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Prosperi Desenzi Ciaralo P, Guerreiro Cardoso PF, Minamoto H, Bibas BJ, Ribeiro de Carvalho CR, Pego-Fernandes PM. Implementation and Results of a Dedicated Telemedicine Program ( TeleTrachea) for Patients with Tracheal Diseases. Telemed J E Health 2024; 30:1317-1324. [PMID: 38109228 DOI: 10.1089/tmj.2023.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Background: Central airway diseases requiring frequent outpatient visits to a specialized medical center due to tracheal devices. Many of these patients have mobility and cognition restrictions or require specialized transport due to the need for supplemental oxygen. This study describes the implementation and results of a telemedicine program dedicated to patients with central airway diseases based in a Brazilian public health system. Methods: A retrospective study of telemedicine consultation for patients with central airway diseases referred to a public academic hospital between August 1, 2020 and August 1, 2022. The consultations occurred in a telemedicine department using the hospital's proprietary platform. Data retrieved consisted of demographics, disease characteristics, and the treatment modalities of the patients. The analysis included the savings in kilometers not traveled, the carbon footprint based on reducing CO2 emissions, and the cost savings in transportation. Results: A total of 1,153 telemedicine visits conducted in 516 patients (median age of 31.5 years). Two hundred ninety patients (56.2%) had a tracheal device (129 silicone T-Tube, 128 tracheostomy, and 33 endoprosthesis) and 159 patients (30.8%) had difficulties in transportation to the specialized medical center. Patients were served from 147 Brazilian cities from 22 states. The savings in kilometers traveled was 1,224,108.54 km, corresponding to a 250.14 ton reduction in CO2 emissions. The costs savings in transportation for the municipalities was BRL$ 1,272,283.78. Conclusions: Telemedicine consultations for patients with central airway diseases are feasible and safe. Cost savings and the possibility of disseminating specialized care make telemedicine a fundamental tool in current medical practice.
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Affiliation(s)
- Pedro Prosperi Desenzi Ciaralo
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Benoit Jacques Bibas
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Divisions of Pulmonology, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Manuel Pego-Fernandes
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
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McCann ZH, Chang HH, D'Souza R, Scovronick N, Ebelt S. Assessment of census-tract level socioeconomic position as a modifier of the relationship between short-term PM 2.5 exposure and cardiovascular emergency department visits in Missouri. J Epidemiol Community Health 2024; 78:296-302. [PMID: 38302278 PMCID: PMC11006568 DOI: 10.1136/jech-2023-221438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Ambient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures of socioeconomic position (SEP) modify the relationship between PM2.5 exposure and CVDM in Missouri at the census-tract (CT) level. METHODS We use individual level Missouri emergency department (ED) admissions data (n=3 284 956), modelled PM2.5 data, and yearly CT data from 2012 to 2016 to conduct a two-stage analysis. Stage one uses a case-crossover approach with conditional logistic regression to establish the baseline risk of ED visits associated with IQR changes in PM2.5. In the second stage, we use multivariate metaregression to examine how CT-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM. RESULTS We find that overall, ambient PM2.5 exposure is associated with increased risk for CVDM. We test effect modification in statewide and urban CTs, and in the warm season only. Effect modification results suggest that among SEP measures, poverty is most consistently associated with increased risk for CVDM. For example, across Missouri, the highest poverty CTs are at an elevated risk for CVDM (OR=1.010 (95% CI 1.007 to 1.014)) compared with the lowest poverty CTs (OR=1.004 (95% CI 1.000 to 1.008)). Other SEP modifiers generally display an inconsistent or null effect. CONCLUSION Overall, we find some evidence that area-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM, and suggest that the relationship between air-pollution, area-level SEP and CVDM may be sensitive to spatial scale.
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Affiliation(s)
- Zachary H McCann
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory Univeristy, Atlanta, Georgia, USA
| | - Rohan D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory Univeristy, Atlanta, Georgia, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Shakya S, Stedman-Smith M, White PC, Bhatta MP. Knowledge, Attitudes, Practices, and Prevention Barriers Related to Childhood Lead Poisoning Among Nepali-Speaking Bhutanese Parents in Northeast Ohio, United States. J Immigr Minor Health 2024; 26:351-360. [PMID: 37642886 DOI: 10.1007/s10903-023-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
The study objectives were: (i) to develop and administer a survey to assess childhood lead poisoning (CLP) knowledge, attitudes, practices and prevention barriers (KAP-B) among the Nepali-Speaking Bhutanese (NSB) community in Northeast Ohio; and (ii) to examine the association between socio-demographic characteristics of NSB parents and their understanding of CLP as measured by the constructs of knowledge and attitudes. A Nepali language KAP-B questionnaire was developed and 200 NSB parents with at least one child ≤ 7 years of age from the Akron Metropolitan Area, Ohio were interviewed. NSB parents demonstrated a low level of knowledge about CLP prevention measures. While 82% lived in pre-1978 houses, only 27.5% perceived their house/neighborhood to be potentially lead contaminated. Only 33% of the parents reported understanding lead-related information provided by their child's healthcare provider. Low-level CLP awareness among NSB community emphasizes a need for culturally tailored and linguistically appropriate community-level CLP educational intervention programs in this vulnerable community.
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Affiliation(s)
- Sunita Shakya
- College of Public Health, Kent State University, P.O. Box 5190, 44242-0001, Kent, OH, USA
| | - Maggie Stedman-Smith
- College of Public Health, Kent State University, P.O. Box 5190, 44242-0001, Kent, OH, USA
| | | | - Madhav P Bhatta
- College of Public Health, Kent State University, P.O. Box 5190, 44242-0001, Kent, OH, USA.
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Dyas AR, Carmichael H, Bronsert MR, Stuart CM, Garofalo DM, Henderson WG, Colborn KL, Schulick RD, Meguid RA, Velopulos CG. Social vulnerability is associated with higher risk-adjusted rates of postoperative complications in a broad surgical population. Am J Surg 2024; 229:26-33. [PMID: 37775458 DOI: 10.1016/j.amjsurg.2023.09.028] [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: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE The purpose of this study was to determine if an association between Social Vulnerability Index (SVI) and risk-adjusted complications exists in a broad spectrum of surgical patients. SUMMARY BACKGROUND DATA Growing evidence supports the impact of social circumstances on surgical outcomes. SVI is a neighborhood-based measure accounting for sociodemographic factors putting communities at risk. METHODS This was a multi-hospital, retrospective cohort study including a sample of patients within one healthcare system (2012-2017). Patient addresses were geocoded to determine census tract of residence and estimate SVI. Patients were grouped into low SVI (score<75) and high SVI (score≥75) cohorts. Perioperative variables and postoperative outcomes were tracked and compared using local ACS-NSQIP data. Multivariable logistic regression was performed to generate risk-adjusted odds ratios of postoperative complications in the high SVI cohort. RESULTS Overall, 31,224 patients from five hospitals were included. Patients with high SVI were more likely to be racial minorities, have 12/18 medical comorbidities, have high ASA class, be functionally dependent, be treated at academic hospitals, and undergo emergency operations (all p < 0.05). Patients with high SVI had significantly higher rates of 30-day mortality, overall morbidity, respiratory, cardiac and infectious complications, urinary tract infections, postoperative bleeding, non-home discharge, and unplanned readmissions (all p < 0.05). After risk-adjustment, only the associations between high SVI and mortality and unplanned readmission became non-significant. CONCLUSIONS High SVI was associated with multiple adverse outcomes even after risk adjustment for preoperative clinical factors. Targeted preventative interventions to mitigate risk of these specific complications should be considered in this high-risk population.
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Affiliation(s)
- Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Denise M Garofalo
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - William G Henderson
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn L Colborn
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine G Velopulos
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
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Malla G, Long DL, Cherrington A, Goyal P, Guo B, Safford MM, Khodneva Y, Cummings DM, McAlexander TP, DeSilva S, Judd SE, Hidalgo B, Levitan EB, Carson AP. Neighborhood Disadvantage and Risk of Heart Failure: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circ Cardiovasc Qual Outcomes 2024; 17:e009867. [PMID: 38328917 PMCID: PMC10950536 DOI: 10.1161/circoutcomes.123.009867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status. METHODS We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term. RESULTS The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes. CONCLUSIONS In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.
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Affiliation(s)
- Gargya Malla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Boyi Guo
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Monika M. Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Yulia Khodneva
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Doyle M. Cummings
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Tara P. McAlexander
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shanika DeSilva
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bertha Hidalgo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Liu EF, Ferrara A, Sridhar SB, Greenberg MB, Hedderson MM. Association Between Neighborhood Deprivation in Early Pregnancy and Gestational Diabetes Mellitus. Obstet Gynecol 2024:00006250-990000000-01014. [PMID: 38301256 DOI: 10.1097/aog.0000000000005521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To evaluate whether having a pregnancy in a deprived neighborhood was associated with an increased risk of gestational diabetes mellitus (GDM) compared with having a pregnancy in the least-deprived neighborhoods. METHODS This was a retrospective observational cohort study of pregnant individuals within Kaiser Permanente Northern California from 2011 to 2018 with residential history from prepregnancy through 24 weeks of gestation and clinical data from prepregnancy through delivery. The primary outcome was a diagnosis of GDM. Neighborhood deprivation was characterized with an index aggregating multiple indicators of Census tract-level sociodemographic information. Mediation analysis using inverse odds ratio weighting estimated the mediation effects of prepregnancy body mass index (BMI), gestational weight gain, smoking tobacco, and illegal drug use before GDM diagnosis. RESULTS Overall, 214,375 pregnant individuals were included, and 11.3% had a diagnosis of GDM. Gestational diabetes prevalence increased with neighborhood deprivation from 10.0% in the lowest Neighborhood Deprivation Index quintile to 12.7% in the highest quintile. Compared with pregnant individuals in the least deprived neighborhoods (quintile 1), pregnant individuals in quintiles 2-5 had elevated risk of GDM (relative risk [95% CI]) when adjusted for maternal age, parity, insurance type, and residential history (quintile 2, 1.17 [1.10-1.23]; quintile 3, 1.38 [1.30-1.46]; quintile 4, 1.54 [1.45-1.63]; quintile 5, 1.71 [1.62-1.82]). There was a dose-response relationship between relative risk of GDM and increasing quintile of neighborhood deprivation (P for trend <.001). Prepregnancy BMI mediated 45.8% (95% CI, 40.9-50.7%) of the association. Other potential mediators were found to mediate a small if not negligible proportion of this association (2.4-3.6%). CONCLUSION Neighborhood deprivation was associated with GDM, and a considerable proportion of this relationship was mediated by prepregnancy BMI.
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Affiliation(s)
- Emily F Liu
- Division of Research and the Department of Obstetrics and Gynecology, Kaiser Permanente of Northern California, Oakland, California
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Natour AK, Shepard A, Nypaver T, Weaver M, Peshkepija A, Kafri O, Kabbani L. Socioeconomic status is not associated with unfavorable outcomes in patients with acute limb ischemia. Vascular 2024; 32:118-125. [PMID: 36117451 DOI: 10.1177/17085381221124994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Whether socioeconomic status (SES) is associated with health outcomes in patients with acute limb ischemia (ALI) is largely unknown. We aimed to determine whether SES is associated with worse presentations and outcomes for patients with ALI. METHODS We performed a retrospective medical record review of patients who presented with ALI between April 2016 and October 2020 at a single tertiary care center. SES was quantified using individual variables (median household income, level of education, and employment) and a composite endpoint, the neighborhood deprivation index (NDI). The NDI is a standardized and reproducible index that uses census tract data (higher number indicates lower SES status). The NDI summarizes 8 domains of socioeconomic deprivation. ALI severity was categorized using the Rutherford classification. The association between SES and the severity of ALI at presentation and between SES and other health outcomes were analyzed using bivariate analysis of variance, independent t test, and multivariate logistic regression. RESULTS During the study period, 278 patients were treated for ALI, of whom 211 had complete SES data available. The mean age was 64 years, 55% were men, and 57% were White. The Rutherford classification of disease severity was grade 1, 2a, 2b, and 3 for 6%, 54%, 32%, and 8% of patients, respectively. Patients with a low SES status per the NDI were more likely to have a history of peripheral arterial disease and chronic kidney disease at presentation. The ALI etiology (thrombotic vs embolic) was not associated with SES. No significant differences were seen between SES and the severity of ALI at presentation (p = 0.96) or the treatment modality (p = 0.80). No associations between SES and 30-day or 1-year mortality were observed (mean NDI, 0.15 vs 0.26, p = 0.58, and 0.20 vs 0.26, p = 0.71, respectively) or between SES and 30-day or 1-year limb loss (mean NDI, 0.06 vs 0.30, p = 0.18, and 0.1 vs 0.32, p = 0.17, respectively). Lower SES (higher NDI) was associated with increased 30-day readmission (mean NDI, 0.49 vs 0.15, p = 0.021). However, this association was not significant on multivariate analysis (odds ratio 1.4, 95% CI 0.9-2.1, p = 0.06). CONCLUSIONS SES was not associated with the severity of ALI at patient presentation. Although SES was associated with the presence of peripheral arterial disease and chronic kidney disease at presentation, SES was not a predictor of short-term or 1-year limb loss and mortality. Overall, ALI presentation and treatment outcomes were independent of SES.
