ratio=1.85 [95% confidence interval: 1.11‐3.08]), and ambulatory cardiac testing was associated with lower odds (odds ratio=0.73 [0.55‐0.95]) of inpatient AMI mortality, after adjustment for covariates. Asians had higher odds of inpatient AMI mortality even after adjustment for covariates. Conclusions Among Medicare fee‐for‐service enrollees, Hispanics and Asians had lower rates of ambulatory care visits, and all minority groups had higher odds of hospitalization for AMI. Ambulatory care utilization, including both ambulatory clinic visits and outpatient cardiac tests, were associated with AMI mortality. Further research is needed to understand the causal relationship between ambulatory care utilization and cardiovascular outcomes.
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Affiliation(s)
- Eun Ji Kim
- Division of General Internal Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Lake Success NY
| | - Victoria A Parker
- Peter T. Paul College of Business and Economics University of New Hampshire Durham NH
| | - Jane M Liebschutz
- Division of General Internal Medicine University of Pittsburgh Pittsburgh PA
| | - Joseph Conigliaro
- Division of General Internal Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Lake Success NY
| | | | - Amresh D Hanchate
- Section of General Internal Medicine Boston University School of Medicine Boston MA
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Becker ER, Granzotti AM. Trends in In-hospital Coronary Artery Bypass Surgery Mortality by Gender and Race/Ethnicity --1998-2015: Why Do the Differences Remain? J Natl Med Assoc 2019; 111:527-539. [DOI: 10.1016/j.jnma.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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African Americans are less likely to have elective endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2019; 70:462-470. [DOI: 10.1016/j.jvs.2018.10.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/04/2018] [Indexed: 11/21/2022]
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Socioeconomic Predictors of Surgical Resection and Survival for Patients With Osseous Spinal Neoplasms. Clin Spine Surg 2019; 32:125-131. [PMID: 30531357 DOI: 10.1097/bsd.0000000000000738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OF BACKGROUND DATA Primary osseous spinal neoplasms (POSNs) include locally aggressive tumors such as osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma. For such tumors, surgical resection is associated with improved survival for patients. Socioeconomic predictors of receiving surgery, however, have not been studied. OBJECTIVE To examine the independent effect of race on receiving surgery and survival probability in patients with POSN. STUDY DESIGN A total of 1904 patients from the SEER program at the National Cancer Institute database, all diagnosed with POSN of the spinal cord, vertebral column, pelvis, or sacrum from 2003 through 2012 were included in the study. Race was reported as white or nonwhite. Treatment included receiving surgery and no surgery. MATERIALS AND METHODS Multivariable logistic regression was used to determine odds of receiving surgery based on race. Survival probability based on and race and surgery status was analyzed by Cox proportional hazards model and Kaplan-Meir curves. Results were adjusted for age at diagnosis, sex, socioeconomic status (composite index), tumor size, and tumor grade. Data were analyzed with SAS version 9.4. RESULTS The study found that white patients were significantly more likely to receive surgery (odds ratio=3.076, P<0.01). Furthermore, nonwhite race was associated with significantly shorter survival time [hazard ratio (HR)=1.744, P<0.05]. Receiving surgery was associated with improved overall survival (HR=2.486, P<0.01). After adjusting for receiving surgery, white race remained significantly associated with higher survival probability (HR=2.061, P<0.05). CONCLUSIONS This national study of patients with typically aggressive POSN found a significant correlation between race and the likelihood of receiving surgery. The study also found race to be a significant predictor of overall survival, regardless of receiving surgical treatment. These findings suggest an effect of race on receiving treatment and survival in patients with POSN, regardless of socioeconomic status. Further studies are required to understand reasons underlying these findings, and how they may be addressed.
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McCarthy FH, Zhang L, Tam V, Chen J, Brown C, Patrick WL, Clark Hargrove W, Szeto WY, Desai ND, Wiebe DJ, Groeneveld PW, Williams ML. Geographically Derived Socioeconomic Factors to Improve Risk Prediction in Patients Having Aortic Valve Replacement. Am J Cardiol 2019; 123:116-122. [PMID: 30390990 DOI: 10.1016/j.amjcard.2018.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
Socioeconomic status (SES) has been associated with adverse outcomes after cardiac surgery, but is not included in commonly applied risk adjustment models. This study evaluates whether inclusion of SES improves aortic valve replacement (AVR) risk prediction models, as this is the most common elective operation performed at our institution during the study period. All patients who underwent AVR at a single institution from 2005 to 2015 were evaluated. SES measures included unemployment, poverty, household income, home value, educational attainment, housing density, and a validated SES index score. The risk scores for mortality, complications, and increased length of stay were generated using models published by the Society for Thoracic Surgeons. Univariate models were fitted for each SES covariate and multivariable models for mortality, any complication, and prolonged length of stay (PLOS). A total of 1,386 patients underwent AVR with a 2.7% mortality, 15.1% complication rate, and 9.7% PLOS. In univariate models, higher education was associated with decreased mortality (odds ratio [OR] 0.96, p = 0.04) and complications (OR 0.97, p <0.01). Poverty was associated with increased length of stay (OR 1.02, p = 0.02). In the multivariable models, the inclusion of SES covariates increased the area under the curve for mortality (0.735 to 0.750, p = 0.14), for any complications (0.663 to 0.680, p <0.01), and for PLOS (0.749 to 0.751, p = 0.12). The inclusion of census-tract-level socioeconomic factors into the the Society of Thoracic Surgeons risk predication models is new and shows potential to improve risk prediction for outcomes after cardiac surgery. With the possibility of reimbursement and institutional ranking based on these outcomes, this study represents an improvement in risk prediction model.
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Sims JN, Yedjou CG, Abugri D, Payton M, Turner T, Miele L, Tchounwou PB. Racial Disparities and Preventive Measures to Renal Cell Carcinoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1089. [PMID: 29843394 PMCID: PMC6024978 DOI: 10.3390/ijerph15061089] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023]
Abstract
Kidney cancer ranks among the top 10 cancers in the United States. Although it affects both male and female populations, it is more common in males. The prevalence rate of renal cell carcinoma (RCC), which represents about 85% of kidney cancers, has been increasing gradually in many developed countries. Family history has been considered as one of the most relevant risk factors for kidney cancer, although most forms of an inherited predisposition for RCC only account for less than four percent. Lifestyle and other factors such as occupational exposure, high blood pressure, poor diet, and heavy cigarette smoking are highly associated with its incidence and mortality rates. In the United States, White populations have the lowest prevalence of RCC compared to other ethnic groups, while Black Americans suffer disproportionally from the adverse effects of RCC. Hence, this review article aims at identifying the major risk factors associated with RCC and highlighting the new therapeutic approaches for its control/prevention. To achieve this specific aim, articles in peer-reviewed journals with a primary focus on risk factors related to kidney cancer and on strategies to reduce RCC were identified. The review was systematically conducted by searching the databases of MEDLINE, PUBMED Central, and Google Scholar libraries for original articles. From the search, we found that the incidence and mortality rates of RCC are strongly associated with four main risk factors, including family history (genetics), lifestyle (poor diet, cigarette smoking, excess alcohol drinking), environment (community where people live), and occupation (place where people work). In addition, unequal access to improvement in RCC cancer treatment, limited access to screening and diagnosis, and limited access to kidney transplant significantly contribute to the difference observed in survival rate between African Americans and Caucasians. There is also scientific evidence suggesting that some physicians contribute to racial disparities when performing kidney transplant among minority populations. New therapeutic measures should be taken to prevent or reduce RCC, especially among African Americans, the most vulnerable population group.
