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Wang SD, Wroblewski KE, Iveniuk J, Schumm LP, Hawkley LC, McClintock MK, Huang ES. Prediabetes Progression and Reversion: Social Factors and Racial/Ethnic Differences. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02046-5. [PMID: 38869678 DOI: 10.1007/s40615-024-02046-5] [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] [Received: 01/11/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Racial and ethnic minorities are disproportionately affected by diabetes. Social characteristics, such as family structure, social support, and loneliness, may contribute to these health disparities. In a nationally representative sample of diverse older adults, we evaluated longitudinal rates of both progression from prediabetes to diabetes and reversion from prediabetes to normoglycemia. RESEARCH DESIGN AND METHODS Using the longitudinal Health and Retirement Study (2006-2014), our sample included 2625 follow-up intervals with a prediabetes baseline (provided by 2229 individuals). We analyzed 4-year progression and reversion rates using HbA1c and reported presence or absence of physician-diagnosed diabetes. We utilized chi-square and logistic regression models to determine how race/ethnicity and social variables influenced progression or reversion controlling for comorbidities and demographics. RESULTS Overall, progression to diabetes was less common than reversion (17% vs. 36%). Compared to Whites, Hispanic/Latino respondents had higher odds of progression to diabetes from prediabetes while Black respondents had lower odds of reversion, adjusting for physical health and demographics. For social variables, Hispanics/Latinos had the highest reliance on and openness with family and the lowest rates of loneliness. The inclusion of social variables in regression models reduced the odds of progression for Hispanics/Latinos but did not alter Black's lower rate of reversion. CONCLUSIONS Hispanic/Latinos and Blacks not only had different transition pathways leading to diabetes, but also had different social profiles, affecting Hispanic/Latino progression, but not Black reversion. These differences in the influence of social variables on diabetes risk may inform the design of culturally-specific efforts to reduce disparities in diabetes burden.
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Affiliation(s)
- Sabrina D Wang
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - James Iveniuk
- The Bridge at NORC at the University of Chicago, Chicago, IL, USA
| | - L Phillip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Louise C Hawkley
- The Bridge at NORC at the University of Chicago, Chicago, IL, USA
| | - Martha K McClintock
- Department of Psychology and Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA
| | - Elbert S Huang
- Section of General Internal Medicine, The University of Chicago, Chicago, IL, USA.
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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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He Q, Hawkins GT, Park C, Han S, LaManna JB, Ng BP. Patient attitudes, experiences, and satisfaction with healthcare and office visit utilization among Medicare beneficiaries with type 2 diabetes. Chronic Illn 2024; 20:64-75. [PMID: 36802824 DOI: 10.1177/17423953231158139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To examine patient attitudes, experiences, and satisfaction with healthcare associated with office visit utilization among Medicare beneficiaries with type 2 diabetes. METHODS We analyzed the 2019 Medicare Current Beneficiary Survey Public Use File of beneficiaries aged ≥65 years with type 2 diabetes (n = 1092). The ordinal dependent variable was defined as 0, 1 to 5, and ≥6 office visits. An ordinal partial proportional odds model was conducted to examine associations of beneficiaries' attitudes, experiences, and satisfaction with healthcare and office visit utilization. RESULTS Among the beneficiaries, approximately 17.7%, 22.8%, and 59.5% reported having 0, 1 to 5, and ≥6 office visits, respectively. Being male (OR = 0.67, p = 0.004), Hispanic (OR = 0.53, p = 0.006), divorced/separated (OR = 0.62, p = 0.038) and living in a non-metro area (OR = 0.53, p < 0.001) were associated with a lower likelihood of attending more office visits. Trying to keep sickness to themselves (OR = 0.66, p = 0.002) and dissatisfaction with the ease and convenience of getting to providers from home (OR = 0.45, p = 0.010) were associated with a lower likelihood of having more office visits. DISCUSSION The proportion of beneficiaries foregoing office visits is concerning. Attitudes concerning healthcare and transportation challenges can be barriers to office visits. Efforts to ensure timely and appropriate access to care should be prioritized for Medicare beneficiaries with diabetes.
