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MacRae C, Mercer SW, Lawson A, Marshall A, Pearce J, Abubakar E, Zheng C, van den Akker M, Williams T, Swann O, Pollock L, Rawlings A, Fry R, Lyons RA, Lyons J, Mizen A, Dibben C, Guthrie B. Impact of individual, household, and area characteristics on health and social care outcomes for people with multimorbidity: Protocol for a multilevel analysis. PLoS One 2023; 18:e0282867. [PMID: 37796888 PMCID: PMC10553261 DOI: 10.1371/journal.pone.0282867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Multimorbidity is one of the greatest challenges facing health and social care systems globally. It is associated with high rates of health service use, adverse healthcare events, and premature death. Despite its importance, little is known about the effects of contextual determinants such as household and area characteristics on health and care outcomes for people with multimorbidity. This study protocol presents a plan for the examination of associations between individual, household, and area characteristics with important health and social care outcomes. METHODS The study will use a cross-section of data from the SAIL Databank on 01 January 2019 and include all people alive and registered with a Welsh GP. The cohort will be stratified according to the presence or absence of multimorbidity, defined as two or more long-term conditions. Multilevel models will be used to examine covariates measured for individuals, households, and areas to account for social processes operating at different levels. The intra-class correlation coefficient will be calculated to determine the strength of association at each level of the hierarchy. Model outcomes will be any emergency department attendance, emergency hospital or care home admission, or mortality, within the study follow-up period. DISCUSSION Household and area characteristics might act as protective or risk factors for health and care outcomes for people with multimorbidity, in which case results of the analyses can be used to guide clinical and policy responses for effective targeting of limited resources.
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Affiliation(s)
- Clare MacRae
- Advanced Care Research Centre, Bio Cube 1, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart W. Mercer
- Advanced Care Research Centre, Bio Cube 1, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Lawson
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Alan Marshall
- Advanced Care Research Centre, Bio Cube 1, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, United Kingdom
- School of Geosciences, College of Science and Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Jamie Pearce
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Eleojo Abubakar
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chunyu Zheng
- School of Geosciences, College of Science and Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Williams
- Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Olivia Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Louisa Pollock
- Child Health, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Anna Rawlings
- Swansea University Medical School, Swansea, United Kingdom
| | - Rich Fry
- Swansea University Medical School, Swansea, United Kingdom
| | - Ronan A. Lyons
- Swansea University Medical School, Swansea, United Kingdom
| | - Jane Lyons
- Swansea University Medical School, Swansea, United Kingdom
| | - Amy Mizen
- Swansea University Medical School, Swansea, United Kingdom
| | - Chris Dibben
- School of Geosciences, College of Science and Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Bruce Guthrie
- Advanced Care Research Centre, Bio Cube 1, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Hyer JM, Diaz A, Tsilimigras D, Pawlik TM. A novel machine learning approach to identify social risk factors associated with textbook outcomes after surgery. Surgery 2022; 172:955-961. [PMID: 35710534 DOI: 10.1016/j.surg.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/18/2021] [Accepted: 05/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Identifying social determinants of health has become a priority for many researchers, health care providers, and payers. The vast amount of patient and population-level data available on social determinants creates, however, both an opportunity and a challenge as these data can be difficult to synthesize and analyze. METHODS Medicare beneficiaries who underwent 1 of 4 common operations between 2013 and 2017 were identified. Using a machine learning algorithm, the primary independent variable, surgery social determinants of health index, was derived from 15 common, publicly available social determents of health measures. After development of a surgery social determinants of health index, multivariable logistic regression was used to estimate the association of this index with textbook outcomes, as well as the component metrics of textbook outcomes. RESULTS A novel surgery social determinants of health index was developed with factor component weights that varied relative to their impact on postoperative outcomes. Factors with the highest weight in the algorithm relative to postoperative outcomes were the proportion of noninstitutionalized civilians with a disability and persons without high school diploma, while components with the lowest weights were the proportion of households with more people than rooms and persons below poverty. Overall, an increase in surgery social determinants of health index was associated with 6% decreased odds (95% confidence interval: 0.93-0.94) of achieving a textbook outcome. In addition, an increase in surgery social determinants of health index was associated with increased odds of each of the individual components of textbook outcome; ranging from 3% increased odds (95% confidence interval: 1.03-1.04) for 90-day readmission to 10% increased odds (95% confidence interval: 1.09-1.11) for 90-day mortality. Further, there was 6% increased odds (95% confidence interval: 1.05-1.07) of experiencing a complication and 7% increased odds (95% confidence interval: 1.06-1.07) of having an extended length of stay. Minority patients from a high surgery social determinants of health index had 38% lower odds (95% confidence interval: 0.60-0.65) of achieving a textbook outcome compared with White/non-Hispanic patients from a low surgery social determinants of health index area. CONCLUSION Using a machine learning approach, we developed a novel social determents of health index to predict the probability of achieving a textbook outcome after surgery.