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Affiliation(s)
- Jennifer N Sims
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, 350 W. Woodrow Wilson Dr., P.O. Box 17038, Jackson, MS 39217, USA.
| | - Clement G Yedjou
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
- Natural Chemotherapeutics Research Laboratory, RCMI Center for Environmental Health, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
| | - Daniel Abugri
- Department of Chemistry and Department of Biology, Laboratory of Ethno-Medicine, Parasitology and Drug Discovery, College of Arts and Science, Tuskegee University, 1200 Old Montgomery Road, Tuskegee, AL 36088, USA.
| | - Marinelle Payton
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, 350 W. Woodrow Wilson Dr., P.O. Box 17038, Jackson, MS 39217, USA.
| | - Timothy Turner
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
| | - Lucio Miele
- Department of Genetics, Louisiana State University, Health Sciences Center, School of Medicine, 533 Bolivar St., Room 657, New Orleans, LA 70112, USA.
| | - Paul B Tchounwou
- Natural Chemotherapeutics Research Laboratory, RCMI Center for Environmental Health, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
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Kim EJ, Kressin NR, Paasche-Orlow MK, Lopez L, Rosen JE, Lin M, Hanchate AD. Racial/ethnic disparities among Asian Americans in inpatient acute myocardial infarction mortality in the United States. BMC Health Serv Res 2018; 18:370. [PMID: 29769083 PMCID: PMC5956856 DOI: 10.1186/s12913-018-3180-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/02/2018] [Indexed: 01/10/2023] Open
Abstract
Background Acute myocardial infarction (AMI) is a common high-risk disease with inpatient mortality of 5% nationally. But little is known about this outcome among Asian Americans (Asians), a fast growing racial/ethnic minority in the country. The objectives of the study are to obtain near-national estimates of differences in AMI inpatient mortality between minorities (including Asians) and non-Hispanic Whites and identify comorbidities and sociodemographic characteristics associated with these differences. Method This is a retrospective analysis of 2010–2011 state inpatient discharge data from 10 states with the largest share of Asian population. We identified hospitalization with a primary diagnosis of AMI using the ICD-9 code and used self-reported race/ethnicity to identify White, Black, Hispanic, and Asian. We performed descriptive analysis of sociodemographic characteristics, medical comorbidities, type of AMI, and receipt of cardiac procedures. Next, we examined overall inpatient AMI mortality rate based on patients’ race/ethnicity. We also examined the types of AMI and a receipt of invasive cardiac procedures by race/ethnicity. Lastly, we used sequential multivariate logistic regression models to study inpatient mortality for each minority group compared to Whites, adjusting for covariates. Results Over 70% of the national Asian population resides in the 10 states. There were 496,472 hospitalizations with a primary diagnosis of AMI; 75% of all cases were Whites, 10% were Blacks, 12% were Hispanics, and 3% were Asians. Asians had a higher prevalence of cardiac comorbidities, including hypertension, diabetes, and kidney failure compared to Whites (p-value< 0.01). There were 158,623 STEMI (ST-elevation AMI), and the proportion of hospitalizations for STEMI was the highest for Asians (35.2% for Asians, 32.7% for Whites, 25.3% for Blacks, and 32.1% for Hispanics). Asians had the highest rates of inpatient AMI mortality: 7.2% for Asians, 6.3% for Whites, 5.4% for Blacks, and 5.9% for Hispanics (ANOVA p-value < 0.01). In adjusted analyses, Asians (OR = 1.11 [95% CI: 1.04–1.19]) and Hispanics (OR = 1.14 [1.09–1.19]) had a higher likelihood of inpatient mortality compared to Whites. Conclusions Asians had a higher risk-adjusted likelihood of inpatient AMI mortality compared to Whites. Further research is needed to identify the underlying reasons for this finding to improve AMI disparities for Asians.
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Affiliation(s)
- Eun Ji Kim
- General Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, 2001 Marcus Avenue Suite S160, Lake Success, NY, 11042, USA.
| | - Nancy R Kressin
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA.,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Michael K Paasche-Orlow
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA
| | - Lenny Lopez
- University of California San Francisco School of Medicine, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Jennifer E Rosen
- MedStar Washington Hospital Center, 106 Irving Street NW POB South 124, Washington, DC, 20010, USA
| | - Mengyun Lin
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA
| | - Amresh D Hanchate
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA.,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
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Weisband YL, Gallo MF, Klebanoff MA, Shoben AB, Norris AH. Progression of care among women who use a midwife for prenatal care: Who remains in midwife care? Birth 2018; 45:28-36. [PMID: 28887813 DOI: 10.1111/birt.12308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prenatal care provided by midwives provides a safe and cost-effective alternative to care provided by physicians. However, no studies have evaluated the frequency of women who leave midwifery care, in a hospital setting. Our study objectives were to measure the frequency of transfers of care to physicians, to describe the sociodemographic and pregnancy-related characteristics of women who transferred to the care of a physician during prenatal care and at delivery, and to assess correlates of these transfers. METHODS We used electronic medical records to perform a retrospective cohort study of women who delivered at The Ohio State University Wexner Medical Center (OSUWMC) and had at least one prenatal care visit within OSUWMC's network. We report descriptive findings, using proportions and means with standard deviations. We used logistic regression, with Firth's bias correction as necessary, to assess correlates of transferring to a physician during prenatal care and at delivery. RESULTS Most women who initiated prenatal care with a midwife remained in midwifery care throughout delivery, with 4.7% transferring to a physician during prenatal care, and an additional 21.4% transferring to a physician during delivery. After adjusting for pregnancy-related factors, the black race was statistically significantly associated with leaving midwifery care during prenatal care (adjusted odds ratio AOR 3.0 [95% CI 1.4-6.6]) and delivery (AOR 2.5 [95% CI 1.5-4.3]). CONCLUSION Findings indicate that most women remain in midwifery care throughout pregnancy, but raise important questions with respect to the possible role that race has in pregnancy care.
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Affiliation(s)
| | - Maria F Gallo
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, OH, USA
| | - Abigail B Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Alison H Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Dong L, Fakeye OA, Graham G, Gaskin DJ. Racial/Ethnic Disparities in Quality of Care for Cardiovascular Disease in Ambulatory Settings: A Review. Med Care Res Rev 2017; 75:263-291. [DOI: 10.1177/1077558717725884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. The objective of this review is to synthesize recent evidence on racial and ethnic disparities in management of CVD in the ambulatory setting. Database searches yielded 550 articles of which 25 studies met the inclusion criteria. Reviewed studies were categorized into non-interventional studies examining the association between race and receipt of ambulatory CVD services with observational designs, and interventional studies evaluating specific clinical courses of action intended to ameliorate disparities. Based on the Donabedian framework, this review demonstrates that significant racial/ethnic disparities persist in process and outcome measures of quality of ambulatory CVD care. Multimodal interventions were most effective in reducing disparities in CVD outcomes.