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Affiliation(s)
| | | | - Timothy Nypaver
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Mitchell Weaver
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Andi Peshkepija
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Omar Kafri
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Loay Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
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Ruther MH, Hsieh N. Explaining Health Disparities in the Sexual Minority Population: The Role of Neighborhood Effects. FAMILY & COMMUNITY HEALTH 2024; 47:49-58. [PMID: 37753939 DOI: 10.1097/fch.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Individual health is affected not only by characteristics and behaviors of the individual, but also by the environment in which the individual lives. Although neighborhood effects are well-established in the health literature, whether these effects are different for sexual minority populations is unknown. There is evidence that the neighborhoods in which sexual minorities reside are distinct from those in which heterosexuals reside, which could give rise to differential neighborhood effects. This research uses restricted data from the National Center for Health Statistics Research Data Center-which include neighborhood identifiers-to investigate health-relevant differences between the neighborhoods in which heterosexuals and sexual minorities reside. We also provide preliminary evidence on whether neighborhood effects explain any or all the disparities in health behaviors or health outcomes between sexual minority and heterosexual populations or mediate or moderate the effects of other covariates in explaining these disparities.
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Affiliation(s)
- Matthew H Ruther
- Department of Urban and Public Affairs, University of Louisville, Louisville, Kentucky (Dr Ruther); and Department of Sociology, Michigan State University, East Lansing (Dr Hsieh)
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Stansberry TT, Tran L, Myers C. Using Geographic Information Systems in health disparities research: Access to care considerations. Res Nurs Health 2023; 46:635-644. [PMID: 37840372 DOI: 10.1002/nur.22348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
In health disparities research, Geographic Information Systems (GIS) provide nurse researchers with powerful tools to incorporate spatial factors, such as access to care and related attributes like socioeconomic and environmental characteristics, into their studies. This article educates nurse scientists about GIS-based research benefits and considerations (focusing on access-to-care factors) and the influence of various access-to-care metrics on research outcomes. We present an overview of GIS in nursing and health disparities research, along with findings from our 2022 study examining access to care's relationship with county-level mortality rates in Tennessee, especially in areas where rural hospitals closed between 2010 and 2019. We highlight three distinct access-to-care measures (Euclidean distances and road network-based travel times based on county and census tract centroids), showcasing how different calculations impact our modeling results. Our results underscore the importance of understanding the choice of access-to-care metrics in GIS-based research to draw valid conclusions.
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Affiliation(s)
| | - Liem Tran
- Department of Geography, University of Tennessee, Knoxville, Tennessee, USA
| | - Carole Myers
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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Ahmed F, Lim R, Moseley I, Hoang M, Wisco O, Robinson-Bostom L, Qureshi A, Cho E. Neighborhood-Level Socioeconomic Predictors of Melanoma Thickness, Ulceration, and Metastasis at a Rhode Island Academic Center. J Invest Dermatol 2023; 143:2541-2546.e2. [PMID: 37406960 DOI: 10.1016/j.jid.2023.06.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Fadwa Ahmed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rachel Lim
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Isabelle Moseley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Megan Hoang
- Brown University, Providence, Rhode Island, USA
| | - Oliver Wisco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Meyer OL, Harrati A, Gavett BE, Farias ST, Whitmer RA, Widaman K, Hoang V, Tobias M, Mungas D. Effects of early-life environment and adulthood SES on cognitive change in a multiethnic cohort. J Int Neuropsychol Soc 2023; 29:742-750. [PMID: 36880230 PMCID: PMC10483016 DOI: 10.1017/s135561772200087x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Early-life socioeconomic status (SES) and adversity are associated with late-life cognition and risk of dementia. We examined the association between early-life SES and adversity and late-life cross-sectional cognitive outcomes as well as global cognitive decline, hypothesizing that adulthood SES would mediate these associations. METHODS Our sample (N = 837) was a racially and ethnically diverse cohort of non-Hispanic/Latino White (48%), Black (27%), and Hispanic/Latino (19%) participants from Northern California. Participant addresses were geocoded to the level of the census tract, and US Census Tract 2010 variables (e.g., percent with high school diploma) were extracted and combined to create a neighborhood SES composite. We used multilevel latent variable models to estimate early-life (e.g., parental education, whether participant ever went hungry) and adult (participant's education, main occupation) SES factors and their associations with cross-sectional and longitudinal cognitive outcomes of episodic memory, semantic memory, executive function, and spatial ability. RESULTS Child and adult factors were strongly related to domain-specific cognitive intercepts (0.20-0.48 SD per SD of SES factor); in contrast, SES factors were not related to global cognitive change (0.001-0.01 SD per year per SD of SES factor). Adulthood SES mediated a large percentage (68-75%) of the total early-life effect on cognition. CONCLUSIONS Early-life sociocontextual factors are more strongly associated with cross-sectional late-life cognitive performance compared to cognitive change; this effect is largely mediated through associations with adulthood SES.
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Affiliation(s)
- Oanh L. Meyer
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Amal Harrati
- Mathematica, 505 14th Street, Suite 800, Oakland, CA 94645, USA
| | - Brandon E. Gavett
- School of Psychological Science, University of Western Australia, 35 Stirling Highway (M304), Crawley WA 6009, Australia
| | - Sarah T. Farias
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California, Davis, Davis, CA 95616 USA
| | - Keith Widaman
- School of Education, University of California, Riverside, Riverside, CA 92521, USA
| | - Victoria Hoang
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Michele Tobias
- UC Davis DataLab, University of California, Davis, Davis, CA 95616 USA
| | - Dan Mungas
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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12
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Neo DT, Martin CL, Carmichael SL, Gucsavas-Calikoglu M, Conway KM, Evans SP, Feldkamp ML, Gilboa SM, Insaf TZ, Musfee FI, Shaw GM, Shumate C, Werler MM, Olshan AF, Desrosiers TA. Are individual-level risk factors for gastroschisis modified by neighborhood-level socioeconomic factors? Birth Defects Res 2023; 115:1438-1449. [PMID: 37439400 PMCID: PMC10527855 DOI: 10.1002/bdr2.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/18/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Two strong risk factors for gastroschisis are young maternal age (<20 years) and low/normal pre-pregnancy body mass index (BMI), yet the reasons remain unknown. We explored whether neighborhood-level socioeconomic position (nSEP) during pregnancy modified these associations. METHODS We analyzed data from 1269 gastroschisis cases and 10,217 controls in the National Birth Defects Prevention Study (1997-2011). To characterize nSEP, we applied the neighborhood deprivation index and used generalized estimating equations to calculate odds ratios and relative excess risk due to interaction. RESULTS Elevated odds of gastroschisis were consistently associated with young maternal age and low/normal BMI, regardless of nSEP. High-deprivation neighborhoods modified the association with young maternal age. Infants of young mothers in high-deprivation areas had lower odds of gastroschisis (adjusted odds ratio [aOR]: 3.1, 95% confidence interval [CI]: 2.6, 3.8) than young mothers in low-deprivation areas (aOR: 6.6; 95% CI: 4.6, 9.4). Mothers of low/normal BMI had approximately twice the odds of having an infant with gastroschisis compared to mothers with overweight/obese BMI, regardless of nSEP (aOR range: 1.5-2.3). CONCLUSION Our findings suggest nSEP modified the association between gastroschisis and maternal age, but not BMI. Further research could clarify whether the modification is due to unidentified biologic and/or non-biologic factors.
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Affiliation(s)
- Dayna T. Neo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chantel L. Martin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Suzan L. Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Muge Gucsavas-Calikoglu
- Department of Pediatrics, Division of Genetics and Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Shannon Pruitt Evans
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Eagle Global Scientific LLC, San Antonio, Texas, USA
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tabassum Z. Insaf
- Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Fadi I. Musfee
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little, Arkansas, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Charles Shumate
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, Texas, USA
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tania A. Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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Delong S. Urban health inequality in shifting environment: systematic review on the impact of gentrification on residents' health. Front Public Health 2023; 11:1154515. [PMID: 37546305 PMCID: PMC10399630 DOI: 10.3389/fpubh.2023.1154515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/09/2023] [Indexed: 08/08/2023] Open
Abstract
The impacts of changing neighborhoods, and the influence of neighborhood stability on residents' health have not received enough attention in the literature; one of the most important aspects is gentrification. Research on the impact of gentrification on residents' health has gradually increased in recent years, mainly from North America. Based on the guidelines of PRISMA 2020 and SCIE, 66 papers were included for analysis, six aspects of selected studies are discussed: the research design, theoretical framework, methods of analysis, definition and measurement of gentrification effects, and impact pathways. In general, most of the literature in this field can be seen as using an ecological research design, of which cross-sectional research accounts for a large proportion. The identified effects vary in their direction as well as strength due to difference in population, temporal, and geographical characteristics. Gentrification could affect health outcomes through the combination of economic, social, and physical environment factors. Existing research could be improved in the following aspects: (1) The definition and measurement of gentrification should be both generic and site-specific; Various measurement methods should be compared to enhance the robustness of the results. Furthermore, more consideration should be given to the impact of spatial issues; (2) As for health outcomes, it is suggested to expand the scope of the discussion of health outcomes and strengthen the biological explanation of the influencing mechanisms. It is also necessary to determine the research time points according to the characteristics of the incubation period of different diseases; (3) As for research design, applying longitudinal research design is more likely to improve the reliability; (4) Theoretical frameworks should be addressed to link the definition and measurement of gentrification, patterns of health outcomes, methodology and pathways.
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Affiliation(s)
- Sun Delong
- Key Laboratory of Ecology and Energy Saving Study of Dense Habitat, Ministry of Education, Shanghai, China
- School of Architecture, Tianjin University, Tianjin, China
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14
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Neo DT, Desrosiers TA, Martin CL, Carmichael SL, Gucsavas-Calikoglu M, Conway KM, Evans SP, Feldkamp ML, Gilboa SM, Insaf TZ, Musfee FI, Shaw GM, Shumate CJ, Werler MM, Olshan AF. Neighborhood-level Socioeconomic Position During Early Pregnancy and Risk of Gastroschisis. Epidemiology 2023; 34:576-588. [PMID: 36976718 PMCID: PMC10291502 DOI: 10.1097/ede.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Neighborhood-level socioeconomic position has been shown to influence birth outcomes, including selected birth defects. This study examines the un derstudied association between neighborhood-level socioeconomic position during early pregnancy and the risk of gastroschisis, an abdominal birth defect of increasing prevalence. METHODS We conducted a case-control study of 1,269 gastroschisis cases and 10,217 controls using data from the National Birth Defects Prevention Study (1997-2011). To characterize neighborhood-level socioeconomic position, we conducted a principal component analysis to construct two indices-Neighborhood Deprivation Index (NDI) and Neighborhood Socioeconomic Position Index (nSEPI). We created neighborhood-level indices using census socioeconomic indicators corresponding to census tracts associated with addresses where mothers lived the longest during the periconceptional period. We used generalized estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with multiple imputations for missing data and adjustment for maternal race-ethnicity, household income, education, birth year, and duration of residence. RESULTS Mothers residing in moderate (NDI Tertile 2 aOR = 1.23; 95% CI = 1.03, 1.48 and nSEPI Tertile 2 aOR = 1.24; 95% CI = 1.04, 1.49) or low socioeconomic neighborhoods (NDI Tertile 3 aOR = 1.28; 95% CI = 1.05, 1.55 and nSEPI Tertile 3 aOR = 1.32, 95% CI = 1.09, 1.61) were more likely to deliver an infant with gastroschisis compared with mothers residing in high socioeconomic neighborhoods. CONCLUSIONS Our findings suggest that lower neighborhood-level socioeconomic position during early pregnancy is associated with elevated odds of gastroschisis. Additional epidemiologic studies may aid in confirming this finding and evaluating potential mechanisms linking neighborhood-level socioeconomic factors and gastroschisis.