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Affiliation(s)
- Qing He
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, USA
| | | | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Sola Han
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | | | - Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
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Yip JLY, Poduval S, de Souza-Thomas L, Carter S, Fenton K. Anti-racist interventions to reduce ethnic disparities in healthcare in the UK: an umbrella review and findings from healthcare, education and criminal justice. BMJ Open 2024; 14:e075711. [PMID: 38418232 PMCID: PMC10910548 DOI: 10.1136/bmjopen-2023-075711] [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: 05/16/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To assess the evidence for anti-racist interventions which aim to reduce ethnic disparities in healthcare, with a focus on implementation in the UK healthcare system. DESIGN Umbrella review. DATA SOURCES Embase, Medline, Social Policy and Practice, Social Care Online and Web of Science were searched for publications from the year 2000 up to November 2023. ELIGIBILITY CRITERIA Only systematic and scoping reviews of anti-racist interventions reported in English were included. Reviews were excluded if no interventions were reported, no comparator interventions were reported or the study was primarily descriptive. DATA EXTRACTION AND SYNTHESIS A narrative synthesis approach was used to integrate and categorise the evidence on anti-racist interventions for healthcare. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool. RESULTS A total of 29 reviews are included in the final review. 26 are from the healthcare sector and three are from education and criminal justice. The most promising interventions targeting individuals include group-based health education and providing culturally tailored interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority communities may provide an effective approach to reducing ethnic health disparities. Interventions to improve quality of care for conditions with disproportionately worse outcomes in ethnic minority communities show promise. At a policy level, structural interventions including minimum wage policies and integrating non-medical interventions such as housing support in clinical care has some evidence for improving outcomes in ethnic minority communities. CONCLUSIONS Many of the included studies were low or critically low quality due to methodological or reporting limitations. For programme delivery, different types of pathway integration, and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on individual behaviour change and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multilevel approach.
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Affiliation(s)
| | - Shoba Poduval
- Institute of Health Informatics, University College London, London, UK
| | | | - Sophie Carter
- Office for Health Improvement and Disparities, London, UK
- Health Innovation Manchester, Manchester, UK
| | - Kevin Fenton
- Office for Health Improvement and Disparities, London, UK
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Kunnath AJ, Sack DE, Wilkins CH. Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis. BMC Public Health 2024; 24:405. [PMID: 38326799 PMCID: PMC10851469 DOI: 10.1186/s12889-024-17834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Although sociodemographic characteristics are associated with health disparities, the relative predictive value of different social and demographic factors remains largely unknown. This study aimed to describe the sociodemographic characteristics of All of Us participants and evaluate the predictive value of each factor for chronic diseases associated with high morbidity and mortality. METHODS We performed a cross-sectional analysis using de-identified survey data from the All of Us Research Program, which has collected social, demographic, and health information from adults living in the United States since May 2018. Sociodemographic data included self-reported age, sex, gender, sexual orientation, race/ethnicity, income, education, health insurance, primary care provider (PCP) status, and health literacy scores. We analyzed the self-reported prevalence of hypertension, coronary artery disease, any cancer, skin cancer, lung disease, diabetes, obesity, and chronic kidney disease. Finally, we assessed the relative importance of each sociodemographic factor for predicting each chronic disease using the adequacy index for each predictor from logistic regression. RESULTS Among the 372,050 participants in this analysis, the median age was 53 years, 59.8% reported female sex, and the most common racial/ethnic categories were White (54.0%), Black (19.9%), and Hispanic/Latino (16.7%). Participants who identified as Asian, Middle Eastern/North African, and White were the most likely to report annual incomes greater than $200,000, advanced degrees, and employer or union insurance, while participants who identified as Black, Hispanic, and Native Hawaiian/Pacific Islander were the most likely to report annual incomes less than $10,000, less than a high school education, and Medicaid insurance. We found that age was most predictive of hypertension, coronary artery disease, any cancer, skin cancer, diabetes, obesity, and chronic kidney disease. Insurance type was most predictive of lung disease. Notably, no two health conditions had the same order of importance for sociodemographic factors. CONCLUSIONS Age was the best predictor for the assessed chronic diseases, but the relative predictive value of income, education, health insurance, PCP status, race/ethnicity, and sexual orientation was highly variable across health conditions. Identifying the sociodemographic groups with the largest disparities in a specific disease can guide future interventions to promote health equity.
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Affiliation(s)
- Ansley J Kunnath
- Vanderbilt University Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Daniel E Sack
- Vanderbilt University Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End, Suite 600, Nashville, TN, 37203, USA.