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Affiliation(s)
- Liming Dong
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Practice Variation Among Hospitals in Revascularization Therapy and Its Association With Procedure-related Mortality. Med Care 2017; 54:623-31. [PMID: 27050445 DOI: 10.1097/mlr.0000000000000536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND While substantial practice variation in coronary revascularization has been described and deviation from clinical practice guidelines has been associated with worse outcomes, the degree to which this is driven by flawed decision making and/or appropriate deviation associated with comorbid conditions is unknown. We evaluated heterogeneity in procedure use, and the extent to which hospital-level practice variation is related to surgical mortality. METHODS We analyzed data on 554,563 inpatients undergoing either percutaneous coronary intervention or coronary artery bypass grafting at 391 centers in 6 states. Procedure-specific risk models were developed based on demographics and comorbidities, allowing for differential effects of comorbidities for each sex. For each patient, the revascularization procedure that minimized predicted probability of inhospital mortality was designated as the model-preferred procedure.Hospital-level discordance rates-the proportion of cases in each hospital for which the opposite from the model-preferred procedure was performed-were calculated. Hierarchical linear models were used to analyze the relationship between HDRs and hospital-level risk-standardized mortality ratios (RSMRs). RESULTS Comorbidities and demographics alone explained between 68% and 86% of overall variation in inhospital mortality (corresponding C-statistics of 0.84-0.93). The mean (SD) HDR was 26.3% (9.6%). There was a positive independent association between HDRs and inhospital mortality, with a 10% increase in HDR associated with an 11% increase in RSMR (P<0.001). CONCLUSIONS Variance in procedure use according to model preference was strongly associated with worse outcomes. A systematic approach to incorporating comorbidity as part of the decision-making process for coronary revascularization is needed.
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Ibrahim SA, Blum M, Lee GC, Mooar P, Medvedeva E, Collier A, Richardson D. Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial. JAMA Surg 2017; 152:e164225. [PMID: 27893033 PMCID: PMC5726272 DOI: 10.1001/jamasurg.2016.4225] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance Black patients with advanced osteoarthritis (OA) of the knee are significantly less likely than white patients to undergo surgery. No strategies have been proved to improve access to surgery for black patients with end-stage OA of the knee. Objective To assess whether a decision aid improves access to total knee replacement (TKR) surgery for black patients with OA of the knee. Design, Setting, and Participants In a randomized clinical trial, 336 eligible participants who self-identified as black and 50 years or older with chronic and frequent knee pain, a Western Ontario McMaster Universities Osteoarthritis Index score of at least 39, and radiographic evidence of OA of the knee were recruited from December 1, 2010, to May 31, 2014, at 3 medical centers. Exclusion criteria were history of major joint replacement, terminal illness, inflammatory arthritis, prosthetic leg, cognitive impairment, lack of a telephone, or contraindications to elective replacement surgery. Data were analyzed on a per-protocol and intention-to-treat (ITT) basis. Exposure Access to a decision aid for OA of the knee, a 40-minute video that describes the risks and benefits of TKR surgery. Main Outcomes and Measures Receipt of TKR surgery within 12 months and/or a recommendation for TKR surgery from an orthopedic surgeon within 6 months after the intervention. Results Among 336 patients (101 men [30.1%]; 235 women [69.9%]; mean [SD] age, 59.1 [7.2] years) randomized to the intervention or control group, 13 of 168 controls (7.7%) and 25 of 168 intervention patients (14.9%) underwent TKR within 12 months (P = .04). These changes represent a 70% increase in the TKR rate, which increased by 86% (11 of 154 [7.1%] vs 23 of 150 [15.3%]; P = .02) in the per-protocol sample. Twenty-six controls (15.5%) and 34 intervention patients (20.2%) in the ITT analysis received a recommendation for surgery within 6 months (P = .25). The difference in the surgery recommendation rate between the controls (24 of 154 [15.6%]) and the intervention group (31 of 150 [20.7%]) in the per-protocol analysis also was not statistically significant (P = .25). Adjustment for study site yielded similar results: for receipt of TKR at 12 months, adjusted ORs were 2.10 (95% CI, 1.04-4.27) for the ITT analysis and 2.39 (95% CI, 1.12-5.10) for the per-protocol analysis; for recommendation of TKR at 6 months, 1.39 (95% CI, 0.79-2.44) and 1.41 (95% CI, 0.78-2.55). Conclusions and Relevance A decision aid increased rates of TKR among black patients. However, rates of recommendation for surgery did not differ significantly. A patient-centered counseling and educational intervention may help to address racial variations in the use of TKR for the management of end-stage OA of the knee. Trial Registration clinicaltrials.gov Identifer: NCT01851785.
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Affiliation(s)
- Said A Ibrahim
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania2Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Marissa Blum
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Gwo-Chin Lee
- Department of Orthopedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Pekka Mooar
- Department of Orthopedic Surgery and Sports Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Elina Medvedeva
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Aliya Collier
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania2Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Diane Richardson
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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McLeod D, Dew K, Morgan S, Dowell A, Cumming J, Cormack D, McKinlay E, Love T. Equity of access to elective surgery: reflections from NZ clinicians. J Health Serv Res Policy 2016; 9 Suppl 2:41-7. [PMID: 15511325 DOI: 10.1258/1355819042349916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians’ perceptions of equity and the factors they consider when prioritising patients for elective surgery. Methods A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. Results General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians’ perceptions of the “value” that patients would receive from the surgery and patients” needs for public sector funding. Conclusions The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.
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Affiliation(s)
- Deborah McLeod
- Department of General Practice, Wellington School of Medicine, University of Otago, PO Box 7343, Wellington South, New Zealand
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Biopsychosocial-Spiritual Factors Impacting Referral to and Participation in Cardiac Rehabilitation for African American Patients. J Cardiopulm Rehabil Prev 2016; 36:320-30. [DOI: 10.1097/hcr.0000000000000183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Malat J. Expanding research on the racial disparity in medical treatment with ideas from sociology. Health (London) 2016; 10:303-21. [PMID: 16775017 DOI: 10.1177/1363459306064486] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While hundreds of studies document racial differences in the use of medical procedures in the United States, by comparison little is known about the causes of these differences. This gap in knowledge should serve as a call to sociologists who, drawing on their disciplinary tradition of studying inequality, could improve understanding of the disparity. This article offers suggestions about how medical sociologists in the USA might bring sociology to the study of racial disparities in medical treatment. The article begins by reviewing the existing approaches to understanding the racial disparity in medical treatment. After considering the extant research and its limits, the article goes on to describe how a few specific concepts from sociology - cultural capital, social networks, self-presentation and social distance, all framed in a race critical framework - and more diverse methodological approaches can advance studies of the racial disparity in medical treatment
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Affiliation(s)
- Jennifer Malat
- Department of Sociology, University of Cincinnati, OH 45221, USA.
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Tucker CM, Ferdinand LA, Mirsu-Paun A, Herman KC, Delgado-Romero E, van den Berg JJ, Jones JD. The Roles of Counseling Psychologists in Reducing Health Disparities. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000007301687] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents an overview of the health disparities problem that exists among individuals from ethnic minority and low-income backgrounds and their majority counterparts. The argument is made that the involvement of counseling psychologists in addressing this health disparities problem presents an opportunity for the field to remain true to its commitment to prevention, multiculturalism, and social justice while becoming more competitive in the health care and health promotion fields. This article highlights the prevalence of health disparities and identifies the primary factors contributing to these disparities. In addition, the roles and approaches that counseling psychologists can adopt to help alleviate this problem are specified.