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Affiliation(s)
- Dayna T. Neo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tania A. Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Chantel L. Martin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Suzan L. Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Muge Gucsavas-Calikoglu
- Department of Pediatrics, Division of Genetics and Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristin M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA
| | - Shannon Pruitt Evans
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Eagle Global Scientific LLC, San Antonio, TX, USA
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tabassum Z. Insaf
- Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany, NY
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
| | - Fadi I. Musfee
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Helath, University of Arkansas for Medical Sciences, Little Risk, AR
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Charles J. Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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15
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Shi F, Zhang J, Zeng C, Sun X, Li Z, Yang X, Weissman S, Olatosi B, Li X. County-level variations in linkage to care among people newly diagnosed with HIV in South Carolina: A longitudinal analysis from 2010 to 2018. PLoS One 2023; 18:e0286497. [PMID: 37256896 DOI: 10.1371/journal.pone.0286497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Timely linkage to care (LTC) is key in the HIV care continuum, as it enables people newly diagnosed with HIV (PNWH) to benefit from HIV treatment at the earliest stage. Previous studies have found LTC disparities by individual factors, but data are limited beyond the individual level, especially at the county level. This study examined the temporal and geographic variations of county-level LTC status across 46 counties in South Carolina (SC) from 2010 to 2018 and the association of county-level characteristics with LTC status. METHODS All adults newly diagnosed with HIV from 2010 to 2018 in SC were included in this study. County-level LTC status was defined as 1 = "high LTC (≥ yearly national LTC percentage)" and 0 = "low LTC (< yearly national LTC percentage)". A generalized estimating equation model with stepwise selection was employed to examine the relationship between 29 county-level characteristics and LTC status. RESULTS The number of counties with high LTC in SC decreased from 34 to 21 from 2010 to 2018. In the generalized estimating equation model, six out of 29 factors were significantly associated with LTC status. Counties with a higher percentage of males (OR = 0.07, 95%CI: 0.02~0.29) and persons with at least four years of college (OR = 0.07, 95%CI: 0.02~0.34) were less likely to have high LTC. However, counties with more mental health centers per PNWH (OR = 45.09, 95%CI: 6.81~298.55) were more likely to have high LTC. CONCLUSIONS Factors associated with demographic characteristics and healthcare resources contributed to the variations of LTC status at the county level. Interventions targeting increasing the accessibility to mental health facilities could help improve LTC.
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Affiliation(s)
- Fanghui Shi
- South Carolina SmartState Center for Healthcare Quality, Columbia, South Carolina, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, Columbia, South Carolina, United States of America
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Columbia, South Carolina, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
| | - Xiaowen Sun
- South Carolina SmartState Center for Healthcare Quality, Columbia, South Carolina, United States of America
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Zhenlong Li
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
- Geoinformation and Big data Research Lab, Department of Geography, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, United States of America
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Columbia, South Carolina, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
| | - Sharon Weissman
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
- School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Columbia, South Carolina, United States of America
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
- Department of Health Services, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Columbia, South Carolina, United States of America
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, United States of America
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16
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Vagal A, Sucharew H, Wang LL, Kissela B, Alwell K, Haverbusch M, Woo D, Ferioli S, Mackey J, De Los Rios La Rosa F, Mistry EA, Demel SL, Coleman E, Jasne AS, Walsh K, Khatri P, Slavin S, Star M, Stephens C, Kleindorfer D. Trends in Disparities in Advanced Neuroimaging Utilization in Acute Stroke: A Population-Based Study. Stroke 2023; 54:1001-1008. [PMID: 36972349 DOI: 10.1161/strokeaha.122.040790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background:
Our primary objective was to evaluate if disparities in race, sex, age, and socioeconomic status (SES) exist in utilization of advanced neuroimaging in year 2015 in a population-based study. Our secondary objective was to identify the disparity trends and overall imaging utilization as compared with years 2005 and 2010.
Methods:
This was a retrospective, population-based study that utilized the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study) data. Patients with stroke and transient ischemic attack were identified in the years 2005, 2010, and 2015 in a metropolitan population of 1.3 million. The proportion of imaging use within 2 days of stroke/transient ischemic attack onset or hospital admission date was computed. SES determined by the percentage below the poverty level within a given respondent’s US census tract of residence was dichotomized. Multivariable logistic regression was used to determine the odds of advanced neuroimaging use (computed tomography angiogram/magnetic resonance imaging/magnetic resonance angiogram) for age, race, gender, and SES.
Results:
There was a total of 10 526 stroke/transient ischemic attack events in the combined study year periods of 2005, 2010, and 2015. The utilization of advanced imaging progressively increased (48% in 2005, 63% in 2010, and 75% in 2015 [
P
<0.001]). In the combined study year multivariable model, advanced imaging was associated with age and SES. Younger patients (≤55 years) were more likely to have advanced imaging compared with older patients (adjusted odds ratio, 1.85 [95% CI, 1.62–2.12];
P
<0.01), and low SES patients were less likely to have advanced imaging compared with high SES (adjusted odds ratio, 0.83 [95% CI, 0.75–0.93];
P
<0.01). A significant interaction was found between age and race. Stratified by age, the adjusted odds of advanced imaging were higher for Black patients compared with White patients among older patients (>55 years; adjusted odds ratio, 1.34 [95% CI, 1.15–1.57];
P
<0.01), but no racial differences among the young.
Conclusions:
Racial, age, and SES-related disparities exist in the utilization of advanced neuroimaging for patients with acute stroke. There was no evidence of a change in trend of these disparities between the study periods.
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Affiliation(s)
- Achala Vagal
- Department of Radiology (A.V., L.W., C.S.), University of Cincinnati Medical Center, OH
| | - Heidi Sucharew
- Department of Emergency Medicine (H.S.), University of Cincinnati Medical Center, OH
| | - Lily L Wang
- Department of Radiology (A.V., L.W., C.S.), University of Cincinnati Medical Center, OH
| | - Brett Kissela
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | - Kathleen Alwell
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | - Mary Haverbusch
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | - Daniel Woo
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | - Simona Ferioli
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | - Jason Mackey
- Indiana University School of Medicine, Indianapolis (J.M.)
| | | | - Eva A Mistry
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | - Stacie L Demel
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | | | | | - Kyle Walsh
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | - Pooja Khatri
- Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH
| | | | | | - Cody Stephens
- Department of Radiology (A.V., L.W., C.S.), University of Cincinnati Medical Center, OH
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17
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Neighborhood disparities and the burden of lead poisoning. Pediatr Res 2023:10.1038/s41390-023-02476-7. [PMID: 36899126 PMCID: PMC10000346 DOI: 10.1038/s41390-023-02476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 11/07/2022] [Accepted: 01/04/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND To assess the persistence of neighborhood-level lead poisoning disparities in Rhode Island. METHODS Rhode Island Department of Health blood lead levels (BLL) collected from 2006-2019 were linked to census block group rates of poverty and housing built pre-1950. We computed multivariate logistic regression models of elevated BLLs (≥5 µg/dL and ≥10 µg/dL). RESULTS Of the 197,384 study children, 12.9% had BLLs ≥5 µg/dL and 2.3% had BLLs ≥10 µg/dL. The proportion of children with BLL ≥ 5 µg/dL increased across quintiles of poverty and old housing. The odds ratio for highest quintiles was 1.44 (95% CI: 1.29, 1.60) and 1.92 (95% CI: 1.70, 2.17) for poverty and pre-1950 housing, respectively. A significant temporal decline was observed for BLL ≥ 5 µg/dL (2006: 20.5%, 2019: 3.6%). Disparities narrowed over the study period across quintiles of poverty and old housing with a similar trend appearing in the proportion of children with BLL ≥ 10 µg/dL. CONCLUSION Despite tremendous progress in reducing lead exposure, substantial neighborhood disparities in lead poisoning persist. These findings provide valuable considerations for primary childhood lead exposure prevention. IMPACT Through linkage of Rhode Island Department of Health childhood lead poisoning and census data, this study captures neighborhood-level disparities in lead poisoning from 2006-2019. This study demonstrates that the odds of lead poisoning increased in a stepwise fashion for neighborhood quintiles of poverty and housing built pre-1950. While the magnitude of lead poisoning disparities narrowed across quintiles of poverty and old housing, disparities persist. Children's exposure to sources of lead contamination continues to be an important public health concern. The burden of lead poisoning is not equally distributed among all children or communities.
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18
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Khan NU, Khan U, Khudadad U, Ali A, Raheem A, Waheed S, Razzak JA. Trends in mortality related to unintentional poisoning in the South Asian region from 1990 to 2019: analysis of data from the Global Burden of Disease Study. BMJ Open 2023; 13:e062744. [PMID: 36754559 PMCID: PMC9923325 DOI: 10.1136/bmjopen-2022-062744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE This study aimed to estimate the burden of unintentional poisoning in South Asian countries from 1999 to 2019. DESIGN An ecological study conducted at the regional level for South Asian countries, based on data from the Global Burden of Disease Study 2019. SETTING We extracted unintentional poisoning data from the Global Burden of Disease Study data set from 1990 to 2019 to assess trends in mortality, disability-adjusted life-years (DALYs), years of life lost, years lived with disability (YLDs) and causative agents in South Asian countries (Bangladesh, Bhutan, India, Nepal and Pakistan). OUTCOME MEASURES We determined the per cent change and 95% CI for the period between 1990 and 2019 by age, gender and country. We also conducted Poisson regression to measure the percentage change in the rate per year. RESULTS The absolute number of deaths due to unintentional poisoning in South Asia decreased (-32.6%) from 10 558 deaths in 1990 to 7112 deaths in 2019. The age standardised death rate from unintentional poisoning in South Asia has seen a downward trend (-55.88%), declining from 0.87 (0.67-1.01) age-standardised per 100 000 population in 1990 to 0.41 (0.34-0.47) in 2019. Among age groups, under 9 years and 10-19 years have seen downward trends for death and DALYs, accounting for -93.5% and -38.3%, respectively. YLDs have seen an upward trend (5.9%), increasing from 10 461.7 per 100 000 in 1990 to 11 084 per 100 000 in 2019. YLDs in women increased by 7.4%, from 11 558.2 per 100 000 to 12 418.3 per 100 000. The incidence rate ratios (IRRs) adjusted by all age groups and gender for DALYs in all South Asian countries has reduced significantly (IRR 0.97, 95% CI 0.96 to 0.97) from 1990 to 2019. CONCLUSION This study showed reduction in death and DALYs due to unintentional poisoning in South Asia except YLDs which is showing an increasing trend. Public health systems should continue efforts to minimise and prevent disabilities arising from unintentional poisoning in South Asia.
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Affiliation(s)
- Nadeem Ullah Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Uzma Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Umerdad Khudadad
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Asrar Ali
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Ahmed Raheem
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Shahan Waheed
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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19
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Vandentorren S, Brabant G, Spanjers L, Coudret S, Haidar S, Mondeilh A, Gault G, Comba M, Etchevers A. Activities at risk of lead exposure and lead poisoning in children of travellers' families in charente, France. Heliyon 2023; 9:e13056. [PMID: 36711280 PMCID: PMC9879783 DOI: 10.1016/j.heliyon.2023.e13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Background -A study to assess lead exposure of traveller children aged from 9 months to 18 years old was conducted in Charente-France between 2017 and 2019. Methods A face-to-face questionnaire was administered to each participating family (N = 78). Blood samples were collected, and in case of lead poisoning, an environmental survey of soil, dust and water samples was also performed. Results -Among the 100 children, they were 39 girls and 61 boys. Among them, 40 suffered from lead poisoning (Blood Lead Level ≥50 μg/L). Being a boy aged between 11 and 14 years old, and participating in lead exposure at-risk activities were significantly associated with higher mean blood lead level. Conclusion -The high levels of lead detected advocate the reinforcement of lead poisoning screening for all children in the traveller population.