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Scanzera AC, Kravets S, Hallak JA, Musick H, Krishnan JA, Chan RP, Kim SJ. Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments. Ophthalmic Epidemiol 2024; 31:11-20. [PMID: 36820490 PMCID: PMC10444903 DOI: 10.1080/09286586.2023.2180806] [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: 09/19/2022] [Revised: 01/28/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments. METHODS In this retrospective cohort study, records of all patients ≥18 years scheduled for an ophthalmology appointment between September 12, 2020, and February 8, 2021, were reviewed. Primary exposure is neighborhood-level Social Vulnerability Index (SVI) based on the patient's residential location. SVI is a rank score of 15 social factors into four themes (socioeconomic status, household composition/disability, minority status/language, and housing type/transportation), ranging from 0 to 1.0, with higher ranks indicating greater social vulnerability. The overall SVI score and each theme were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, appointment status (new or established), race, and distance from clinic. The primary outcome, non-adherence, was defined as missing more than 25% of scheduled appointments. RESULTS Of 8,322 patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) with scheduled appointments, 28% were non-adherent. Non-adherence was associated with greater social vulnerability (adjusted odds ratio [aOR] per 0.01 increase in overall SVI = 2.46 [95% confidence interval, 1.99, 3.06]) and each SVI theme (socioeconomic status: aOR = 2.38 [1.94, 2.91]; household composition/disability: aOR = = 1.51 [1.26, 1.81]; minority status/language: aOR = 2.03 [1.55, 2.68]; housing type/transportation: aOR = 1.41 [1.16, 1.73]). CONCLUSION Neighborhood-level social vulnerability is associated with greater risk of non-adherence to scheduled ophthalmology appointments, controlling for individual characteristics. Multi-level intervention strategies that incorporate neighborhood-level vulnerabilities are needed to reduce disparities in access to ophthalmology care.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Sasha Kravets
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, Chicago, IL 60612, United States
| | - Joelle A. Hallak
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Population Health Sciences Program, University of Illinois Chicago, 1220 S. Wood Street, Chicago, IL 60657, United States
| | - Jerry A. Krishnan
- Institute for Healthcare Delivery Design, Population Health Sciences Program, University of Illinois Chicago, 1220 S. Wood Street, Chicago, IL 60657, United States
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Sage J. Kim
- Division of Health Policy & Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, Chicago, IL 60612, United States
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Reyes Nieva H, Bakken S, Elhadad N. Mining the health disparities and minority health bibliome: A computational scoping review and gap analysis of 200,000+ articles. SCIENCE ADVANCES 2024; 10:eadf9033. [PMID: 38266089 PMCID: PMC10807818 DOI: 10.1126/sciadv.adf9033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
Without comprehensive examination of available literature on health disparities and minority health (HDMH), the field is left vulnerable to disproportionately focus on specific populations or conditions, curtailing our ability to fully advance health equity. Using scalable open-source methods, we conducted a computational scoping review of more than 200,000 articles to investigate major populations, conditions, and themes as well as notable gaps. We also compared trends in studied conditions to their relative prevalence using insurance claims (42 million Americans). HDMH publications represent 1% of articles in Medical Literature Analysis and Retrieval System Online (MEDLINE). Most studies are observational in nature, although randomized trial reporting has increased fivefold in the past 20 years. Half of HDMH articles concentrate on only three disease groups (cancer, mental health, and endocrine/metabolic disorders), while hearing, vision, and skin-related conditions are among the least well represented despite substantial prevalence. To support further investigation, we present HDMH Monitor, an interactive dashboard and repository generated from the HDMH bibliome.
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Affiliation(s)
- Harry Reyes Nieva
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
- School of Nursing, Columbia University, NY, New York 10032, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
- Data Science Institute, Columbia University, New York, NY 10027, USA
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ElSayed NA, Bannuru RR, Bakris G, Bardsley J, de Boer IH, Gabbay RA, Gockerman J, McCoy RG, McCracken E, Neumiller JJ, Pilla SJ, Rhee CM. Diabetic Kidney Disease Prevention Care Model Development. Clin Diabetes 2023; 42:274-294. [PMID: 38694240 PMCID: PMC11060626 DOI: 10.2337/cd23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.
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Affiliation(s)
- Nuha A. ElSayed
- American Diabetes Association, Alexandria, VA
- Harvard Medical School, Boston, MA
| | | | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago School of Medicine, Chicago, IL
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar System Nursing, Columbia, MD
| | - Ian H. de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | | | | | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, University of Maryland Institute for Health Computing, Rockville, MD
| | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
- Providence Medical Research Center, Providence Health Care, Spokane, WA
| | - Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie M. Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Irvine, CA
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Nieva HR, Bakken S, Elhadad N. Mining the Health Disparities and Minority Health Bibliome: A Computational Scoping Review and Gap Analysis of 200,000+ Articles. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.17.23296754. [PMID: 37905137 PMCID: PMC10615014 DOI: 10.1101/2023.10.17.23296754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Without comprehensive examination of available literature on health disparities and minority health (HDMH), the field is left vulnerable to disproportionately focus on specific populations or conditions, curtailing our ability to fully advance health equity. Using scalable open-source methods, we conducted a computational scoping review of more than 200,000 articles to investigate major populations, conditions, and themes in the literature as well as notable gaps. We also compared trends in studied conditions to their relative prevalence in the general population using insurance claims (42MM Americans). HDMH publications represent 1% of articles in MEDLINE. Most studies are observational in nature, though randomized trial reporting has increased five-fold in the last twenty years. Half of all HDMH articles concentrate on only three disease groups (cancer, mental health, endocrine/metabolic disorders), while hearing, vision, and skin-related conditions are among the least well represented despite substantial prevalence. To support further investigation, we also present HDMH Monitor, an interactive dashboard and repository generated from the HDMH bibliome.