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Vina ER, Ran D, Ashbeck EL, Ibrahim SA, Hannon MJ, Zhou JJ, Kwoh CK. Patient preferences for total knee replacement surgery: Relationship to clinical outcomes and stability of patient preferences over 2 years. Semin Arthritis Rheum 2016; 46:27-33. [PMID: 27132535 DOI: 10.1016/j.semarthrit.2016.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/16/2016] [Accepted: 03/25/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate the relationship between patient preferences for total knee replacement (TKR) with receipt of TKR, and assess participant characteristics that may influence change in willingness to undergo TKR. METHODS Structured interviews of knee osteoarthritis (OA) patients were conducted. Logistic regression models were conducted to assess the association between baseline willingness and eventual receipt of TKR, adjusted for sociodemographic and clinical variables. Mixed models for repeated measures were used to estimate the effects of sex, race, social support, Δ WOMAC, and orthopedic consult on change in willingness. RESULTS A total of 589 participants were willing, and 215 participants were unwilling to undergo TKR. Willing participants, compared to others, were more often White (69.4% vs. 48.4%), with more than a high school education (60.8% vs. 47.0%) and employed (39.1% vs. 26.5%). At follow-up, the odds of having TKR were twice as high among those who were willing to have the procedure at baseline, but this was no longer significant when adjusted for demographic variables (adjusted OR = 1.82, 95% CI: 0.89-3.69). Willingness to undergo TKR declined over 2 years. Among those who were willing to undergo TKR at baseline but did not obtain one, only 66.5% were still willing at the 2-year follow-up. This decline was less among those who had a greater increase (>median) in WOMAC disability (adjusted Δ = -0.34, 95% CI: -0.47 to -0.20) than those who had minimal change in their WOMAC disability (p = 0.08). The decline in willingness was also less among those who had seen an orthopedic surgeon (adjusted Δ = -0.32, 95% CI: -0.46 to -0.17) than those who did not (p = 0.05). CONCLUSIONS Preference for TKR was consistent with TKR surgery utilization, but not after controlling for patient demographic characteristics. Willingness to undergo TKR declined over time, but this decrease was mitigated by worsening OA-related disability and by consultation with an orthopedic surgeon.
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Affiliation(s)
- Ernest R Vina
- Division of Rheumatology, Department of Medicine, University of Arizona Arthritis Center, University of Arizona, 1501 N Campbell Ave., PO Box 245093, Tucson, AZ 85724-5093.
| | - Di Ran
- Division of Rheumatology, Department of Medicine, University of Arizona Arthritis Center, University of Arizona, 1501 N Campbell Ave., PO Box 245093, Tucson, AZ 85724-5093; Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Erin L Ashbeck
- Division of Rheumatology, Department of Medicine, University of Arizona Arthritis Center, University of Arizona, 1501 N Campbell Ave., PO Box 245093, Tucson, AZ 85724-5093
| | - Said A Ibrahim
- Department of Medicine, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, University of Pennsylvania, Philadelphia, PA
| | - Michael J Hannon
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Philadelphia, PA
| | - Jin J Zhou
- Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - C Kent Kwoh
- Division of Rheumatology, Department of Medicine, University of Arizona Arthritis Center, University of Arizona, 1501 N Campbell Ave., PO Box 245093, Tucson, AZ 85724-5093
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Nguyen T, Haberland CA, Hernandez-Boussard T. Pediatric Patient and Hospital Characteristics Associated With Treatment of Peritonsillar Abscess and Peritonsillar Cellulitis. Clin Pediatr (Phila) 2015; 54:1240-6. [PMID: 25589309 DOI: 10.1177/0009922814565884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify patient and hospital characteristics associated with the choice of treatment for pediatric patients who present in the acute setting with peritonsillar abscess/cellulitis (PTA/PTC). STUDY DESIGN A retrospective cohort study was performed using Healthcare Cost and Utilization Project emergency department, ambulatory, and inpatient state databases for the years 2010 and 2011. Children aged 0 to 17 years were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for PTA/PTC. The main outcome of interest was treatment received, which included medical therapy alone, incision and drainage (IND) or tonsillectomy. Multiple logistic regression analyses were conducted to model non-clinical factors associated with treatment received after adjusting for age, hospital state, race, primary expected payer, existing chronic condition(s), and type of hospital. RESULTS We identified 2994 patients who presented with PTA/PTC. The most common treatment choice was medical therapy alone (30.8%), followed by IND (30.5%) and tonsillectomy (9.4%). There were significant associations between treatment choice and race, primary payer status, and type of hospital (P < .05). We found that Hispanic patients, those with Medicaid as their primary expected payer, and those treated at a designated children's hospital were 3 nonclinical factors independently associated with an increase in likelihood of receiving tonsillectomy as treatment. CONCLUSION There are important nonclinical factors associated with treatment of children who present in the acute setting with PTA/PTC. Additional research is recommended to understand these observed differences in care and how they may affect health outcomes.
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Affiliation(s)
- Thuy Nguyen
- Stanford University School of Medicine, Palo Alto, CA, USA
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Mead H, Ramos C, Grantham SC. Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use: Patient and Provider Perspectives. Med Care Res Rev 2015; 73:251-82. [PMID: 26400868 DOI: 10.1177/1077558715606261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/20/2015] [Indexed: 01/24/2023]
Abstract
Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. The purpose of this study was to identify factors that drive this disparity at the system, provider, and patient levels. A mixed methods study combined descriptive analysis of 2007 Medicare claims data and thematic analysis of 19 clinician interviews, 8 minority patient focus groups and 8 one-on-one interviews with minority heart patients across three communities. The disparity between White and non-White CR use ranged from 7 to 11 percentage points among study sites (p < .05). Key themes suggest disparities are driven by (a) flawed financing and reimbursement that creates disincentives to invest in CR programs, (b) a health care system whose priorities are misaligned with the needs of patients, and (c) subjective decision-making around referral processes. These findings suggest that the health care system needs to address multiple levels of problems to mitigate disparities in CR use.
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Affiliation(s)
- Holly Mead
- George Washington University, Washington, DC, USA
| | | | - Sarah C Grantham
- Center for Consumer Information and Insurance Oversight, Bethesda, MD, USA
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Williams RL, Romney C, Kano M, Wright R, Skipper B, Getrich CM, Sussman AL, Zyzanski SJ. Racial, gender, and socioeconomic status bias in senior medical student clinical decision-making: a national survey. J Gen Intern Med 2015; 30:758-67. [PMID: 25623298 PMCID: PMC4441663 DOI: 10.1007/s11606-014-3168-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/01/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. OBJECTIVE The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. DESIGN We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. PARTICIPANTS The study included senior medical students. MAIN MEASURES We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. KEY RESULTS Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p = .03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p < .001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. CONCLUSIONS In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions between patient race and gender on student recommendations.
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Affiliation(s)
- Robert L Williams
- Department of Family and Community Medicine, MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA,
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Different measures, different mechanisms: A new perspective on racial disparities in health care. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0275-4959(2009)0000027004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Feldman CH, Dong Y, Katz JN, Donnell-Fink LA, Losina E. Association between socioeconomic status and pain, function and pain catastrophizing at presentation for total knee arthroplasty. BMC Musculoskelet Disord 2015; 16:18. [PMID: 25768862 PMCID: PMC4329215 DOI: 10.1186/s12891-015-0475-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/22/2015] [Indexed: 11/12/2022] Open
Abstract
Background Patients with higher socioeconomic status (SES) are shown to have better total knee arthroplasty (TKA) outcomes compared to those with lower SES. The relationship between SES and factors that influence TKA use is understudied. We examined the association between SES and pain, function and pain catastrophizing at presentation for TKA. Methods In patients undergoing TKA at an academic center, we obtained preoperative pain and functional status (WOMAC Index 0–100, 100 worst), pain catastrophizing (PCS, ≥16 high), and mental health (MHI-5, <68 poor). We described individual-level SES using education as a proxy, and area-level SES using a validated composite index linking geocoded addresses to U.S. Census data. We measured associations between these indicators and pain, function and pain catastrophizing, adjusting for age, sex and BMI. Results Among 316 patients, mean age was 65.9 (SD 8.7), 59% were female, and 88% were Caucasian; 17% achieved less than college education and 62% were college graduates. The median area SES index score was 59 (U.S. median 51). Bivariable analyses demonstrated associations between higher individual- and area-level SES and lower pain, higher function and less pain catastrophizing (all p<0.05). Adjusted analyses demonstrated statistically significant associations between higher individual- and area-level SES and better function and less pain. Conclusion In this cohort, patients with higher individual- and area-level SES had lower pain and higher function at the time of TKA than lower SES patients. Further research is needed to assess what constitutes appropriate levels of pain and function to undergo TKA in these higher SES groups. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0475-8) contains supplementary material, which is available to authorized users.