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Affiliation(s)
- Stéphanie Vandentorren
- Santé Publique France, Paris, France,University of Bordeaux; Bordeaux Population Health, Inserm U1219, Bordeaux, France,Corresponding author.
| | - Gilles Brabant
- Santé Publique France, Paris, France,Fédération Nationale des Associations Solidaires D’action avec Les Tsiganes et Les Gens Du Voyage (FNASAT – Gens Du Voyage), Paris, France
| | - Lisbeth Spanjers
- Centre Social Le Chemin Du Hérisson, Terres-de-Haute-Charente, France
| | | | | | - Aude Mondeilh
- Fédération Nationale des Associations Solidaires D’action avec Les Tsiganes et Les Gens Du Voyage (FNASAT – Gens Du Voyage), Paris, France
| | | | - Marylène Comba
- ARS - Délégation Départementale de La Charente, Angoulême, France
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Moise IK, Piquero AR. Geographic disparities in violent crime during the COVID-19 lockdown in Miami-Dade County, Florida, 2018-2020. JOURNAL OF EXPERIMENTAL CRIMINOLOGY 2023; 19:97-106. [PMID: 34155439 PMCID: PMC8210521 DOI: 10.1007/s11292-021-09474-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVES This study uses two cluster detection techniques to identify clusters of violent crime during the 3 months of the 2020 COVID-19 lockdown in Miami-Dade County compared to that during an equivalent period in 2018 and 2019. METHODS Violent crime data from the Miami-Dade Central Records Bureau were analyzed. The Local Indicators of Spatial Association statistics and a space-time permutation statistic were used to identify clusters of violent crimes and outliers, and Global Moran's I tool was used to assess spatial patterning in violent crime. Neighborhood disadvantage data were obtained from the American Community Survey 5-year estimates linked with arrest locations. RESULTS Violent crime arrests fell by 7.1% in 2020. Arrests were concentrated in predominantly Black disadvantaged neighborhoods in the northern part, and similar results were produced for core clusters by the two cluster techniques with positive global Moran's I for all study years. Although accounting for only 17% of the county population, nearly half of violent crime arrests were for Black or African American. Males comprised most violent crime arrests. CONCLUSIONS Crime prevention and intervention efforts should be focused on both high-risk places and offenders.
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Affiliation(s)
- Imelda K. Moise
- Department of Geography and Regional Studies, University of Miami, 1300 Campo Sano Ave, Coral Gables, FL 33124 USA
| | - Alex R. Piquero
- Department of Sociology, University of Miami, 5202 University Drive, Coral Gables, FL 33124 USA
- Criminology, Monash University, Melbourne, Australia
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Abstract
BACKGROUND Firearm ownership is strongly related to suicide risk, yet little is known about how much risk declines when ownership ends ("divestment"). METHODS Using data from 523,182 handgun owners, we estimated the effect of divesting and remaining divested versus never divesting on the risk of suicide and firearm-specific suicide. We used pooled logistic regression with inverse probability weighting, adjusting for demographic and area-level measures. RESULTS The 5-year risk of suicide death was 25.6 (95% confidence interval [CI] = 15.1, 37.2) per 10,000 persons with divestment and 15.2 (95% CI = 13.2, 17.3) per 10,000 persons with no divestment, corresponding to a risk difference of 10.4 (95% CI = 0.7, 21.1) per 10,000 persons. The 5-year risk of firearm-specific suicide death was 6.3 (95% CI = 1.4, 11.9) per 10,000 persons with divestment and 12.9 (95% CI = 11.0, 14.6) per 10,000 persons with no divestment, corresponding to a risk difference of -6.6 (95% CI = -11.4, -0.1) per 10,000 persons. Comparing divestment to no divestment, risks were elevated for deaths due to other causes proposed as negative control outcomes; we incorporated these estimates into a series of bias derivations to better understand the magnitude of unmeasured confounding. CONCLUSIONS Collectively, these estimates suggest that divestment reduces firearm suicide risk by 50% or more and likely reduces overall suicide risk as well, although future data collection is needed to fully understand the extent of biases such as unmeasured confounding.
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22
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Oka M. Census-Tract-Level Median Household Income and Median Family Income Estimates: A Unidimensional Measure of Neighborhood Socioeconomic Status? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:211. [PMID: 36612534 PMCID: PMC9819545 DOI: 10.3390/ijerph20010211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Previous studies suggested either census-tract-level median household income (MHI) or median family income (MFI) estimates may be used as a unidimensional measure of neighborhood socioeconomic status (SES) in the United States (US). To better understand its general use, the purpose of this study was to assess the usefulness of MHI and MFI in a wide range of geographic areas. Area-based socioeconomic data at the census tract level were obtained from the 2000 Census as well as the 2005-2009, 2010-2014, and 2015-2019 American Community Survey. MHI and MFI were used as two simple measures of neighborhood SES. Based on the five area-based indexes developed in the US, several census-tract-level socioeconomic indicators were used to derive five composite measures of neighborhood SES. Then, a series of correlation analyses was conducted to assess the relationships between these seven measures in the State of California and its seven Metropolitan Statistical Areas. Two simple measures were very strongly and positively correlated with one another, and were also strongly or very strongly correlated, either positively or negatively, with five composite measures. Hence, the results of this study support an analytical thinking that simple measures and composite measures may capture the same dimension of neighborhood SES in different geographic areas.
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Affiliation(s)
- Masayoshi Oka
- Department of Management, Faculty of Management, Josai University, Sakado 350-0295, Japan
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23
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Kim U, Koroukian SM, Stange KC, Spilsbury JC, Dong W, Rose J. Describing and assessing a new method of approximating categorical individual-level income using community-level income from the census (weighting by income probabilities). Health Serv Res 2022; 57:1348-1360. [PMID: 35832029 PMCID: PMC9643096 DOI: 10.1111/1475-6773.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess a new approach (weighting by "income probabilities [IP]") that uses US Census data from the patients' communities to approximate individual-level income, an important but often missing variable in health services research. DATA SOURCES Community (census tract level) income data came from the 2017 5-year American Community Survey (ACS). The patient data included those diagnosed with cancer in 2017 in Ohio (n = 65,759). The reference population was the 2017 5-year ACS Public Use Microdata Sample (n = 564,357 generalizing to 11,288,350 Ohioans). STUDY DESIGN/METHODS We applied the traditional approach of income approximation using median census tract income along with two IP based approaches to estimate the proportions in the patient data with incomes of 0%-149%, 150%-299%, 300%-499%, and 500%+ of the federal poverty level (FPL) ("class-relevant income grouping") or 0%-138%, 139%-249%, 250%-399%, and 400%+ FPL ("policy-relevant income grouping"). These estimated income distributions were then compared with the known income distributions of the reference population. DATA COLLECTION/EXTRACTION METHODS The patient data came from Ohio's cancer registry. The other data were publicly available. PRINCIPAL FINDINGS Both IP based approaches consistently outperformed the traditional approach overall and in subgroup analyses, as measured by the weighted average absolute percentage point differences between the proportions of each of the income categories of the reference population and the estimated proportions generated by the income approximation approaches ("average percent difference," or APD). The smallest APD for an IP based method, 0.5%, was seen in non-Hispanic White females in the class-relevant income grouping (compared with 16.5% for the conventional method), while the largest APD, 7.1%, was seen in non-Hispanic Black females in the policy-relevant income grouping (compared with 18.0% for the conventional method). CONCLUSIONS Weighting by IP substantially outperformed the conventional approach of estimating the distribution of incomes in patient data.
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Affiliation(s)
- Uriel Kim
- Center for Community Health IntegrationCase Western Reserve University School of MedicineClevelandOhioUSA
- Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA
- Kellogg School of ManagementNorthwestern UniversityEvanstonILUSA
| | - Siran M. Koroukian
- Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA
- Population Cancer Analytics Shared ResourceCase Comprehensive Cancer CenterClevelandOhioUSA
| | - Kurt C. Stange
- Center for Community Health IntegrationCase Western Reserve University School of MedicineClevelandOhioUSA
| | - James C. Spilsbury
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Weichuan Dong
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA
- Population Cancer Analytics Shared ResourceCase Comprehensive Cancer CenterClevelandOhioUSA
| | - Johnie Rose
- Center for Community Health IntegrationCase Western Reserve University School of MedicineClevelandOhioUSA
- Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA
- Population Cancer Analytics Shared ResourceCase Comprehensive Cancer CenterClevelandOhioUSA
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Zhu J, Lois AW, Gitonga B, Chen-Meekin JY, Williams EJ, Khandelwal S, Carrera Ceron R, Oelschlager BK, Wright AS. The impact of socioeconomic status on telemedicine utilization during the COVID-19 pandemic among surgical clinics at an academic tertiary care center. Surg Endosc 2022; 36:9304-9312. [PMID: 35332387 PMCID: PMC8945866 DOI: 10.1007/s00464-022-09186-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused many surgical providers to conduct outpatient evaluations using remote audiovisual conferencing technology (i.e., telemedicine) for the first time in 2020. We describe our year-long institutional experience with telemedicine in several general surgery clinics at an academic tertiary care center and examine the relationship between area-based socioeconomic measures and the likelihood of telemedicine participation. METHODS We performed a retrospective review of our outpatient telemedicine utilization among four subspecialty clinics (including two acute care and two elective surgery clinics). Geocoding was used to link patient visit data to area-based socioeconomic measures and a multivariable analysis was performed to examine the relationship between socioeconomic indicators and patient participation in telemedicine. RESULTS While total outpatient visits per month reached a nadir in April 2020 (65% decrease in patient visits when compared to January 2020), there was a sharp increase in telemedicine utilization during the same month (38% of all visits compared to 0.8% of all visits in the month prior). Higher rates of telemedicine utilization were observed in the two elective surgery clinics (61% and 54%) compared to the two acute care surgery clinics (14% and 9%). A multivariable analysis demonstrated a borderline-significant linear trend (p = 0.07) between decreasing socioeconomic status and decreasing odds of telemedicine participation among elective surgery visits. A sensitivity analysis to examine the reliability of this trend showed similar results. CONCLUSION Telemedicine has many patient-centered benefits, and this study demonstrates that for certain elective subspecialty clinics, telemedicine may be utilized as the preferred method for surgical consultations. However, to ensure the equitable adoption and advancement of telemedicine services, healthcare providers will need to focus on mitigating the socioeconomic barriers to telemedicine participation.
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Affiliation(s)
- Jay Zhu
- Department of Surgery, University of New Mexico School of Medicine, MSC10 5610, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Alex W Lois
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Baraka Gitonga
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Judy Y Chen-Meekin
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Estell J Williams
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Saurabh Khandelwal
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Rocio Carrera Ceron
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Brant K Oelschlager
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Andrew S Wright
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
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25
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Moussaoui S, Chauvin P, Ibanez G, Soler M, Nael V, Morgand C, Robert S. Construction and Validation of an Individual Deprivation Index: a Study Based on a Representative Cohort of the Paris Metropolitan Area. J Urban Health 2022; 99:1170-1182. [PMID: 35653078 PMCID: PMC9161768 DOI: 10.1007/s11524-022-00648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 12/31/2022]
Abstract
The association between health status and deprivation is well established. However, it is difficult to measure deprivation at an individual level and already-existing indices in France are not validated or do not meet the needs of health practitioners. The aim of this work was to establish a validated, easy-to-use, multidimensional, relevant index that was representative of the population in the Paris metropolitan area. From the SIRS 2010 cohort study, 14 socio-economic characteristics were selected: health insurance, educational background, socio-professional category, professional status, feelings of loneliness, emotional situation, household type, income, perceived financial situation, social support (support in daily life, financial and emotional), housing situation, and migration origin. In addition, a total of 12 health status, healthcare use, and nutrition-related variables were also selected. Content validity and internal validity of the index were explored. The 14 socio-economic indicators were associated to varying degrees with poorer health status, less use of healthcare, and poorer nutrition and were distributed across the 14 multiple-choice questions of the index. Each answer was rated from 0 to 2. The index value of 10 that isolates 20% of the most deprived individuals was used as threshold. "Being deprived," as defined with this value, was significantly associated with 9 of the 12 studied health variables. This index could be a relevant instrument in the assessment of deprivation and social inequalities of health.
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Affiliation(s)
- Sohela Moussaoui
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France.