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Affiliation(s)
- Harry Reyes Nieva
- Department of Biomedical Informatics, Columbia University
- Department of Medicine, Harvard Medical School
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University
- School of Nursing, Columbia University
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University
- Data Science Institute, Columbia University
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10
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Youn EJ, Shin C, Haratian R, Guzman A, Kim JY, McGahan P, Chen JL. Income and Insurance Status Impact Access to Health Care for Hip Osteoarthritis. Arthrosc Sports Med Rehabil 2023; 5:100747. [PMID: 37645390 PMCID: PMC10461205 DOI: 10.1016/j.asmr.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/18/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To explore differences in the affordability of and accessibility to health care among adults with hip osteoarthritis with respect to race/ethnicity, income, and insurance status. Methods This cross-sectional retrospective study was conducted using 2016 National Health Interview Survey (NHIS) data. NHIS data collection occurred continuously from January to December 2016. Individuals belonging to households and noninstitutionalized groups were included in the study. Because NHIS randomized surveys are conducted face-to-face on an annual basis, follow-up data are not collected. Results Answers from 38,158,634 weighted respondents with a mean age of 58.33 ± 0.33 years were assessed. Among adults with hip osteoarthritis, those with public insurance had increased odds of delaying care owing to lack of transportation and had decreased odds of delaying care and follow-up care owing to cost. Individuals who were uninsured or who belonged to lower income brackets were associated with increased odds of being unable to afford or utilize health care. Conclusions In this study, we found that income bracket and insurance status affect the accessibility to health care among adults with hip osteoarthritis in the United States. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Erin J. Youn
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
- Williams College, Williamstown, Massachusetts, U.S.A
| | - Caleb Shin
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ryan Haratian
- Department of Orthopaedic Surgery, Sports Medicine & Rehabilitation, Wright State University Boonshoft School of Medicine, Dayton, Ohio, U.S.A
| | - Alvarho Guzman
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Joo Yeon Kim
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - James L. Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
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11
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Lagu T, Schroth SL, Haywood C, Heinemann A, Kessler A, Morse L, Khan SS, Kershaw KN, Nash MS. Diagnosis and Management of Cardiovascular Risk in Individuals With Spinal Cord Injury: A Narrative Review. Circulation 2023; 148:268-277. [PMID: 37459417 PMCID: PMC10403284 DOI: 10.1161/circulationaha.123.064859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
More than 16 000 Americans experience spinal cord injury (SCI), resulting in chronic disability and other secondary sequelae, each year. Improvements in acute medical management have increased life expectancy. Cardiovascular disease is a leading cause of death in this population, and seems to occur earlier in individuals with SCI compared with the general population. People with SCI experience a high burden of traditional cardiovascular disease risk factors, including dyslipidemia and diabetes, and demonstrate anatomic, metabolic, and physiologic changes alongside stark reductions in physical activity after injury. They also experience multiple, complex barriers to care relating to disability and, in many cases, compounding effects of intersecting racial and socioeconomic health inequities. Given this combination of risk factors, some investigators have proposed that people with SCI are at increased risk for cardiovascular disease, beyond that associated with traditional risk factors, and SCI could be considered a risk-enhancing factor, analogous to other risk-enhancing factors defined by the 2019 American Heart Association/American College of Cardiology Primary Prevention Guidelines. However, more research is needed in this population to clarify the role of traditional risk factors, novel risk factors, health care access, social determinants of health, and intersectionality of disability, race, and socioeconomic status. There is an urgent need for primary care physicians and cardiologists to have awareness of the importance of timely diagnosis and management of cardiac risk factors for people with SCI.
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Affiliation(s)
- Tara Lagu
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (T.L., S.L.S., C.H., A.H., A.K., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Divisions of Hospital Medicine (T.L.), Northwestern Feinberg School of Medicine, Chicago, IL
- Department of Medicine (T.L., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
| | - Samantha L Schroth
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (T.L., S.L.S., C.H., A.H., A.K., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Cardiology (S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Departments of Pathology (S.L.S.), Northwestern Feinberg School of Medicine, Chicago, IL
| | - Carol Haywood
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (T.L., S.L.S., C.H., A.H., A.K., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Medical Social Sciences (C.H.), Northwestern Feinberg School of Medicine, Chicago, IL
| | - Allen Heinemann
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (T.L., S.L.S., C.H., A.H., A.K., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Physical Medicine and Rehabilitation (A.H., A.K.), Northwestern Feinberg School of Medicine, Chicago, IL
| | - Allison Kessler
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (T.L., S.L.S., C.H., A.H., A.K., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Physical Medicine and Rehabilitation (A.H., A.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Shirley Ryan Ability Lab, Chicago, IL (A.K., A.K.)
| | - Leslie Morse
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis (L.M.)
| | - Sadiya S Khan
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (T.L., S.L.S., C.H., A.H., A.K., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Department of Medicine (T.L., S.S.K.), Northwestern Feinberg School of Medicine, Chicago, IL
- Preventive Medicine (S.S.K., K.N.K.), Northwestern Feinberg School of Medicine, Chicago, IL
| | - Kiarri N Kershaw
- Preventive Medicine (S.S.K., K.N.K.), Northwestern Feinberg School of Medicine, Chicago, IL
| | - Mark S Nash
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, FL (M.S.N.)