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Dare AJ, Grimes CE, Gillies R, Greenberg SLM, Hagander L, Meara JG, Leather AJM. Global surgery: defining an emerging global health field. Lancet 2014; 384:2245-7. [PMID: 24853601 DOI: 10.1016/s0140-6736(14)60237-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Anna J Dare
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | - Caris E Grimes
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Rowan Gillies
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston MA, USA
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston MA, USA
| | - Lars Hagander
- Department of Clinical Sciences, International Paediatrics and Paediatric Surgery, Lund University, Sweden
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston MA, USA
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
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Lo CC, Cheng TC, Howell RJ. Problem drinking's associations with social structure and mental health care: race/ethnicity differences. J Psychoactive Drugs 2014; 46:233-42. [PMID: 25052882 DOI: 10.1080/02791072.2014.887161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This research used a nationally representative sample of 12,756 respondents self-identified as White, Black, Hispanic, or Asian to examine problem drinking in relationship to social structure and mental healthcare factors. Associations between problem drinking and particular factors varied by racial/ethnic group. Results also indicated that Whites' problem-drinking rates were higher than those of Hispanics, Blacks, and Asians. Americans sometimes use alcohol to manage stress stemming from social disadvantage and inadequate material resources. Across racial/ethnic groups, drinking level was associated with the type and degree of such disadvantage. Additionally, the presence of a mental health problem was associated with problem drinking.
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Affiliation(s)
- Celia C Lo
- a Professor, Department of Sociology & Social Work , Texas Woman's University , Denton , TX
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Beohar N, Sansing VV, Davis AM, Srinivas VS, Helmy T, Althouse AD, Thomas SB, Brooks MM. Race/ethnic disparities in risk factor control and survival in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial. Am J Cardiol 2013; 112:1298-305. [PMID: 23910429 DOI: 10.1016/j.amjcard.2013.05.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 02/07/2023]
Abstract
This study sought to evaluate the impact of race/ethnicity on cardiovascular risk factor control and on clinical outcomes in a setting of comparable access to medical care. The BARI 2D trial enrolled 1,750 participants from the United States and Canada that self-reported either White non-Hispanic (n = 1,189), Black non-Hispanic (n = 349), or Hispanic (n = 212) race/ethnicity. Participants had type 2 diabetes and coronary artery disease and were randomized to cardiac and glycemic treatment strategies. All patients received intensive target-based medical treatment for cardiac risk factors. Average follow-up was 5.3 years. Kaplan-Meier survival curves and Cox proportional hazards regression models were constructed to assess potential differences in mortality and cardiovascular outcomes across racial/ethnic groups. Long-term risk of death and death/myocardial infarction/stroke did not vary significantly by race/ethnicity (5-year death: 11.0% Whites, 13.7% Blacks, 8.7% Hispanics, p = 0.19; adjusted hazard ratio 1.18 Black versus White, 95% confidence interval 0.84 to 1.67, p = 0.33 and 0.82 Hispanic versus White, 95% confidence interval 0.51 to 1.34, p = 0.43). Among the 1,168 patients with suboptimal risk factor control at baseline, the ability to attain better risk factor control during the trial was associated with higher 5-year survival (71%, 86% and 95% for patients with 0 or 1, 2, and 3 factors in control, respectively, p <0.001); this pattern was observed within each race/ethnic group. In conclusion, significant race/ethnic differences in cardiac risk profiles that persisted during follow-up did not translate into significant differences in 5-year death or death/MI/stroke.
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Affiliation(s)
- Nirat Beohar
- Division of Cardiology, Columbia University, Mount Sinai Medical Center, Miami Beach, Florida
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Hannan EL, Zhong Y, Walford G, Jacobs AK, Venditti FJ, Stamato NJ, Holmes DR, Sharma S, Gesten F, King SB. Underutilization of percutaneous coronary intervention for ST-elevation myocardial infarction in medicaid patients relative to private insurance patients. J Interv Cardiol 2013; 26:470-81. [PMID: 23962131 DOI: 10.1111/joic.12059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines. PATIENTS AND METHODS A total of 5,022 Medicaid and private insurance patients in New York from January 1, 2008 through December 31, 2009 under age 65 with ST-elevation myocardial infarction (STEMI) were compared with regard to their access to percutaneous coronary interventions (PCI) before and after controlling for numerous patient characteristics and other important factors. RESULTS Medicaid patients were significantly less likely to be admitted initially to a hospital certified to perform PCI (90.4% vs. 94.3%, P < 0.001). Also, Medicaid patients were found to be significantly less likely to undergo PCI than other patients (adjusted odds ratio [AOR] = 0.81, 95% CI 0.66, 0.98, P = 0.03). When the probability of each hospital performing PCI for STEMI patients was controlled for, Medicaid patients were still less likely to undergo PCI after controlling for other risk factors (AOR = 0.80, 95% CI 0.65, 0.99, P = 0.04). CONCLUSIONS Medicaid STEMI patients are significantly less likely to undergo PCI within the same day of admission as private pay patients even after adjusting for patient characteristics related to receiving PCI, and the strength of this relationship is not diminished when controlling for whether the admitting hospital has approval to perform PCI or controlling for the tendency of the admitting hospital to treat STEMI with PCI.
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Affiliation(s)
- Edward L Hannan
- School of Public Health, University at Albany, Albany, New York
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O'Neal WT, Efird JT, Davies SW, O'Neal JB, Anderson CA, Ferguson TB, Chitwood WR, Kypson AP. Impact of race and postoperative atrial fibrillation on long-term survival after coronary artery bypass grafting. J Card Surg 2013; 28:484-91. [PMID: 23909382 DOI: 10.1111/jocs.12178] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Postoperative atrial fibrillation (POAF) is a known predictor of in-hospital morbidity and short-term survival after coronary artery bypass grafting (CABG). The impact of race and long-term survival has not been examined in this population. We aimed to examine the influence of these factors on long-term survival in patients undergoing CABG. METHODS Patients undergoing first-time, isolated CABG between 1992 and 2011 were included in this study. Long-term survival was compared in patients with and without POAF and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. RESULTS A total of 2,907 (22%) patients developed POAF (black n=370; white n=2,537) following CABG (N=13,165). Median follow-up for study participants was 8.2 years. Long-term survival after CABG differed by POAF status and race (no POAF: HR=1.0; white POAF: adjusted HR=1.1, 95% CI=1.06-1.2; black POAF: adjusted HR=1.4, 95% CI=1.2-1.6; pTrend=0.0002). lack POAF patients also died sooner after surgery than their white counterparts (adjusted HR=1.2, 95% CI=1.02-1.4). CONCLUSION Black race was a statistically significant predictor of decreased survival among POAF patients after CABG. This finding provides useful outcome information for surgeons and their patients.