- Sorbonne Université, Faculty of Medicine Pierre et Marie Curie, Department of Education and Research in General Medicine, F75012, Paris, France.
| | - Pierre Chauvin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France
| | - Gladys Ibanez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France
- Sorbonne Université, Faculty of Medicine Pierre et Marie Curie, Department of Education and Research in General Medicine, F75012, Paris, France
| | - Marion Soler
- University Hospital of Montpellier, 191 Av. du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Virginie Nael
- Bordeaux University, 146 Rue Léo Saignat, 33076, Bordeaux, France
| | - Claire Morgand
- Inserm UMRS 1137, Paris, France
- Evaluation Department and Tools for Quality and Safety of Care, French National Authority for health, Saint Denis, France
| | - Sarah Robert
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France
- Sorbonne Université, Faculty of Medicine Pierre et Marie Curie, Department of Education and Research in General Medicine, F75012, Paris, France
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26
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Improving our estimates: assessing misclassification of abortion accessibility in the United States. Ann Epidemiol 2022; 76:98-107. [DOI: 10.1016/j.annepidem.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
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Reilly EB, Dickerson KL, Pierce LJ, Leppänen J, Valdes V, Gharib A, Thompson BL, Schlueter LJ, Levitt P, Nelson CA. Maternal stress and development of infant attention to threat-related facial expressions. Dev Psychobiol 2022; 64:e22332. [PMID: 36282765 PMCID: PMC11071158 DOI: 10.1002/dev.22332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023]
Abstract
Attentional biases to threat-related stimuli, such as fearful and angry facial expressions, are important to survival and emerge early in development. Infants demonstrate an attentional bias to fearful facial expressions by 5-7 months of age and an attentional bias toward anger by 3 years of age that are modulated by experiential factors. In a longitudinal study of 87 mother-infant dyads from families predominantly experiencing low income, we examined whether maternal stress and depressive symptoms were associated with trajectories of attentional biases to threat, assessed during an attention disengagement eye-tracking task when infants were 6-, 9-, and 12-month old. By 9 months, infants demonstrated a generalized bias toward threat (both fearful and angry facial expressions). Maternal perceived stress was associated with the trajectory of the bias toward angry facial expressions between 6 and 12 months. Specifically, infants of mothers with higher perceived stress exhibited a greater bias toward angry facial expressions at 6 months that decreased across the next 6 months, compared to infants of mothers with lower perceived stress who displayed an increased bias to angry facial expressions over this age range. Maternal depressive symptoms and stressful life events were not associated with trajectories of infant attentional bias to anger or fear. These findings highlight the role of maternal perceptions of stress in shaping developmental trajectories of threat-alerting systems.
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Affiliation(s)
- Emily B. Reilly
- Institute of Child Development, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Kelli L. Dickerson
- Department of Pediatrics, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lara J. Pierce
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Jukka Leppänen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Viviane Valdes
- Department of Pediatrics, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Alma Gharib
- Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Barbara L. Thompson
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Lisa J. Schlueter
- Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Pat Levitt
- Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Charles A. Nelson
- Department of Pediatrics, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
- Harvard Center on the Developing Child, Cambridge, Massachusetts, USA
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28
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Sathi NJ, Ahammed B, Alam K, Hashmi R, Lee KY, Keramat SA. Socioeconomic inequalities in low birth weight in South Asia: A comparative analysis using Demographic and Health Surveys. SSM Popul Health 2022; 20:101248. [PMID: 36281248 PMCID: PMC9587321 DOI: 10.1016/j.ssmph.2022.101248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022] Open
Abstract
Background Low Birth Weight (LBW) continues to be a prominent universal cause of various short- and long-term health hazards throughout infancy and adulthood. However, no study has revealed the socioeconomic inequalities in LBW among South Asian countries. This study assesses the socioeconomic inequalities among under-five South Asian children with LBW. Methods Secondary data were derived from six (Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan) nationally representative South Asian Demographic and Health Surveys conducted between 2015 and 2021, and included 170,547 under-five years of age children. The study employed the concentration curve and concentration index to assess the socioeconomic inequalities of those with LBW. Additionally, mixed-effect logistic regression was applied to determine the factors associated with LBW. Results A significant negative concentration index indicates the wealth-related and education-related inequalities of LBW among under-five South Asian children. LBW is highly concentrated in the socio-economically poor section of the society. Our study found statistically significant negative concentration index in all South Asian countries: Afghanistan (Education: -0.108), Bangladesh (wealth: -0.070 & education: -0.083), India (wealth: -0.059 & education: -0.052), Nepal (by wealth: -0.064 & by education: -0.080), and Pakistan (by wealth: -0.080 & by education: -0.095). Findings from the mixed-effects logistic regression model also show that children from the poorest quintiles (AOR: 1.53, 95% CI: 1.41-1.67) and illiterate mothers (AOR: 1.39, 95% CI: 1.29-1.51) had higher odds of being afflicted with LBW compared to the wealthiest quintiles and educated mothers respectively. Women's pregnancy assessments, such as antenatal care utilisation, iron supplementation intake, and normal delivery mode, are significantly correlated with decreased odds of children's LBW. Conclusion There exists a strong association between LBW cases and socioeconomic inequalities among South-Asian children below five years of age. This indicates the urgent need for health education and prenatal care services for women from Afghanistan, Bangladesh, India, Nepal, and Pakistan, especially those with lower socioeconomic status.
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Affiliation(s)
- Nusrat Jahan Sathi
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, 9208, Bangladesh
| | - Benojir Ahammed
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, 9208, Bangladesh
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia,Centre for Health Research, University of Southern Queensland, Australia
| | - Rubayyat Hashmi
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia,Centre for Health Research, University of Southern Queensland, Australia,QUT Business School, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden,Corresponding author.
| | - Syed Afroz Keramat
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia,Centre for Health Research, University of Southern Queensland, Australia,Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh,Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Australia
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Fareed N, Singh P, Jonnalagadda P, Swoboda C, Odden C, Doogan N. Construction of the Ohio Children's Opportunity Index. Front Public Health 2022; 10:734105. [PMID: 35942261 PMCID: PMC9356199 DOI: 10.3389/fpubh.2022.734105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To describe the development of an area-level measure of children's opportunity, the Ohio Children's Opportunity Index (OCOI). Data Sources/Study Setting Secondary data were collected from US census based-American Community Survey (ACS), US Environmental Protection Agency, US Housing and Urban Development, Ohio Vital Statistics, US Department of Agriculture-Economic Research Service, Ohio State University Center for Urban and Regional Analysis, Ohio Incident Based Reporting System, IPUMS National Historical Geographic Information System, and Ohio Department of Medicaid. Data were aggregated to census tracts across two time periods. Study Design OCOI domains were selected based on existing literature, which included family stability, infant health, children's health, access, education, housing, environment, and criminal justice domains. The composite index was developed using an equal weighting approach. Validation analyses were conducted between OCOI and health and race-related outcomes, and a national index. Principal Findings Composite OCOI scores ranged from 0–100 with an average value of 74.82 (SD, 17.00). Census tracts in the major metropolitan cities across Ohio represented 76% of the total census tracts in the least advantaged OCOI septile. OCOI served as a significant predictor of health and race-related outcomes. Specifically, the average life expectancy at birth of children born in the most advantaged septile was approximately 9 years more than those born in least advantaged septile. Increases in OCOI were associated with decreases in proportion of Black (48 points lower in the most advantaged vs. least advantaged septile), p < 0.001) and Minority populations (54 points lower in most advantaged vs. least advantaged septile, p < 0.001). We found R-squared values > 0.50 between the OCOI and the national Child Opportunity Index scores. Temporally, OCOI decreased by 1% between the two study periods, explained mainly by decreases in the children health, accessibility and environmental domains. Conclusion As the first opportunity index developed for children in Ohio, the OCOI is a valuable resource for policy reform, especially related to health disparities and health equity. Health care providers will be able to use it to obtain holistic views on their patients and implement interventions that can tackle barriers to childhood development using a more tailored approach.
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Affiliation(s)
- Naleef Fareed
- CATALYST—The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University Institute for Behavioral Medicine Research, Columbus, OH, United States
- Department of Biomedical Informatics, College of Medicine, The Ohio State University Institute for Behavioral Medicine Research, Columbus, OH, United States
- *Correspondence: Naleef Fareed
| | - Priti Singh
- CATALYST—The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University Institute for Behavioral Medicine Research, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- CATALYST—The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University Institute for Behavioral Medicine Research, Columbus, OH, United States
| | - Christine Swoboda
- CATALYST—The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University Institute for Behavioral Medicine Research, Columbus, OH, United States
- Department of Family Medicine, College of Medicine, The Ohio State University Institute for Behavioral Medicine Research, Columbus, OH, United States
| | - Colin Odden
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Nathan Doogan
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, OH, United States
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Sutton TL, Koprowski MA, Gold JA, Liu B, Grossblatt-Wait A, Macuiba C, Lehman A, Hedlund S, Rocha FG, Brody JR, Sheppard BC. Disparities in Electronic Screening for Cancer-Related Psychosocial Distress May Promote Systemic Barriers to Quality Oncologic Care. J Natl Compr Canc Netw 2022; 20:765-773.e4. [PMID: 35830889 DOI: 10.6004/jnccn.2022.7015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/25/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Screening for cancer-related psychosocial distress is an integral yet laborious component of quality oncologic care. Automated preappointment screening through online patient portals (Portal, MyChart) is efficient compared with paper-based screening, but unstudied. We hypothesized that patient access to and engagement with EHR-based screening would positively correlate with factors associated with digital literacy (eg, age, socioeconomic status). METHODS Screening-eligible oncology patients seen at our Comprehensive Cancer Center from 2014 through 2019 were identified. Patients with active Portals were offered distress screening. Portal and screening participation were analyzed via multivariable logistic regression. Household income in US dollars and educational attainment were estimated utilizing zip code and census data. RESULTS Of 17,982 patients, 10,279 (57%) had active Portals and were offered distress screening. On multivariable analysis, older age (odds ratio [OR], 0.97/year; P<.001); male gender (OR, 0.89; P<.001); Black (OR, 0.47; P<.001), Hawaiian/Pacific Islander (OR, 1.54; P=.007), and Native American/Alaskan Native race (OR, 0.67; P=.04); Hispanic ethnicity (OR, 0.76; P<.001); and Medicare (OR, 0.59; P<.001), Veteran's Affairs/military (OR, 0.09; P<.01), Medicaid (OR, 0.34; P<.001), or no insurance coverage (OR, 0.57; P<.001) were independently associated with lower odds of being offered distress screening; increasing income (OR, 1.05/$10,000; P<.001) and educational attainment (OR, 1.03/percent likelihood of bachelor's degree or higher; P<.001) were independently associated with higher odds. In patients offered electronic screening, participation rate was 36.6% (n=3,758). Higher educational attainment (OR, 1.01; P=.03) was independently associated with participation, whereas Black race (OR, 0.58; P=.004), Hispanic ethnicity (OR, 0.68; P=.01), non-English primary language (OR, 0.67; P=.03), and Medicaid insurance (OR, 0.78; P<.001) were independently associated with nonparticipation. CONCLUSIONS Electronic portal-based screening for cancer-related psychosocial distress leads to underscreening of vulnerable populations. At institutions using electronic distress screening workflows, supplemental screening for patients unable or unwilling to engage with electronic screening is recommended to ensure efficient yet equal-opportunity distress screening.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Flavio G Rocha
- 4Knight Cancer Institute.,5Division of Surgical Oncology, Department of Surgery, and
| | - Jonathan R Brody
- 1Department of Surgery.,6Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, Oregon
| | - Brett C Sheppard
- 1Department of Surgery.,6Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, Oregon
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Kamai EM, Daniels JL, Delamater PL, Lanphear BP, MacDonald Gibson J, Richardson DB. Patterns of Children's Blood Lead Screening and Blood Lead Levels in North Carolina, 2011-2018-Who Is Tested, Who Is Missed? ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:67002. [PMID: 35647633 PMCID: PMC9158533 DOI: 10.1289/ehp10335] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND No safe level of lead in blood has been identified. Blood lead testing is required for children on Medicaid, but it is at the discretion of providers and parents for others. Elevated blood lead levels (EBLLs) cannot be identified in children who are not tested. OBJECTIVES The aims of this research were to identify determinants of lead testing and EBLLs among North Carolina children and estimate the number of additional children with EBLLs among those not tested. METHODS We linked geocoded North Carolina birth certificates from 2011-2016 to 2010 U.S. Census data and North Carolina blood lead test results from 2011-2018. We estimated the probability of being screened for lead and created inverse probability (IP) of testing weights. We evaluated the risk of an EBLL of ≥3μg/dL at <30 months of age, conditional on characteristics at birth, using generalized linear models and then applied IP weights to account for missing blood lead results among unscreened children. We estimated the number of additional children with EBLLs of all North Carolina children using the IP-weighted population and bootstrapping to produce 95% credible intervals (CrI). RESULTS Mothers of the 63.5% of children (402,002 of 633,159) linked to a blood lead test result were disproportionately young, Hispanic, Black, American Indian, or on Medicaid. In full models, maternal age ≤20y [risk ratio (RR)=1.10; 95% confidence interval (CI): 1.13, 1.20] or smoking (RR=1.14; 95% CI: 1.12, 1.17); proximity to a major roadway (RR=1.10; 95% CI: 1.05, 1.15); proximity to a lead-releasing Toxics Release Inventory site (RR=1.08; 95% CI: 1.03, 1.14) or a National Emissions Inventory site (RR=1.11; 95% CI: 1.07, 1.14); and living in neighborhoods with more housing built before 1950 (RR=1.10; 95% CI: 1.05, 1.14) or before 1940 (RR=1.18; 95% CI: 1.11, 1.25) or more vacant housing (RR=1.14; 95% CI: 1.11, 1.17) were associated with an increased risk of EBLL, whereas overlap with a public water service system was associated with a decreased risk of EBLL (RR=0.85; 95% CI: 0.83, 0.87). Children of Black mothers were no more likely than children of White mothers to have EBLLs (RR=0.98; 95% CI: 0.96, 1.01). Complete blood lead screening in 2011-2018 may have identified an additional 17,543 (95% CrI: 17,462, 17,650) children with EBLLs ≥3μg/dL. DISCUSSION Our results indicate that current North Carolina lead screening strategies fail to identify over 30% (17,543 of 57,398) of children with subclinical lead poisoning and that accounting for characteristics at birth alters the conclusions about racial disparities in children's EBLLs. https://doi.org/10.1289/EHP10335.