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Masters RK, Tilstra AM, Simon DH, Coleman-Minahan K. Differences in Determinants: Racialized Obstetric Care and Increases in U.S. State Labor Induction Rates. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:174-191. [PMID: 37098856 PMCID: PMC10848243 DOI: 10.1177/00221465231165284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states' IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states' racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states' White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not "centered at the margins" but is instead responsive to characteristics in states' White populations.
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Affiliation(s)
- Ryan K. Masters
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Andrea M. Tilstra
- University of Colorado Population Center, Boulder, CO, USA
- Oxford University, Oxford, UK
| | - Daniel H. Simon
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Kate Coleman-Minahan
- University of Colorado Population Center, Boulder, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Tanumihardjo JP, Davis H, Christensen J, Smith RA, Kauffman-Smith S, Gunter KE. Hospital-Based, Community Teaching Kitchen Integrates Diabetes Education, Culinary Medicine, and Food Assistance: Case Study During the COVID-19 Pandemic. J Gen Intern Med 2023; 38:33-37. [PMID: 36864275 PMCID: PMC9980866 DOI: 10.1007/s11606-022-07931-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/01/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Recent USDA Economic Research Service Population Survey cites a stabilization of food insecurity overall in the USA between 2019 and 2020, but Black, Hispanic, and all households with children cited increases - underscoring that the COVID-19 pandemic caused severe disruptions to food insecurity for historically disenfranchised populations. AIM Describe lessons learned, considerations, and recommendations from the experience of a community teaching kitchen (CTK) in addressing food insecurity and chronic disease management among patients during the COVID-19 pandemic. SETTING The Providence CTK is co-located at Providence Milwaukie Hospital in Portland, Oregon. PARTICIPANTS Providence CTK serves patients who report a higher prevalence of food insecurity and multiple chronic conditions. PROGRAM DESCRIPTION Providence CTK has five components: chronic disease self-management education, culinary nutrition education, patient navigation, a medical referral-based food pantry (Family Market), and an immersive training environment. PROGRAM EVALUATION CTK staff highlight that they provided food and education support when it was needed most, leveraged existing partnerships and staffing to sustain operations and Family Market accessibility, shifted delivery of educational services based-on billing and virtual service considerations, and repurposed roles to support evolving needs. DISCUSSION The Providence CTK case study provides a blueprint for how healthcare organizations could design a model of culinary nutrition education that is immersive, empowering, and inclusive.
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Affiliation(s)
| | - Heidi Davis
- Community Teaching Kitchen, Providence Milwaukie Hospital, Providence Health & Services, Milwaukie, OR, USA.
| | - Jill Christensen
- Community Teaching Kitchen, Providence Milwaukie Hospital, Providence Health & Services, Milwaukie, OR, USA
| | - Rachel A Smith
- Community Health Division, Providence Health & Services, Portland, OR, USA
| | | | - Kathryn E Gunter
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
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Saulsberry L, Gunter KE, O'Neal Y, Tanumihardjo J, Gauthier R, Chin MH, Peek ME. "Everything in One Place": Stakeholder Perceptions of Integrated Medical and Social Care for Diabetes Patients in Western Maryland. J Gen Intern Med 2023; 38:25-32. [PMID: 36864266 PMCID: PMC10043057 DOI: 10.1007/s11606-022-07919-1] [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: 04/13/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Patients with type 2 diabetes frequently have both medical- and health-related social needs that must be addressed for optimal disease management. Growing evidence suggests that intersectoral partnerships between health systems and community-based organizations may effectively support improved health outcomes for patients with diabetes. OBJECTIVE The purpose of this study was to describe stakeholders' perceptions of the implementation factors associated with a diabetes management program, an intervention involving coordinated clinical and social services supports to address both medical- and health-related social needs. This intervention delivers proactive care alongside community partnerships, and leverages innovative financing mechanisms. DESIGN Qualitative study with semi-structured interviews. PARTICIPANTS Study participants included adults (18 years or older) who were patients with diabetes and essential staff (e.g., members of a diabetes care team, health care administrators) and leaders of community-based organizations. APPROACH We used the Consolidated Framework for Implementation Research (CFIR) to develop a semi-structured interview guide designed to elicit perspectives from patients and essential staff on their experiences within an outpatient center to support patients with chronic conditions (the CCR) as a part of an intervention to improve care for patients with diabetes. KEY RESULTS Interviews illuminated three key takeaways: (1) team-based care held an important role in promoting accountability across stakeholders motivating patient engagement and positive perceptions, (2) mission-driven alignment across the health care and community sectors was needed to synergize a broad range of efforts, and (3) global payment models allowing for flexible resource allocation can invaluably support the appropriate care being directed where it is needed the most whether medical or social services. CONCLUSIONS The views and experiences of patient and essential staff stakeholder groups reported here thematically according to CFIR domains may inform the development of other chronic disease interventions that address medical- and health-related social needs in additional settings.