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Affiliation(s)
- Wesley T O'Neal
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. Influence of Patients' Gender on Informed Decision Making Regarding Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2013; 65:1281-90. [DOI: 10.1002/acr.21970] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 01/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Cornelia M. Borkhoff
- The Hospital for Sick Children and University of Toronto; Toronto Ontario Canada
| | - Gillian A. Hawker
- University of Toronto and Women's College Research Institute, Women's College Hospital; Toronto Ontario Canada
| | - Hans J. Kreder
- University of Toronto and Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Richard H. Glazier
- University of Toronto and St. Michael's Hospital; Toronto Ontario Canada
| | - Nizar N. Mahomed
- University of Toronto and University Health Network; Toronto Ontario Canada
| | - James G. Wright
- The Hospital for Sick Children and University of Toronto; Toronto Ontario Canada
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Li S, Chen A, Mead K. Racial disparities in the use of cardiac revascularization: does local hospital capacity matter? PLoS One 2013; 8:e69855. [PMID: 23875005 PMCID: PMC3713060 DOI: 10.1371/journal.pone.0069855] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/12/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity. DATA SOURCES Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006. STUDY DESIGN The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity. PRINCIPAL FINDINGS Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate. CONCLUSIONS County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.
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Affiliation(s)
- Suhui Li
- Department of Health Policy, George Washington University, Washington, District of Columbia, United States of America.
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Effect of Peripheral Arterial Disease and Race on Survival After Coronary Artery Bypass Grafting. Ann Thorac Surg 2013; 96:112-8. [DOI: 10.1016/j.athoracsur.2013.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/03/2013] [Accepted: 04/05/2013] [Indexed: 12/18/2022]
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Napoli AM, Choo EK, Dai J, Desroches B. Racial disparities in stress test utilization in an emergency department chest pain unit. Crit Pathw Cardiol 2013; 12:9-13. [PMID: 23411602 DOI: 10.1097/hpc.0b013e31827c9a86] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Epidemiological studies have demonstrated racial disparities in the workup of emergency department patients with chest pain and the referral of admitted patients for intervention. However, little is known about possible disparities in stress test utilization in low-risk chest pain patients admitted to emergency department chest pain units. METHODS A retrospective observational study of consecutive chest pain unit patients was conducted. Eligibility criteria included age >18 years, American Heart Association low-to-intermediate risk, nondynamic electrocardiograms, and normal initial troponin I. Patients aged >75 years with a history of coronary artery heart disease were excluded. On each patient, we calculated a Thrombolysis in Myocardial Infarction (TIMI) risk prediction score and a Diamond and Forrester (D&F) score for likelihood of coronary artery disease. Two separate multivariate analyses were completed, one including the TIMI score and the other including D&F score, using logistic regression to estimate odds ratios (ORs) for receiving testing based on race, controlling for other relevant covariates. RESULTS Two thousand four hundred fifty-one patients were enrolled over a planned 1.5-year period. In total, 59.7% [95% confidence interval (CI) 57.8-61.7] of patients were white, 11.6% (95% CI 10.4-12.9) African American, and 28.6% (95% CI 26.9-30.4) "other." The overall stress testing rate was 50.3% (95% CI 48.4-52.3). After controlling for insurance and TIMI or D&F scores, African American patients had significantly decreased odds of stress testing (OR(TIMI) 0.68, 95% CI 0.52-0.89; OR(D&F) 0.67, 95% CI 0.51-0.89). CONCLUSIONS Our study confirms racial disparities in the utilization of stress testing in the chest pain unit. Further investigation is needed to identify specific provider or patient-level factors that may contribute to this disparity.
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Affiliation(s)
- Anthony M Napoli
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
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Bevevino AJ, Lehman RA. Commentary: Access to care affects the rate of spinal deformity surgery. Spine J 2013; 13:124-6. [PMID: 23452568 DOI: 10.1016/j.spinee.2012.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 11/20/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Adam J Bevevino
- Division of Orthopaedics, Department of Orthopaedic Surgery and Rehabilitation, Uniform Services University of Health Sciences, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA
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Nuño M, Drazin DG, Acosta FL. Differences in treatments and outcomes for idiopathic scoliosis patients treated in the United States from 1998 to 2007: impact of socioeconomic variables and ethnicity. Spine J 2013. [PMID: 23182025 DOI: 10.1016/j.spinee.2012.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Scoliosis is a significant cause of disability and health-care resource utilization in the United States. PURPOSE Our aim was to evaluate potential disparities in the selection of treatments and outcomes for idiopathic scoliosis patients on a national level. To date, only one study has examined inpatient complications, discharge disposition, and mortality with respect to scoliosis treatment on a national scale. STUDY DESIGN/SETTING Retrospective review of cases having a primary diagnosis of idiopathic scoliosis using the nationwide inpatient sample (NIS) administrative data from 1998 to 2007. PATIENT SAMPLE The NIS data were queried to identify patients with a primary diagnosis of idiopathic scoliosis (International Classification of Diseases, Ninth Revision [ICD-9] diagnosis code: 737.30) admitted routinely. Surgically treated patients were identified as those patients who underwent a spinal fusion (ICD-9-Clinical Modification code: 81.08) as a principal procedure. OUTCOME MEASURES Rates of surgical versus nonsurgical treatments were measured as were inhospital complications and mortality rates. METHODS No external funding was received for this work. Univariate and multivariate analyses evaluated race, sex, socioeconomic factors, and hospital characteristics as predictors of surgical versus nonsurgical treatments, as well as inhospital complications and mortality rates. RESULTS The study analyzed 9,077 surgically and 1,098 nonsurgically treated patients with idiopathic scoliosis. Univariate analysis showed both patient- and hospital-level variables as strongly associated with surgical versus nonsurgical treatments and outcomes. Multivariate analysis revealed that Caucasians and private insurance patients were more likely to undergo surgical treatment (p<.05) even when controlling for comorbidities. Additionally, Caucasians had a reduced risk of nonroutine discharge compared with non-Caucasians (p=.03). Large hospitals had higher surgery rates (p=.08) than small- or medium-sized facilities and a lower risk of mortality (p=.04). Caucasians (65.1%) were more commonly admitted to large teaching hospitals than African American (59.8%) or Hispanic (41.8%) patients. CONCLUSIONS Differences were found in the selection of surgical versus nonsurgical treatments, as well as inhospital morbidity for hospitalized idiopathic scoliosis patients based on ethnic and socioeconomic variables. This may in part be because of differences in access to the resources of large teaching hospitals for different ethnic and socioeconomic groups or variability in severity of scoliosis among these groups that was not captured in this database.
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Affiliation(s)
- Miriam Nuño
- Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West 3rd St, Suite 800E, Los Angeles, CA 90048, USA
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Efird JT, O'Neal WT, Gouge CA, Kindell LC, Kennedy WL, Bolin P, O'Neal JB, Anderson CA, Rodriguez E, Ferguson TB, Chitwood WR, Kypson AP. Implications of Hemodialysis in Patients Undergoing Coronary Artery Bypass Grafting. ACTA ACUST UNITED AC 2013; 2. [PMID: 25309935 DOI: 10.4172/2324-8602.1000154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population. METHODS Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model. RESULTS Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2). CONCLUSION Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations.