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Affiliation(s)
- J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI. https://twitter.com/DiazAdrian10
| | - Diamantis Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
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Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery. Surgery 2021; 171:1043-1050. [PMID: 34538339 DOI: 10.1016/j.surg.2021.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Regionalization of hepatopancreatic surgery to high-volume hospitals has been associated with fragmentation of postoperative care and, in turn, inferior outcomes after surgery. The objective of this study was to examine the association of social vulnerability with the likelihood of experiencing fragmentation of postoperative care (FPC) after hepatopancreatic surgery. METHODS Patients who underwent hepatopancreatic surgery and had at least 1 readmission within 90 days were identified using Medicare 100% Standard Analytical Files between 2013 and 2017. Fragmentation of postoperative care was defined as readmission at a hospital other than the index institution where the initial surgery was performed. The association of social vulnerability index and its components with fragmentation of postoperative care was examined. RESULTS Among 11,142 patients, 8,053 (72.3%) underwent pancreatectomy, and 3,089 (27.7%) underwent hepatectomy. The overall incidence of fragmentation of postoperative care was 32.9% (n = 3,667). Patients who experienced fragmentation of postoperative care were older (73 years [interquartile range: 69-77]FPC vs 72 years [interquartile range: 68-77]non-FPC) and had a higher Charlson comorbidity score (4 [interquartile range: 2-8]FPC vs 3 [interquartile range: 2-8]non-FPC) (both P < .001). Median overall social vulnerability index was higher among patients who experienced fragmentation of postoperative care (52.5 [interquartile range: 29.3-70.4]FPC vs 51.3 [interquartile range: 27.9-69.4]non-FPC, P = .02). On multivariable analysis, the odds of experiencing fragmentation of postoperative care was higher with increasing overall social vulnerability index (odds ratio: 1.14; 95% confidence interval 1.01-1.30). Additionally, the odds of experiencing fragmentation of postoperative care were higher among patients with high vulnerability owing to their socioeconomic status (odds ratio: 1.28; 95% confidence interval 1.12-1.45) or their household composition and disability (odds ratio: 1.35; 95% confidence interval 1.19-1.54), whereas high vulnerability owing to minority status and language was inversely associated with fragmentation of postoperative care (odds ratio: 0.73; 95% confidence interval 0.64-0.84). CONCLUSION Social vulnerability was strongly associated with the odds of experiencing fragmented postoperative care after hepatopancreatic surgery.
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The impact of social vulnerability subthemes on postoperative outcomes differs by racial/ethnic minority status. Am J Surg 2021; 223:353-359. [PMID: 34099239 DOI: 10.1016/j.amjsurg.2021.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Social vulnerability is an important driver of disparate surgical outcomes, however the extent to which certain types of vulnerability impact outcomes is poorly understood. METHODS Medicare beneficiaries 65 years or older who underwent one of four operations were identified. Multivariable mixed-effects logistic regression was used to measure the association of four social vulnerability subthemes from the social vulnerability index (SVI) were assessed relative to the likelihood to achieve a textbook outcome (TO). RESULTS Among 579,846 Medicare beneficiaries, median age was 74 years and most patients (536,455,92.5%) were White/non-Hispanic. On multivariable analysis, the overall impact of the composite SVI metric on the odds to achieve a postoperative TO was lower among White/non-Hispanic patients (Δ25%ile SVI:OR:0.98,95%CI:0.97-0.98) compared with ethnic/minority patients (Δ25%ile SVI:OR:0.93,95%CI:0.91-0.94). Increasing vulnerability in the subthemes of socioeconomic status (Δ25%ile SVI:ethnic/minority:OR:0.92, 95%CI:0.91-0.94) and household composition (Δ25%ile SVI:ethnic/minority:OR:0.92,95%CI:0.91-0.94) was associated with a greater likelihood not to achieve a TO among minority patients. CONCLUSIONS Worsening SES and household compositions & disability had a detrimental effect on odds of TO following surgery with the most pronounced effect on non-White minority patients.