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Affiliation(s)
- Elizabeth M. Kamai
- Department of Epidemiology, University of North Carolina at Chapel Hill (UNC-Chapel Hill), Chapel Hill, North Carolina, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Julie L. Daniels
- Department of Epidemiology, University of North Carolina at Chapel Hill (UNC-Chapel Hill), Chapel Hill, North Carolina, USA
- Department of Maternal and Child Health, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul L. Delamater
- Department of Geography, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, UNC-Chapel Hill, North Carolina, USA
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - David B. Richardson
- Department of Environmental and Occupational Health, University of California, Irvine, California, USA
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Sociodemographic and Geographic Disparities in Obstetrical Ultrasound Imaging Utilization: A Population-based Study. Acad Radiol 2022; 29:650-662. [PMID: 34452819 DOI: 10.1016/j.acra.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 07/10/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES Obstetrical ultrasound imaging is an important part of prenatal care, though not all patients have readily available access to ultrasound services. This study aimed to assess the association between sociodemographic and geographic factors and (1) having a second trimester complete obstetrical ultrasound and (2) overall obstetrical ultrasound utilization. METHODS All pregnancies and obstetrical ultrasound exams billed from 2014-2018 in Saskatchewan, Canada were identified from province-wide databases. Generalized estimating equation (GEE) models with binomial and Poisson distributions were used to identify factors associated with having a second trimester ultrasound and overall obstetrical ultrasound utilization, respectively. RESULTS 80,536 pregnancies from 57,881 individuals were included. Of 57,186 pregnancies carried to ≥23 weeks, a second trimester ultrasound was performed in 50,180 (87.7%). Patients living in rural areas (adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.63-0.77; p <0.0001), remote areas (aOR, 0.35 for greatest vs. least remoteness level; 95% CI, 0.32-0.39; p <0.0001), and status First Nations individuals (aOR, 0.50; 95% CI, 0.46-0.53; p <0.0001) were less likely to have a second trimester ultrasound. Patients living in higher income neighbourhoods (aOR, 1.86 for highest vs. lowest quintile; 95% CI, 1.62-2.13; p <0.0001) were more likely to have a second trimester ultrasound. GEE Poisson regression analysis demonstrated these same factors, except rural residence, were associated with overall obstetrical ultrasound utilization. CONCLUSION Substantial disparities in obstetrical ultrasound utilization exist among patients in remote geographic areas, Indigenous peoples, and patients in low income neighbourhoods. Addressing barriers which these demographic groups face in accessing ultrasound imaging is critical to ensure health equity.
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Powell WR, Hansmann KJ, Carlson A, Kind AJ. Evaluating How Safety-Net Hospitals Are Identified: Systematic Review and Recommendations. Health Equity 2022; 6:298-306. [PMID: 35557553 PMCID: PMC9081065 DOI: 10.1089/heq.2021.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
Objective: To systematically review how safety-net hospitals' status is identified and defined, discuss current definitions' limitations, and provide recommendations for a new classification and evaluation framework. Data Sources: Safety-net hospital-related studies in the MEDLINE database published before May 16, 2019. Study Design: Systematic review of the literature that adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data Collection/Extraction Methods: We followed standard selection protocol, whereby studies went through an abstract review followed by a full-text screening for eligibility. For each included study, we extracted information about the identification method itself, including the operational definition, the dimension(s) of disadvantage reflected, study objective, and how safety-net status was evaluated. Principal Findings: Our review identified 132 studies investigating safety-net hospitals. Analysis of identification methodologies revealed substantial heterogeneity in the ways disadvantage is defined, measured, and summarized at the hospital level, despite a 4.5-fold increase in studies investigating safety-net hospitals for the past decade. Definitions often exclusively used low-income proxies captured within existing health system data, rarely incorporated external social risk factor measures, and were commonly separated into distinct safety-net status categories when analyzed. Conclusions: Consistency in research and improvement in policy both require a standard definition for identifying safety-net hospitals. Yet no standardized definition of safety-net hospitals is endorsed and existing definitions have key limitations. Moving forward, approaches rooted in health equity theory can provide a more holistic framework for evaluating disadvantage at the hospital level. Furthermore, advancements in precision public health technologies make it easier to incorporate detailed neighborhood-level social determinants of health metrics into multidimensional definitions. Other countries, including the United Kingdom and New Zealand, have used similar methods of identifying social need to determine more accurate assessments of hospital performance and the development of policies and targeted programs for improving outcomes.
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Affiliation(s)
- W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kellia J. Hansmann
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew Carlson
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy J.H. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Social vulnerability is associated with increased morbidity following colorectal surgery. Am J Surg 2022; 224:100-105. [DOI: 10.1016/j.amjsurg.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
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Wiese D, Lynch SM, Stroup AM, Maiti A, Harris G, Vucetic S, Henry KA. Examining socio-spatial mobility patterns among colon cancer patients after diagnosis. SSM Popul Health 2022; 17:101023. [PMID: 35097183 PMCID: PMC8783098 DOI: 10.1016/j.ssmph.2022.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022] Open
Abstract
Given the growing number of cancer survivors, it is important to better understand socio-spatial mobility patterns of cancer patients after diagnosis that could have public health implications regarding post-diagnostic access to care for treatment and follow-up surveillance. In this exploratory study, residential histories from LexisNexis were linked to New Jersey colon cancer cases diagnosed from 2006 to 2011 to examine differences in socio-spatial mobility patterns after diagnosis by stage at cancer diagnosis, sex, and race/ethnicity. For the colon cancer cases, we summarized and compared the number of residences and changes in the residential census tract and neighborhood poverty after the diagnosis. We found only minor changes in neighborhood poverty among the cases during the follow-up period after diagnosis. During the follow-up period of up to 10 years after diagnosis, 67% of the patients did not move to a different residential census tract, and 10.8% moved from New Jersey to another state. Cases that moved to a different census tract changed after diagnosis were generally less wealthy than non-movers, but the destination of relocation varied by race/ethnicity and socioeconomic status. We also found a significant association between residential mobility and stage at diagnosis, whereby patients diagnosed with colon cancer at an early stage were more likely to be movers. This study contributes to understanding of the socio-spatial mobility patterns in colon cancer patients and may help to inform cancer research by summarizing the extent to which colon cancer patients move after diagnosis. Post-diagnosis socio-spatial mobility is relatively low among colon cancer patients. Post-diagnosis, ∼67% of all colon cancer patients in NJ did not change residence. Movers spent more time living in high-poverty neighborhoods than non-movers. Approximately 10% of all patients left New Jersey for other states. Geographic destinations vary by race/ethnicity and socioeconomic status.
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CURTIS DAVIDS, FULLER‐ROWELL THOMASE, CARLSON DANIELL, WEN MING, KRAMER MICHAELR. Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers. Milbank Q 2022; 100:38-77. [PMID: 34609027 PMCID: PMC8932634 DOI: 10.1111/1468-0009.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted. CONTEXT Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators. METHODS Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality. FINDINGS An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities. CONCLUSIONS Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.
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Affiliation(s)
| | | | | | - MING WEN
- University of UtahSalt Lake City
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37
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Liu EF, Rubinsky AD, Pacca L, Mujahid M, Fontil V, DeRouen MC, Fields J, Bibbins-Domingo K, Lyles CR. Examining Neighborhood Socioeconomic Status as a Mediator of Racial/Ethnic Disparities in Hypertension Control Across Two San Francisco Health Systems. Circ Cardiovasc Qual Outcomes 2022; 15:e008256. [PMID: 35098728 PMCID: PMC8847331 DOI: 10.1161/circoutcomes.121.008256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A contextual understanding of hypertension control can inform population health management strategies to mitigate cardiovascular disease events. This retrospective cohort study links neighborhood-level data with patients' health records to describe racial/ethnic differences in uncontrolled hypertension and determine if and to what extent these differences are mediated by neighborhood socioeconomic status (nSES). METHODS We conducted a mediation analysis using a sample of patients with hypertension from 2 health care delivery systems in San Francisco over 2 years (n=47 031). We used generalized structural equation modeling, adjusted for age, sex, and health care system, to estimate the contribution of nSES to disparities in uncontrolled hypertension between White patients and Black, Hispanic/Latino, and Asian patients, respectively. Sensitivity analysis removed adjustment for health care system. RESULTS Over half the cohort (62%) experienced uncontrolled hypertension during the study period. Racial/ethnic groups showed substantial differences in prevalence of uncontrolled hypertension and distribution of nSES quintiles. Compared with White patients, Black, and Hispanic/Latino patients had higher adjusted odds of uncontrolled hypertension: odds ratio, 1.79 [95% CI, 1.67-1.91] and odds ratio, 1.38 [95% CI, 1.29-1.47], respectively and nSES accounted for 7% of the disparity in both comparisons. Asian patients had slightly lower adjusted odds of uncontrolled hypertension when compared with White patients: odds ratio, 0.95 [95% CI, 0.89-0.99] and the mediating effect of nSES did not change the direction of the relationship. Sensitivity analysis increased the proportion mediated by nSES to 11% between Black and White patients and 13% between Hispanic/Latino and White patients, but did not influence differences between Asian and White patients. CONCLUSIONS Among patients with hypertension in this study, nSES mediated a small proportion of racial/ethnic disparities in uncontrolled hypertension. Population health management strategies may be most effective by focusing on additional structural and interpersonal pathways such as racism and discrimination in health care settings.
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Affiliation(s)
- Emily F. Liu
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Anna D. Rubinsky
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA United States
| | - Lucia Pacca
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Valy Fontil
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Mindy C. DeRouen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA United States,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica Fields
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA United States,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA United States,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Courtney R. Lyles
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA United States,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
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Sutton TL, Koprowski MA, Grossblatt-Wait A, Brown S, McCarthy G, Liu B, Gross A, Macuiba C, Hedlund S, Brody JR, Sheppard BC. Psychosocial distress is dynamic across the spectrum of cancer care and requires longitudinal screening for patient-centered care. Support Care Cancer 2022; 30:4255-4264. [PMID: 35089365 DOI: 10.1007/s00520-022-06814-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Screening for cancer-related psychosocial distress is recommended for patients with cancer; however, data on the long-term prevalence of distress and its natural history in survivors are scarce, preventing recommendations for screening frequency and duration. We sought to evaluate longitudinal distress in cancer patients. METHODS We evaluated longitudinal distress screening data for patients with cancer treated or surveilled at our institution from 2010 to 2018. Anxiety, depression, insurance/financial, family, memory, and strength-related distress were separately assessed and analyzed. Multivariable logistic regression was utilized to evaluate factors associated with distress subtypes. RESULTS In 5660 patients, distress was the highest at diagnosis for anxiety, depression, financial, and overall distress. On multivariable analysis, factors independently associated with distress at diagnosis included younger age, female gender, disease site/stage, payor, and income, varying by subtype-specific analyses. Severe distress in at least one subtype persisted in over 30% of survivors surveyed through 10 years after diagnosis. Over half of patients with initially severe distress at diagnosis improved within 12 months; however, distress worsened in 20-30% of patients with moderate, low, and no initial distress, regardless of the distress subtype. CONCLUSION Psychosocial distress in cancer survivors is a long-lasting burden with implications for quality of life and oncologic outcomes. Severe distress remains prevalent through 10 years after diagnosis in survivors receiving continued care at cancer centers and results from both persistent and new sources of distress in a variety of psychosocial domains. Longitudinal distress screening is an invaluable tool for providing comprehensive patient-centered cancer care and is recommended to detect new or recurrent distress in cancer survivors.