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Affiliation(s)
- Jimmy T Efird
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA ; Center for Health Disparity Research, East Carolina University, USA
| | - Wesley T O'Neal
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Catherine A Gouge
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Linda C Kindell
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Whitney L Kennedy
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Paul Bolin
- Department of Internal of Medicine, Division of Nephrology and Hypertension. Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Jason B O'Neal
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Curtis A Anderson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | | | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - W Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Alan P Kypson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
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Mays VM. The Legacy of the U. S. Public Health Services Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years After President Clinton's Apology. ETHICS & BEHAVIOR 2012; 22:411-418. [PMID: 23630410 PMCID: PMC3636721 DOI: 10.1080/10508422.2012.730808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This special issue addresses the legacy of the United States Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act (ACA). The 12 manuscripts cover the history and current practices of ethical abuses affecting American Indians, Latinos, Asian Americans and African Americans in the United States and in one case, internationally. Commentaries and essays include the voice of a daughter of one of the study participants in which we learn of the stigma and maltreatment some of the families experienced and how the study has impacted generations within the families. Consideration is given in one essay to utilizing narrative storytelling with the families to help promote healing. This article provides the reader a roadmap to the themes that emerged from the collection of articles. These themes include population versus individual consent issues, need for better government oversight in research and health care, the need for overhauling our bioethics training to develop a population level, culturally driven approach to research bioethics. The articles challenge and inform us that some of our assumptions about how the consent process best works to protect racial/ethnic minorities may be merely assumptions and not proven facts. Articles challenge the belief that low participation rates seen in biomedical studies have resulted from the legacy of the USPHS Syphilis Study rather than a confluence of factors rooted in racism, bias and negative treatment. Articles in this special issue challenge the "cultural paranoia" of mistrust and provide insights into how the distrust may serve to lengthen rather than shorten the lives of racial/ethnic minorities who have been used as guinea pigs on more than one occasion. We hope that the guidance offered on the importance of developing a new framework to bioethics can be integrated into the foundation of health care reform.
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Affiliation(s)
- Vickie M Mays
- Professor of Psychology and Health Services, Director, UCLA Center on Bridging Research, Innovation, Training and Education for Minority Health Disparities Solutions
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Lavernia CJ, Contreras JS, Parvizi J, Sharkey PF, Barrack R, Rossi MD. Do patient expectations about arthroplasty at initial presentation for hip or knee pain differ by sex and ethnicity? Clin Orthop Relat Res 2012; 470:2843-53. [PMID: 22733183 PMCID: PMC3441988 DOI: 10.1007/s11999-012-2431-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 06/04/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many studies show gender and ethnic differences in healthcare utilization and outcomes. Patients' presurgical cognitions regarding surgical outcomes also may vary by gender and ethnicity and play a role in explaining utilization and outcome differences. However, it is unclear whether and to what extent gender and ethnicity play a role in patients' presurgical cognitions. QUESTIONS/PURPOSES Do gender and ethnicity influence outcome expectations? Is arthroplasty-related knowledge affected by gender and ethnicity? Do gender and ethnicity influence willingness to pay for surgery? METHODS In a prospective, multicenter study we gave 765 patients an anonymous questionnaire on expectations, arthroplasty knowledge, and preferences before their consultation for hip and/or knee pain, from March 2005 to July 2007. RESULTS Six hundred seventy-two of the 765 patients (88%) completed questionnaires. Non-Hispanics and men were more likely to indicate they would be able to engage in more activities. Non-Hispanics and men had greater arthroplasty knowledge. Hispanics and women were more likely to report they would not pay for a total joint arthroplasty (TJA) relative to non-Hispanics and men. CONCLUSIONS Sex and ethnic differences in patients presenting for their initial visit to the orthopaedists for hip or knee pain influence expectations, knowledge, and preferences concerning TJAs. Longitudinal study of relationships between patients' perceptions and utilization or outcomes regarding TJA is warranted.
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Affiliation(s)
- Carlos J. Lavernia
- Orthopaedic Institute at Mercy Hospital, 3659 S Miami Avenue, Suite 4008, Miami, FL 33133 USA
| | | | | | | | - Robert Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine Barnes-Jewish Hospital, St Louis, MO USA
| | - Mark D. Rossi
- Department of Physical Therapy, Florida International University, Miami, FL USA
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Rose KM, Foraker RE, Heiss G, Rosamond WD, Suchindran CM, Whitsel EA. Neighborhood socioeconomic and racial disparities in angiography and coronary revascularization: the ARIC surveillance study. Ann Epidemiol 2012; 22:623-9. [PMID: 22809799 PMCID: PMC3418426 DOI: 10.1016/j.annepidem.2012.06.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/26/2012] [Accepted: 06/20/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE Disparities in the receipt of angiography and subsequent coronary revascularization have not been well-studied. METHODS We estimated prevalence ratios and 95% confidence intervals (PR, 95% CIs) for the association between neighborhood-level income (nINC) and receipt of angiography; and among those undergoing angiography, receipt of revascularization procedures, among 9941 hospitalized myocardial infarction patients under epidemiologic surveillance by the Atherosclerosis Risk in Communities Study (1993-2002). RESULTS In analyses by tertile of nINC controlling for age, study community, gender, and year, compared with white patients from high nINC areas, black patients from low nINC (0.60, 0.54-0.66) and medium nINC (0.70, 0.60-0.78) areas, as well as white patients from low nINC areas (0.83, 0.75-0.91) were less likely to receive angiography, whereas black patients from high nINC and white patients from medium nINC areas were not. Associations were attenuated, but persisted, after we controlled for event severity, medical history, receipt of Medicaid, and hospital type. Compared with high nINC white patients, black patients were less likely, and white patients were as likely, to undergo cardiac revascularization, given receipt of an angiogram. CONCLUSIONS Black and lower nINC patients were less likely to undergo angiography than were white patients and those from higher nINC areas. Among those receiving angiography, race, but not nINC, gradients persisted.
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Affiliation(s)
| | - Randi E. Foraker
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chirayath M. Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Appropriateness of coronary revascularization for patients without acute coronary syndromes. J Am Coll Cardiol 2012; 59:1870-6. [PMID: 22595405 DOI: 10.1016/j.jacc.2012.01.050] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The purpose of this study was to determine appropriateness of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery performed in New York for patients without acute coronary syndrome (ACS) or previous CABG surgery. BACKGROUND The American College of Cardiology Foundation (ACCF) and 6 other societies recently published joint appropriateness criteria for coronary revascularization. METHODS Data from patients who underwent CABG surgery and PCI without acute coronary syndrome or previous CABG surgery in New York in 2009 and 2010 were used to assess appropriateness and to examine the variation across hospitals in inappropriateness ratings. RESULTS Of the 8,168 patients undergoing CABG surgery in New York without ACS/prior CABG who could be rated, 90.0% were appropriate for revascularization, 1.1% were inappropriate, and 8.6% were uncertain. Of the 33,970 PCI patients eligible for rating, 28% lacked sufficient information to be rated. Of the patients who could be rated, 36.1% were appropriate, 14.3% were inappropriate, and 49.6% were uncertain. A total of 91% of the patients undergoing PCI who were classified as inappropriate had 1- or 2-vessel disease without proximal left anterior descending artery disease and had no or minimal anti-ischemic medical therapy. CONCLUSIONS For patients without ACS/prior CABG, only 1% of patients undergoing CABG surgery who could be rated were found to be inappropriate for the procedure according to the ACCF appropriateness criteria, but 14% of the PCI patients who could be rated were found to be inappropriate, and 28% lacked enough noninvasive test information to be rated.