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Woods SB, Bridges K, Carpenter EN. The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature. FAMILY PROCESS 2020; 59:1608-1626. [PMID: 31747478 DOI: 10.1111/famp.12505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.
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Affiliation(s)
- Sarah B Woods
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kate Bridges
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Abstract
Data from the Mexican Census reveal that between 2005 and 2015, nearly two million migrants returned voluntarily to Mexico from the United States. Currently, high rates of voluntary-return migration to Mexico continue at the same time that migration flows to the U.S. steadily decline. This return migration trend presents serious challenges for Mexico, a country that has long struggled to satisfy the health care demands of its population. However, little is known about return migrants' health care needs. In this study, we examine the health risk profiles and healthcare utilization for Mexican return migrants and the non-migrant population. We examine how these outcomes are affected by both the migration and return migration experience of the returnee population, while paying close attention to age-group differences. We employ inverse probability weighting regression adjustment (IPWRA) and logistic regression analysis of a sample of 348,450 respondents from the 2014 National Survey of Demographic Dynamics (ENADID) to test for differences in health conditions between those Mexican return migrants and non-migrants. We then turn to the Survey of Migration at Mexico's Northern Border (EMIF Norte, for its Spanish acronym) for the 2014-2017 period to further assess whether certain characteristics linked to aging and the migration experience influence the prevalence of chronic health conditions, and health insurance coverage among 17,258 returned migrants. Findings reveal that compared to non-migrants, returnees are more likely to be physically impaired. These poor health outcomes are influenced by the migration and return migration experience and vary by age group and duration of residence, the time that has elapsed since returning to Mexico. We do not find an association between return migration and mental or emotional distress. Policy implications are discussed in light of immigration reform and restrictions on eligibility for health insurance coverage for older adults in Mexico.
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Angel JL, Vega W, López-Ortega M. Aging in Mexico: Population Trends and Emerging Issues. THE GERONTOLOGIST 2016; 57:153-162. [PMID: 27927730 DOI: 10.1093/geront/gnw136] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/21/2016] [Indexed: 11/14/2022] Open
Abstract
Although all nations in the America's face a common demographic reality of longevity, declining fertility rates and changes in family roles a growing body of research points to a dramatic demographic transformation in Mexico. Although Mexico's population is relatively young, with a median age of 27.9 in 2015, it will age rapidly in coming years, increasing to 42 years by 2050. The rapid median age in the nation also reflects the growing proportion of people 65 or older, and is expected to triple to 20.2% by 2050. This article examines how the age and gender structure of Mexico offers important insights about current and future political and social stability, as well as economic development. Mexico is the world's eleventh largest country in terms of population size and the "demographic dividend" of a large youthful population is giving way to a growing older population that will inevitably place demands on health care and social security. The shift in age structure will result in increased dependency of retirees on the working-age population in the next 20 years. Mexico does not provide universal coverage of social security benefits and less than half of the labor force is covered by any pension or retirement plan. As a result, elderly Mexicans often continue working into old age. The high total poverty rate in the country, especially among the older population magnifies the problem of the potential dependency burden. The article ends with a discussion of key public policy issues related to aging in Mexico.
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Affiliation(s)
| | - William Vega
- School of Social Work, Roybal Institute on Aging, University of Southern California, Los Angeles
| | - Mariana López-Ortega
- National Institute of Geriatrics, National Institutes of Health, Mexico City, Mexico
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