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Affiliation(s)
- Thomas L Sutton
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Marina Affi Koprowski
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Alison Grossblatt-Wait
- Knight Cancer Institute, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Samantha Brown
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Grace McCarthy
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Benjamin Liu
- Department of Psychiatry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Anne Gross
- Department of Psychiatry, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Caroline Macuiba
- Knight Cancer Institute, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Susan Hedlund
- Knight Cancer Institute, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Jonathan R Brody
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA
| | - Brett C Sheppard
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, OR, 97239, USA.
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Shahian DM, Badhwar V, O'Brien SM, Habib RH, Han J, McDonald DE, Antman MS, Higgins RSD, Preventza O, Estrera AL, Calhoon JH, Grondin SC, Cooke DT. Social Risk Factors in Society of Thoracic Surgeons Risk Models Part 1: Concepts, Indicator Variables, and Controversies. Ann Thorac Surg 2022; 113:1703-1717. [PMID: 34998732 DOI: 10.1016/j.athoracsur.2021.11.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/01/2022]
Affiliation(s)
- David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown WV
| | | | | | - Jane Han
- Society of Thoracic Surgeons, Chicago, IL
| | | | | | - Robert S D Higgins
- Johns Hopkins University School of Medicine and Johns Hopkins Hospital, Baltimore, MD
| | - Ourania Preventza
- Baylor College of Medicine, Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, TX
| | - Anthony L Estrera
- McGovern Medical School at UTHealth; Memorial Hermann Heart and Vascular Institute; Houston, TX
| | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio
| | - Sean C Grondin
- Cumming School of Medicine, University of Calgary, and Foothills Medical Centre, Calgary, Alberta, Canada
| | - David T Cooke
- Division of General Thoracic Surgery, UC Davis Health, Sacramento, CA
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Swanson SA, Miller M, Zhang Y, Prince L, Holsinger EE, Templeton Z, Studdert DM. Patterns of handgun divestment among handgun owners in California. Inj Epidemiol 2022; 9:2. [PMID: 34980268 PMCID: PMC8725449 DOI: 10.1186/s40621-021-00362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about voluntary divestment of firearms among US firearm owners. Here, we aim to estimate the proportion of handgun owners who divest their handguns in the years following their initial acquisition; examine the timing, duration, and dynamics of those divestments; and describe characteristics of those who divest. Methods We use data from the Longitudinal Study of Handgun Ownership and Transfer, a cohort of registered voters in California with detailed information on 626,756 adults who became handgun owners during the 12-year study period, 2004–2016. For the current study, persons were followed from the time of their initial handgun acquisition until divestment, loss to follow-up, death, or the end of the study period. We describe the cumulative proportion who divest overall and by personal and area-level characteristics. We also estimate the proportion who reacquired handguns among persons who divested. Results Overall, 4.5% (95% CI 4.5–4.6) of handgun owners divested within 5 years of their first acquisition, with divestment relatively more common among women and among younger adults. Among those who divested, 36.6% (95% CI 35.8–37.5) reacquired a handgun within 5 years. Conclusions Handgun divestment is rare, with the vast majority of new handgun owners retaining them for years. Supplementary Information The online version contains supplementary material available at 10.1186/s40621-021-00362-6.
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Affiliation(s)
- Sonja A Swanson
- Department of Epidemiology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Matthew Miller
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Yifan Zhang
- Stanford Center for Health Policy, Stanford University, Stanford, CA, USA
| | - Lea Prince
- Stanford Center for Health Policy, Stanford University, Stanford, CA, USA
| | - Erin E Holsinger
- Stanford Center for Health Policy, Stanford University, Stanford, CA, USA
| | - Zachary Templeton
- Department of Healthcare Management and Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - David M Studdert
- Stanford Center for Health Policy, Stanford University, Stanford, CA, USA.,Stanford Law School, Stanford University, Stanford, CA, USA
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Rolheiser L, Zacher M, Subramanian S, Arcaya M. Do health trajectories predict neighborhood outcomes? Evidence of health selection in a diverse sample of U.S. adults. Health Place 2022; 73:102713. [PMID: 34826652 PMCID: PMC9885758 DOI: 10.1016/j.healthplace.2021.102713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 02/01/2023]
Abstract
Across the United States, residents of lower income neighborhoods evince poorer health, on average, than residents of more affluent areas. Studies aiming to explain this pattern have focused largely on the effects of neighborhood characteristics on residents' health, often overlooking the possibility that the reverse causal process-that a person's health impacts where they live, or "health selection into neighborhoods"-also plays a role. We investigated processes of health selection using the Panel Study of Income Dynamics, a longitudinal survey of U.S. households. Using ordinary least squares linear regression, we estimated the effect of householders' self-rated health on their neighborhood socioeconomic status (SES, the Census tract-level family poverty rate) in 2013, adjusting for neighborhood SES and health in 2001 as well as sociodemographic characteristics and residential mobility. Poorer health was associated with residence in higher poverty neighborhoods overall. Stratified models indicated that while health selection was observed across both race/ethnicity and class boundaries, the relationship between poor health and neighborhood poverty was stronger among non-Hispanic Black respondents, those with low income, and respondents who either moved moderate distances or did not move at all during the study period. We conclude with a call for future work exploring the mechanisms leading those in worse health to reside in higher poverty neighborhoods, and for public health policies that seek not only to improve health supporting conditions in economically disadvantaged neighborhoods, but that also support the economic and social needs of residents struggling with health problems.
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Affiliation(s)
| | - Meghan Zacher
- Brown University, 1 Prospect St, Providence, RI 02912-9127, USA
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Sachdev R, Sivanushanthan S, Ring N, Lugossy AM, England RW. Global health radiology planning using Geographic Information Systems to identify populations with decreased access to care. J Glob Health 2021; 11:04073. [PMID: 34956638 PMCID: PMC8684794 DOI: 10.7189/jogh.11.04073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Communities throughout northern Canada face significant health care disparities including decreased access to radiology. A medical hybrid airship is under development which aims to serve remote populations, requiring strategic outreach planning. This study aims to use geographic information systems (GIS) to identify (1) high risk and medically underserved patient populations in northern Canada and (2) potential landing sites for a medical airship to allow for mobile delivery of radiology services. Methods The northern region of Canada extending from the Rocky Mountains to the Atlantic Ocean was analyzed using multi-variable, multi-weighted GIS modeling. Based on population distance from hospitals (50% weight), health centers (eg, clinic; 30% weight), remote communities (not connected to electric grid; 10% weight), and roads (10% weight), individuals were stratified into one of five health care accessibility index (HAI) categories (ranging from very low to very high severity). HAI (80% weight) was combined with population density (20%) to create a health care access severity index (HASI). Topographic and land cover data were used to identify suitable landing sites for the medical airship. A coordinate data set was made from georeferenced health care facilities, and infrastructure data was obtained from OpenStreetMap. Results GIS analyzed 815 772 Canadians. Of this population, 522 094 (64%) were found to live ≥60 km from a hospital, 326 309 (40%) were ≥45 km from the nearest health center, 65 262 (8%) were within 30 km of a remote community, and 57 104 (7%) lived ≥1 km from the nearest road. Combined, the HASI identified 44% of the population as having decreased access to care (high or very high severity). Lastly, 27.5% of land analyzed was found to be suitable for airship operations. Conclusions GIS identified medically underserved populations in northern Canada who may benefit from mobile radiology services. These techniques may help to guide future global health outreach efforts.
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Affiliation(s)
- Rahul Sachdev
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Natalie Ring
- Russel H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Ryan W England
- Russel H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, USA.,RAD-AID International, Chevy Chase, Maryland, USA
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Natour AK, Rteil A, Corcoran P, Weaver M, Ahsan S, Kabbani L. Socioeconomic status and clinical stage of patients presenting for treatment of chronic venous disease. Ann Vasc Surg 2021; 83:305-312. [PMID: 34954041 DOI: 10.1016/j.avsg.2021.12.010] [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: 08/23/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The association between socioeconomic status (SES) and chronic venous insufficiency has not been rigorously studied. This study aimed to determine the influence of SES on the clinical stage of patients presenting for chronic venous disease therapy. METHODS We performed a retrospective study of a prospectively collected data from the Vascular Quality Initiative Varicose Vein Registry at our tertiary referral center. Medical records of patients who underwent therapy for chronic venous disease between January 2015 and June 2019 were queried. SES was quantified using the neighborhood deprivation index (NDI), which summarizes 8 domains of socioeconomic deprivation and is based on census tract data derived from the patients' addresses at the time of the treatment. High NDI scores correspond with lower SES. The association between SES and severity of vein disease at presentation was assessed with bivariate analysis of variance and linear regression analysis. RESULTS A total of 449 patients with complete SES and clinical-etiology-anatomy-pathophysiology (CEAP) class data were included in the study. The mean age was 58 years, 67% were female, and 60% were White. CEAP classes were distributed as follows C2, 22%; C3, 50%; C4, 15%; C5, 5%; and C6, 8%. Patients with lower SES (higher NDI score) tended to have a higher CEAP class at presentation (P < 0.05). SES was not associated with history of deep venous thrombosis, use of compression therapy, or venous clinical severity score. CONCLUSIONS At our institution, patients with more advanced venous disease tended to belong to a lower SES group. This may reflect that patients with a lower SES have a longer time to presentation due to delay in seeking medical help for venous disease.
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Affiliation(s)
| | - Ali Rteil
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI
| | - Paul Corcoran
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI
| | - Mitchell Weaver
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI
| | - Syed Ahsan
- Division of Vascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Loay Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI.
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Oka M. Interpreting a standardized and normalized measure of neighborhood socioeconomic status for a better understanding of health differences. Arch Public Health 2021; 79:226. [PMID: 34911564 PMCID: PMC8672510 DOI: 10.1186/s13690-021-00750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Standardization and normalization of continuous covariates are used to ease the interpretation of regression coefficients. Although these scaling techniques serve different purposes, they are sometimes used interchangeably or confused for one another. Therefore, the objective of this study is to demonstrate how these scaling techniques lead to different interpretations of the regression coefficient in multilevel logistic regression analyses. METHODS Area-based socioeconomic data at the census tract level were obtained from the 2015-2019 American Community Survey for creating two measures of neighborhood socioeconomic status (SES), and a hypothetical data on health condition (favorable versus unfavorable) was constructed to represent 3000 individuals living across 300 census tracts (i.e., neighborhoods). Two measures of neighborhood SES were standardized by subtracting its mean and dividing by its standard deviation (SD) or by dividing by its interquartile range (IQR), and were normalized into a range between 0 and 1. Then, four separate multilevel logistic regression analyses were conducted to assess the association between neighborhood SES and health condition. RESULTS Based on standardized measures, the odds of having unfavorable health condition was roughly 1.34 times higher for a one-SD change or a one-IQR change in neighborhood SES; these reflect a health difference of individuals living in relatively high SES (relatively affluent) neighborhoods and those living in relatively low SES (relatively deprived) neighborhoods. On the other hand, when these standardized measures were replaced by its respective normalized measures, the odds of having unfavorable health condition was roughly 3.48 times higher for a full unit change in neighborhood SES; these reflect a health difference of individuals living in highest SES (most affluent) neighborhoods and those living in lowest SES (most deprived) neighborhoods. CONCLUSION Multilevel logistic regression analyses using standardized and normalized measures of neighborhood SES lead to different interpretations of the effect of neighborhood SES on health. Since both measures are valuable in their own right, interpreting a standardized and normalized measure of neighborhood SES will allow us to gain a more rounded view of the health differences of individuals along the gradient of neighborhood SES in a certain geographic location as well as across different geographic locations.
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Affiliation(s)
- Masayoshi Oka
- Department of Management, Faculty of Management, Josai University, 1-1 Keyakidai, Sakado City, Saitama Prefecture, 350-0295, Japan.