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Li Y, Cai X, Du H, Glance LG, Lyness JM, Cram P, Mukamel DB. Mentally ill Medicare patients less likely than others to receive certain types of surgery. Health Aff (Millwood) 2011; 30:1307-15. [PMID: 21734205 DOI: 10.1377/hlthaff.2010.1084] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mentally ill people may face barriers to receiving elective surgical procedures as a result of societal stigma and the cognitive, behavioral, and interpersonal deficits associated with mental illness. Using data from a cohort of elderly Medicare beneficiaries in 2007, we examined whether the mentally ill have less access than people without mental illness to several common procedures that are typically not for emergencies and are performed at the discretion of the provider and the patient. Results suggest that Medicare patients with mental illness are 30-70 percent less likely than others to receive these "referral-sensitive" surgical procedures. Those who did undergo an elective procedure generally experienced poorer outcomes both in the hospital and after discharge. Efforts to improve access to and outcomes of nonpsychiatric care for mentally ill patients are warranted.
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Affiliation(s)
- Yue Li
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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Freund KM, Jacobs AK, Pechacek JA, White HF, Ash AS. Disparities by race, ethnicity, and sex in treating acute coronary syndromes. J Womens Health (Larchmt) 2011; 21:126-32. [PMID: 22032760 DOI: 10.1089/jwh.2010.2580] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Disparities in the management of coronary artery disease were consistently documented in blacks and women in the 1980s and 1990s. Our objective was to determine if racial/ethnic and sex differences in the use of coronary revascularization persist in a more recent cohort. METHODS We examined all 20,604 Medicare beneficiaries admitted for acute coronary syndrome in 2001 from a random sample of 750,000 enrollees that was oversampled for black and Hispanic subjects to assess any cardiac revascularization. RESULTS After controlling for demographics and comorbidities, black men and women (odds ratios [OR] 0.47, 0.40), Hispanic men and women (ORs 0.61, 0.52), and white women (OR 0.67) had lower rates of revascularization compared with white men. Lower revascularization rates persisted for white women (OR 0.67) and black men and women (OR 0.55 and 0.54), controlling for income status and geographic variation, but were no longer present in the Hispanic population. CONCLUSION The mechanisms by which disparities operate may differ for Hispanic and black populations.
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Affiliation(s)
- Karen M Freund
- Evans Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA.
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Dehlendorf C, Foster DG, de Bocanegra HT, Brindis C, Bradsberry M, Darney P. Race, ethnicity and differences in contraception among low-income women: methods received by Family PACT Clients, California, 2001-2007. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2011; 43:181-7. [PMID: 21884386 PMCID: PMC3412526 DOI: 10.1363/4318111] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
CONTEXT The extent to which racial and ethnic differences in method choice are associated with financial barriers is unclear. Understanding these associations may provide insight into how to address racial and ethnic disparities in unintended pregnancy. METHODS Claims data from the California Family PACT program, which provides free family planning services to low-income residents, were used to determine the proportions of women receiving each type of contraceptive method in 2001-2007. Bivariate and multivariate analyses were performed to identify associations between women's race and ethnicity and the primary contraceptive method they received in 2007. RESULTS Compared with white women, blacks and Latinas were less likely to receive oral contraceptives (odds ratios, 0.4 and 0.6, respectively) and the contraceptive ring (0.7 and 0.5), and more likely to receive the injectable (1.6 and 1.4) and the patch (1.6 and 2.3). Black women were less likely than whites to receive the IUD (0.5), but more likely to receive barrier methods and emergency contraceptive pills (2.6); associations were similar, though weaker, for Latinas. Racial and ethnic disparities in receipt of effective methods declined between 2001 and 2005, largely because receipt of the patch (which was introduced in 2002) was higher among minority than white women. CONCLUSION Although Family PACT eliminates financial barriers to method choice, the methods women received differed substantially by race and ethnicity in this low-income population. The reduction in racial and ethnic disparities following introduction of the patch suggests that methods with novel characteristics may increase acceptability of contraceptives among minority women.
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Affiliation(s)
- Christine Dehlendorf
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, USA.
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Prevalence and variability of internal mammary graft use in contemporary multivessel coronary artery bypass graft. Curr Opin Cardiol 2011; 25:609-12. [PMID: 20881486 DOI: 10.1097/hco.0b013e32833f0498] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To assess the current status of the prevalence and variability of internal mammary graft use in contemporary multivessel coronary artery bypass graft (CABG). RECENT FINDINGS The internal mammary artery (IMA) is considered the gold-standard conduit in coronary artery bypass graft (CABG) surgery. There is universal agreement that the IMA graft is associated with significantly improved short-term and long-term survival in CABG and the use of the IMA is recognized as a key performance measure world wide. In the recently developed Society of Thoracic Surgeons (STS) composite measure for CABG, use of an IMA was found to be the only intra-operative performance measure associated with quality of care. Furthermore, several studies have shown that bilateral IMA (BIMA) use improves long-term outcome compared with single IMA use. An objective assessment of surgical quality is essential to improve surgical outcomes. SUMMARY There is strong evidence that IMA graft use is associated with significantly improved short-term and long-term survival in CABG. In spite of this, the prevalence of IMA grafting is less than expected. Moreover, there is a large variability in IMA use by hospital. There are also disparities in IMA use by sex and race, which should be addressed in the interest of expanding the benefits of IMA grafting to the maximum possible number of patients. Although the frequency of IMA use in CABG procedures seems to increase each year, further actions are necessary at the individual clinician, institutional, and political levels to improve quality of care.
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Rosal MC, Borg A, Bodenlos JS, Tellez T, Ockene IS. Awareness of diabetes risk factors and prevention strategies among a sample of low-income Latinos with no known diagnosis of diabetes. DIABETES EDUCATOR 2011; 37:47-55. [PMID: 21220363 DOI: 10.1177/0145721710392247] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study assessed awareness of type 2 diabetes risk and severity, perceived risk factors, knowledge of diabetes prevention strategies, and challenges of and opportunities for prevention among low-income Latinos in Lawrence, Massachusetts. METHODS Qualitative research design. Latinos with no known diagnosis of diabetes participated in 4 focus groups, conducted in Spanish, which were recorded and transcribed for systematic analysis. RESULTS The sample, (N = 41) was largely female (85%) with a wide age range (22-76 years), most (71%) had an educational level of high school or less, and less than half (46%) were employed. Participants had basic knowledge of diabetes, but gaps were apparent. Many perceived family history of diabetes, poor diet, emotional distress, and stress associated with the United States as risk factors for diabetes. There was little or no awareness of risk associated with Latino ethnicity, gestational diabetes, hypertension, lipid abnormalities, or obesity. Few cited physical activity or weight loss as diabetes prevention strategies. More than half the participants perceived themselves at low risk for diabetes. CONCLUSIONS This Latino sample had limited knowledge of diabetes risk factors and lifestyle changes that can prevent or delay diabetes onset. Insights for intervening for diabetes prevention are offered.
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Affiliation(s)
- Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School
| | - Amy Borg
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts (Borg)
| | - Jamie S Bodenlos
- Department of Psychology, Hobart and William Smith Colleges, Geneva, New York (Bodenlos)
| | - Trinidad Tellez
- New Hampshire Department of Health and Human Services, Concord, New Hampshire (Tellez; at the time of this study, Dr Tellez was at the Greater Lawrence Family Health Center, Lawrence, Massachusetts)
| | - Ira S Ockene
- Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts (Ockene)
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