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Affiliation(s)
- Loren Saulsberry
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA.
| | - Kathryn E Gunter
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Yolanda O'Neal
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jacob Tanumihardjo
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Richard Gauthier
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Marshall H Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for Diabetes Translation Research, Chicago, IL, USA
| | - Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for Diabetes Translation Research, Chicago, IL, USA
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Gay HC, Yu J, Persell SD, Linder JA, Srivastava A, Isakova T, Huffman MD, Khan SS, Mutharasan RK, Petito LC, Feinstein MJ, Shah SJ, Yancy CW, Kho AN, Ahmad FS. Comparison of Sodium-Glucose Cotransporter-2 Inhibitor and Glucagon-Like Peptide-1 Receptor Agonist Prescribing in Patients With Diabetes Mellitus With and Without Cardiovascular Disease. Am J Cardiol 2023; 189:121-130. [PMID: 36424193 PMCID: PMC9908071 DOI: 10.1016/j.amjcard.2022.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022]
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) reduce cardiovascular events and mortality in patients with type 2 diabetes mellitus (T2DM). We sought to describe trends in prescribing for SGLT2is and GLP1-RAs in diverse care settings, including (1) the outpatient clinics of a midwestern integrated health system and (2) small- and medium-sized community-based primary care practices and health centers in 3 midwestern states. We included adults with T2DM and ≥1 outpatient clinic visit. The outcomes of interest were annual active prescription rates for SGLT2is and GLP1-RAs (separately). In the integrated health system, 22,672 patients met the case definition of T2DM. From 2013 to 2019, the overall prescription rate for SGLT2is increased from 1% to 15% (absolute difference [AD] 14%, 95% confidence interval [CI] 13% to 15%, p <0.01). The GLP1-RA prescription rate was stable at 10% (AD 0%, 95% CI -1% to 1%, p = 0.9). In community-based primary care practices, 43,340 patients met the case definition of T2DM. From 2013 to 2017, the SGLT2i prescription rate increased from 3% to 7% (AD 4%, 95% CI 3% to 6%, p <0.01), whereas the GLP1-RA prescription rate was stable at 2% to 3% (AD 1%, 95% CI -1 to 1%, p = 0.40). In a fully adjusted regression model, non-Hispanic Black patients had lower odds of SGLT2i or GLP1-RA prescription (odds ratio 0.56, 95% CI 0.34 to 0.89, p = 0.016). In conclusion, the increase in prescription rates was greater for SGLT2is than for GLP1-RAs in patients with T2DM in a large integrated medical center and community primary care practices. Overall, prescription rates for eligible patients were low, and racial disparities were observed.
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Affiliation(s)
- Hawkins C Gay
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois
| | - Jingzhi Yu
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
| | - Stephen D Persell
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Department of Medicine-General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Jeffrey A Linder
- Department of Medicine-General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Anand Srivastava
- Department of Medicine-Nephrology, and Northwestern University, Chicago, Illinois
| | - Tamara Isakova
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Department of Medicine-Nephrology, and Northwestern University, Chicago, Illinois
| | - Mark D Huffman
- Department of Medicine-Cardiology, Washington University in St. Louis, St. Louis, Missouri; Global Health Center, Washington University in St. Louis, St. Louis, Missouri; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sadiya S Khan
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - R Kannan Mutharasan
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois
| | - Lucia C Petito
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J Feinstein
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois
| | - Sanjiv J Shah
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois
| | - Clyde W Yancy
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois
| | - Abel N Kho
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Department of Medicine-General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Faraz S Ahmad
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois; Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois.
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Hamrah MS, Bartlett L, Jang S, Roccati E, Vickers JC. Modifiable Risk Factors for Dementia Among Migrants, Refugees and Asylum Seekers in Australia: A Systematic Review. J Immigr Minor Health 2023; 25:692-711. [PMID: 36652152 DOI: 10.1007/s10903-022-01445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
While the prevalence of non-communicable disease risk factors is understood to be higher among migrants than for people born in host nations, little is known about the dementia risk profile of migrants, refugees and asylum seekers. This systematic review examines published literature to understand what is currently reported about 12 identified modifiable risk factors for dementia among migrants, refugees, and asylum seekers residing in Australia. Three literature databases (PubMed/CINAHL/MEDLINE) were systematically searched to find articles reporting excessive alcohol consumption, traumatic brain injury, air pollution, lack of education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and limited social contact in Australia's migrant, refugee and asylum seeker population samples. Papers were systematically reviewed following PRISMA guidelines. A total of 763 studies were found, of which 676 articles were excluded, and 79 articles remained. Despite wide variability in study design, size and purpose, the prevalence and correlates of modifiable risk factors of dementia appears markedly different among the studied samples. Compared with Australian-born participants, migrant samples had a higher prevalence of depression, social isolation, physical inactivity and diabetes mellitus. Insufficient information or conflicting evidence prevented inference about prevalence and correlates for the remaining dementia risk factors. A better understanding of the prevalence and correlates of modifiable dementia risk factors is needed in Australia's migrant, refugee and asylum seeker populations. This information, together with a deeper understanding of the contextual and cultural contributing factors affecting people who arrive in Australia through differing pathways is needed before preventive interventions can be realistically targeted and sensitively implemented.