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Wallace BK, Miles CH, Anderson CB. Effects of race and socioeconomic status on treatment for localized renal masses in New York City. Urol Oncol 2021; 40:65.e19-65.e26. [PMID: 34876349 DOI: 10.1016/j.urolonc.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/21/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Partial nephrectomy (PN) is the preferred treatment for localized renal masses (LRM), however its use is not uniform across patient socioeconomic (SES) factors. Our hypothesis is that the effect of increased SES on surgical management of LRMs in New York City (NYC) will not be the same for Black and White patients. PATIENTS AND METHODS Patients were identified from the New York State Cancer Registry (NYSPACED) treated for LRMs with PN or radical nephrectomy from 2004 to 2016. We identified patients' home neighborhoods through Public Use Microdata Areas (PUMA) in NYSCAPED and used a US Census SES index. Logistic regression was used to determine the association of race and SES on receipt of PN, controlling for age, ethnicity, gender, and diagnosis year. RESULTS On unadjusted analyses, patients from higher PUMA SES quartiles were more likely to receive PN (OR = 1.07, P < 0.05), while Black patients were less likely to receive PN as compared to White patients (OR = 0.66, P < 0.001). Multivariable analysis showed a significant interaction between race and SES quartile (interaction P = 0.005) such that the effect of PUMA SES on receipt of PN was modified by race. PN receipt for Black vs. White patients was significantly different within the highest SES quartile (OR = 0.44, P < 0.001), but not within the lowest. CONCLUSION In NYC, patients from higher SES quartile neighborhoods had significantly increased odds for receipt of PN for LRMs. As neighborhood SES quartile increased, White patients were significantly more likely to receive PN, while Black patients were not.
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Affiliation(s)
- Brendan K Wallace
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Caleb H Miles
- Department of Biostatistics, Mailman School of Public Health, Columbia University, NY
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Hardeman RR, Chantarat T, Smith ML, Karbeah J, Van Riper DC, Mendez DD. Association of Residence in High-Police Contact Neighborhoods With Preterm Birth Among Black and White Individuals in Minneapolis. JAMA Netw Open 2021; 4:e2130290. [PMID: 34878551 PMCID: PMC8655601 DOI: 10.1001/jamanetworkopen.2021.30290] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Police contact may have negative psychological effects on pregnant people, and psychological stress has been linked to preterm birth (ie, birth at <37 weeks' gestation). Existing knowledge of racial disparities in policing patterns and their associations with health suggest redesigning public safety policies could contribute to racial health equity. OBJECTIVE To examine the association between community-level police contact and the risk of preterm birth among White pregnant people, US-born Black pregnant people, and Black pregnant people who were born outside the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used medical record data of 745 White individuals, 121 US-born Black individuals, and 193 Black individuals born outside the US who were Minneapolis residents and gave birth to a live singleton at a large health system between January 1 and December 31, 2016. Data were analyzed from March 2019 to October 2020. EXPOSURES Police contact was measured at the level of the census tract where the pregnant people lived. Police incidents per capita (ie, the number of police incidents divided by the census tract population estimate) were dichotomized into high if the value was in the fourth quartile and low for the remaining three quartiles. MAIN OUTCOMES AND MEASURES Preterm birth status was based on the International Statistical Classification of Diseases and Related Health Problems, 10th revision, Clinical Modification (ICD-10-CM) code. Preterm infants were those with ICD-10-CM codes P07.2 and P07.3 documented in their charts. RESULTS Of 1059 pregnant people (745 [70.3%] White, 121 [11.4%] US-born Black, 193 [18.2%] Black born outside the US) in the sample, 336 White individuals (45.1%) and 62 Black individuals who were born outside the US (32.1%) gave birth between the ages of 30 and 34 years, while US-born Black individuals gave birth at younger ages, with 49 (40.5%) aged 25 years or younger. The incidence of preterm birth was 6.7% for White individuals (50 pregnant people), 14.0% for US-born Black individuals (17 pregnant people), and 5.7% for Black individuals born outside the US (11 pregnant people). In areas with high police contact vs low police contact, the odds of preterm birth were 90% higher for White individuals (odds ratio [OR], 1.9; 95% CI, 1.9-2.0), 100% higher for US-born Black individuals (OR, 2.0; 95% CI, 1.8-2.2), and 10% higher for Black individuals born outside the US (OR, 1.1; 95% CI, 1.0-1.2). Secondary geospatial analysis further revealed that the proportion of Black residents in Minneapolis census tracts was correlated with the number of police incidents reported between 2012 and 2016 (P = .001). CONCLUSIONS AND RELEVANCE In this study, police contact was associated with preterm birth for both Black and White pregnant people. Predominantly Black neighborhoods had greater police contact than predominantly White neighborhoods, indicating that Black pregnant people were more likely to be exposed to police than White pregnant people. These findings suggest that racialized police patterns borne from a history of racism in the United States may contribute to racial disparity in preterm birth.
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Affiliation(s)
- Rachel R. Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis
| | - Tongtan Chantarat
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis
| | - Morrison Luke Smith
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - J’Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis
| | - David C. Van Riper
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
| | - Dara D. Mendez
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Underwood JM, Pampati S, Everett Jones S, Bryan LN, Demissie Z, Cavalier Y, Rasberry CN. School-Level Poverty and Rurality Associated With Differences in Sexual Risk Behaviors Among U.S. Public High School Students. J Adolesc Health 2021; 69:964-969. [PMID: 34304989 DOI: 10.1016/j.jadohealth.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE This study examined associations between student sexual behaviors and both school-level socioeconomic status and metropolitan status. METHODS National Youth Risk Behavior Survey data from 2017 (N = 14,765, response rate = 60%) and 2019 (N = 13,677, 60%) were combined. School-level socioeconomic status (low-, mid-, and high-poverty based on the percentage of students eligible for free or reduced-price meals) and metropolitan status (urban, suburban/town, or rural) were identified for students attending public high schools. Sexual behaviors included currently sexually active, four or more lifetime sexual partners, condom use during the last sexual intercourse, hormonal birth control use during the last sexual intercourse, condom and hormonal birth control use during the last sexual intercourse, and drank alcohol or used drugs before the last sexual intercourse. Adjusted prevalence ratios were calculated using logistic regression models, controlling for sex, race/ethnicity, and grade. RESULTS Compared to students attending low-poverty schools, high-poverty school students were significantly more likely to be currently sexually active (adjusted prevalence ratio = 1.4 [95% confidence interval = 1.1-1.8]) and have four or more lifetime sexual partners (1.6 [1.0-2.5]), but were significantly less likely to have drank alcohol or used drugs before the last sexual intercourse (.7 [.5-.9]) and have used hormonal birth control during the last sexual intercourse (.7 [.6-1.0]). Compared to students attending rural schools, urban school students were significantly less likely to be currently sexually active (.8 [.7-.9]) and have four or more lifetime sexual partners (.7 [.5-.9]). CONCLUSIONS School-level socioeconomic status and metropolitan status were associated with differential risk in sexual behaviors.
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Affiliation(s)
- J Michael Underwood
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sanjana Pampati
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah N Bryan
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zewditu Demissie
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Washington, D.C
| | - Yolanda Cavalier
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Catherine N Rasberry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Casey JA, Cushing L, Depsky N, Morello-Frosch R. Climate Justice and California's Methane Superemitters: Environmental Equity Assessment of Community Proximity and Exposure Intensity. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:14746-14757. [PMID: 34668703 PMCID: PMC8936179 DOI: 10.1021/acs.est.1c04328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Methane superemitters emit non-methane copollutants that are harmful to human health. Yet, no prior studies have assessed disparities in exposure to methane superemitters with respect to race/ethnicity, socioeconomic status, and civic engagement. To do so, we obtained the location, category (e.g., landfill, refinery), and emission rate of California methane superemitters from Next Generation Airborne Visible/Infrared Imaging Spectrometer (AVIRIS-NG) flights conducted between 2016 and 2018. We identified block groups within 2 km of superemitters (exposed) and 5-10 km away (unexposed) using dasymetric mapping and assigned level of exposure among block groups within 2 km (measured via number of superemitter categories and total methane emissions). Analyses included 483 superemitters. The majority were dairy/manure (n = 213) and oil/gas production sites (n = 127). Results from fully adjusted logistic mixed models indicate environmental injustice in methane superemitter locations. For example, for every 10% increase in non-Hispanic Black residents, the odds of exposure increased by 10% (95% confidence interval (CI): 1.04, 1.17). We observed similar disparities for Hispanics and Native Americans but not with indicators of socioeconomic status. Among block groups located within 2 km, increasing proportions of non-White populations and lower voter turnout were associated with higher superemitter emission intensity. Previously unrecognized racial/ethnic disparities in exposure to California methane superemitters should be considered in policies to tackle methane emissions.
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Affiliation(s)
- Joan A. Casey
- Columbia University Mailman School of Public Health, Department of Environmental Health Sciences, New York, NY 10034, USA
- Co-corresponding authors: ,
| | - Lara Cushing
- University of California, Los Angeles Fielding School of Public Health, Department of Environmental Health Sciences, Los Angeles, CA 90095, USA
| | - Nicholas Depsky
- University of California, Berkeley, Energy and Resources Group, Berkeley, CA 94720, USA
| | - Rachel Morello-Frosch
- University of California, Berkeley, Department of Environmental Science, Policy and Management and School of Public Health, Berkeley, CA 94720, USA
- Co-corresponding authors: ,
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Azofeifa A, Sripipatana A. Blood Lead Testing Among Medically Underserved and Socially Vulnerable Children in the United States 2012-2017. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:558-566. [PMID: 32956300 DOI: 10.1097/phh.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Lead poisoning can affect intellectual development, growth, hearing, and other health problems. Children 6 years or younger are particularly susceptible to lead poisoning. Health Resources and Services Administration (HRSA)-funded health centers (HCs) serve lower-income, minority, and vulnerable populations across the United States, who may be at a higher risk for lead exposure. At HCs, blood lead testing is monitored; however, little is known about testing rates and characteristics of children tested by HCs. OBJECTIVES We assessed the prevalence and characteristics of children who received a blood lead test at HCs from 2012 to 2017. DESIGN We assessed characteristics of children 12 to 60 months of age who had a blood lead test using available self-reported data from HRSA's Health Center Patient Survey (2014-2015). In addition, using HRSA's Uniform Data System, an administrative performance data set, we calculated the annual percentage change of blood lead testing from 2012 to 2017. RESULTS During 2014-2015, 1.1 million (72.9%; 95% CI, 64.6-81.3) out of the 1.5 million (n = 365 unweighted) eligible children 12 to 60 months of age self-reported receiving a blood lead test at an HRSA-funded HC. There was a significant higher proportion of children with a blood lead test among urban HCs (74.1%; 95% CI, 59.4-88.8) and among those who reported HCs as their usual source of care (99.9%; 95% CI, 99.7-100) (P ≤ .05).The total HC population of children younger than 72 months increased from 2 674 500 in 2012 to 2 989 184 in 2017, and we observed a 34.4% increase in blood lead testing at HRSA-funded HCs over the same time period. CONCLUSIONS HCs play an important role in providing access to blood lead testing in underserved communities in the United States. While HRSA-funded HCs have made substantial efforts to screen and educate patients on lead exposure, nonetheless continued screening and education efforts with both health providers at HCs and parents/guardians are warranted to continue to improve blood lead screening rates among high-risk groups.
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Affiliation(s)
- Alejandro Azofeifa
- Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
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Lead Pollution, Demographics, and Environmental Health Risks: The Case of Philadelphia, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179055. [PMID: 34501644 PMCID: PMC8431549 DOI: 10.3390/ijerph18179055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Lead (Pb) soil contamination in urban environments represents a considerable health risk for exposed populations, which often include environmental justice communities. In Philadelphia, Pennsylvania (PA), Pb pollution is a major concern primarily due to extensive historical Pb-smelting/processing activity and legacy use of Pb-based paints and leaded gasoline. The U.S. Environmental Protection Agency (USEPA) organized and/or compiled community-driven soil sampling campaigns to investigate Pb content in surface soils across Philadelphia. Using these data (n = 1277), combined with our own dataset (n = 1388), we explored the spatial distribution of Pb content in soils across the city using ArcGIS. While assessing Zone Improvement Plan (ZIP)-code level data, we found strong correlations between factors, such as the percentage of children with elevated blood lead levels (% EBLL) and % minority population as well as between % EBLL and % children in poverty. We developed a “Lead Index” that took demographics, median measured Pb-in-soil content, and % EBLLs into account to identify ZIP codes in need of further assessment. Our results will be used to help lower the Pb-exposure risk for vulnerable children living in disproportionately burdened communities.
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