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Affiliation(s)
- Mohammad Shoaib Hamrah
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia
| | - Larissa Bartlett
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia
| | - Sunny Jang
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia.
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia
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Russell AM, Opsasnick L, Yoon E, Bailey SC, O'Brien M, Wolf MS. Association between medication regimen complexity and glycemic control among patients with type 2 diabetes. J Am Pharm Assoc (2003) 2022; 63:769-777. [PMID: 36682933 DOI: 10.1016/j.japh.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/02/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) and comorbid conditions require patients to take complex medication regimens. Greater regimen complexity has been associated with poorer T2DM management; however, the relationship between overall regimen complexity and glycemic control is unclear. OBJECTIVES Our objectives were: (1) to examine associations between regimen complexity (with the Medication Regimen Complexity Index [MRCI]) and glycemic control (A1C), and (2) to compare overall MRCI with other measures of regimen complexity (overall and diabetes-specific medication count) and diabetes-specific MRCI. METHODS This was a secondary data analysis of cross-sectional data from a parent trial. Participants were patients with T2DM taking at least 3 chronic medications followed in safety net clinics in the Chicago area. The MRCI measures complexity based on dosing frequency, route of administration, and special instructions for prescribed medications. MRCI scores were created for overall regimens and diabetes-specific medications. Sociodemographics and outpatient visit utilization were included in models as covariates. Linear regression was used to examine the associations between variables of interest and hemoglobin A1C. RESULTS Participants (N = 432) had a mean age of 56.9 years, most were female (66.0%), and Hispanic or Latino (73.3%). Regimen complexity was high based on overall medications (mean = 6.6 medications, SD: 3.09) and MRCI (mean = 21.4, SD: 11.3). Higher diabetes-specific MRCI was associated with higher A1C in bivariate and multivariable models. In multivariable models, overall MRCI greater than 14, fewer outpatient health care visits, male gender, and absence of health insurance were independently associated with higher A1C. The variance in A1C explained by MRCI was higher compared to medication count for overall and diabetes-specific regimen complexity. CONCLUSIONS More complex regimens are associated with worse A1C and measuring complexity with MRCI may have advantages. Deprescribing, increasing insurance coverage, and promoting engagement in health care may improve A1C among underserved populations with complex regimens.
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Scanzera AC, Thermozier S, Chang AY, Kim SJ, Chan RP. Adherence to Urgent Eye Visits during the COVID-19 Pandemic: A Population Characteristics Study. Ophthalmic Epidemiol 2022; 29:613-620. [PMID: 34895007 PMCID: PMC9189247 DOI: 10.1080/09286586.2021.2015785] [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: 05/14/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore individual and community factors associated with adherence to physician recommended urgent eye visits via a tele-triage system during the COVID-19 pandemic. METHOD We retrospectively reviewed acute visit requests and medical exam data between April 6, 2020 and June 6, 2020. Patient demographics and adherence to visit were examined. Census tract level community characteristics from the U.S. Census Bureau and zip code level COVID-19 related death data from the Cook County Medical Examiner's Office were appended to each geocoded patient address. Descriptive statistics, t-tests, and logistic regression analyses were performed to explore the effects of individual and community variables on adherence to visit. RESULTS Of 229 patients recommended an urgent visit, 216 had matching criteria on chart review, and 192 (88.9%) adhered to their visit. No difference in adherence was found based on individual characteristics including: age (p = .24), gender (p = .94), race (p = .56), insurance (p = .28), nor new versus established patient status (p = .20). However, individuals who did not adhere were more likely to reside in neighborhoods with a greater proportion of Blacks (59.4% vs. 33.4%; p = .03), greater unemployment rates (17.5% vs. 10.7%; p < .01), and greater cumulative deaths from COVID-19 (56 vs. 31; p = .01). Unemployment rate continued to be statistically significant after controlling for race and cumulative deaths from COVID-19 (p = .04). CONCLUSION We found that as community unemployment rate increases, adherence to urgent eye visits decreases, after controlling for relevant neighborhood characteristics. Unemployment rates were highest in predominantly Black neighborhoods early in the pandemic, which may have contributed to existing racial disparities in eye care.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Stephanie Thermozier
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Arthur Y. Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Sage J. Kim
- Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Chicago, United States
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
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Gillis C, Montenigro P, Nejati M, Maserejian N. Estimating prevalence of early Alzheimer's disease in the United States, accounting for racial and ethnic diversity. Alzheimers Dement 2022; 19:1841-1848. [PMID: 36322470 DOI: 10.1002/alz.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Updated estimates of the US Alzheimer's disease (AD) population, including under-represented populations, are needed to improve clinical trial diversity. METHODS A step-wise approach calculating prevalent numbers from clinical syndrome to biomarker-positive mild cognitive impairment (MCI) due to AD and mild AD was developed, using age-and-race/ethnicity-stratified data where available. RESULTS The estimated percentage of Americans aged ≥ 65 years with MCI due to AD was 9.2% of non-Hispanic Whites, 13.6% of non-Hispanic Blacks, 11.1% Hispanics, and 9.7% other race/ethnicities. The estimated percentage of Americans aged ≥ 65 years with mild dementia due to AD among non-Hispanic Whites was 3.7%, non-Hispanic Blacks 7.0%, Hispanics 5.3%, and 3.9% other race/ethnicities. Of these early-stage AD cases, few are likely diagnosed, ranging from 13% of prevalent non-Hispanic Black cases to 27% of non-Hispanic White cases. DISCUSSION Under-representation in clinical trials may be improved by setting recruitment goals reflecting the diversity of the AD patient population and supporting efforts toward timely diagnosis.
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21
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Mitchell SE, Bragg A, De La Cruz BA, Winter MR, Reichert MJ, Laird L, Moldovan IA, Parker KN, Martin-Howard J, Gardiner P. Effectiveness of an immersive telemedicine platform for delivering diabetes medical group visits for African American/ Black and Hispanic/ Latina women with uncontrolled diabetes: The Women in Control 2.0 non-inferiority randomized clinical trial (Preprint). J Med Internet Res 2022; 25:e43669. [PMID: 37163341 DOI: 10.2196/43669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/12/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Medically underserved people with type 2 diabetes mellitus face limited access to group-based diabetes care, placing them at risk for poor disease control and complications. Immersive technology and telemedicine solutions could bridge this gap. OBJECTIVE The purpose of this study was to compare the effectiveness of diabetes medical group visits (DMGVs) delivered in an immersive telemedicine platform versus an in-person (IP) setting and establish the noninferiority of the technology-enabled approach for changes in hemoglobin A1c (HbA1c) and physical activity (measured in metabolic equivalent of task [MET]) at 6 months. METHODS This study is a noninferiority randomized controlled trial conducted from February 2017 to December 2019 at an urban safety net health system and community health center. We enrolled adult women (aged ≥18 years) who self-reported African American or Black race or Hispanic or Latina ethnicity and had type 2 diabetes mellitus and HbA1c ≥8%. Participants attended 8 weekly DMGVs, which included diabetes self-management education, peer support, and clinician counseling using a culturally adapted curriculum in English or Spanish. In-person participants convened in clinical settings, while virtual world (VW) participants met remotely via an avatar-driven, 3D VW linked to video teleconferencing. Follow-up occurred 6 months post enrollment. Primary outcomes were mean changes in HbA1c and physical activity at 6 months, with noninferiority margins of 0.7% and 12 MET-hours, respectively. Secondary outcomes included changes in diabetes distress and depressive symptoms. RESULTS Of 309 female participants (mean age 55, SD 10.6 years; n=195, 63% African American or Black; n=105, 34% Hispanic or Latina; n=151 IP; and n=158 in VW), 207 (67%) met per-protocol criteria. In the intention-to-treat analysis, we confirmed noninferiority for primary outcomes. We found similar improvements in mean HbA1c by group at 6 months (IP: -0.8%, SD 1.9%; VW: -0.5%, SD 1.8%; mean difference 0.3, 97.5% CI -∞ to 0.3; P<.001). However, there were no detectable improvements in physical activity (IP: -6.5, SD 43.6; VW: -9.6, SD 44.8 MET-hours; mean difference -3.1, 97.5% CI -6.9 to ∞; P=.02). The proportion of participants with significant diabetes distress and depressive symptoms at 6 months decreased in both groups. CONCLUSIONS In this noninferiority randomized controlled trial, immersive telemedicine was a noninferior platform for delivering diabetes care, eliciting comparable glycemic control improvement, and enhancing patient engagement, compared to IP DMGVs. TRIAL REGISTRATION ClinicalTrials.gov NCT02726425; https://clinicaltrials.gov/ct2/show/NCT02726425.
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22
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Cohen DJ, Wyte-Lake T, Bonsu P, Albert SL, Kwok L, Paul MM, Nguyen AM, Berry CA, Shelley DR. Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices. J Am Board Fam Med 2022:jabfm.2022.AP.210502. [PMID: 36113991 PMCID: PMC10515112 DOI: 10.3122/jabfm.2022.ap.210502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Guidelines for managing and preventing chronic disease tend to be well-known. Yet, translation of this evidence into practice is inconsistent. We identify a combination of factors that are connected to guideline concordant delivery of evidence-informed chronic disease care in primary care. METHODS Cross-sectional observational study; purposively selected 22 practices to vary on size, ownership and geographic location, using National Quality Forum metrics to ensure practices had a ≥ 70% quality level for at least 2 of the following: aspirin use in high-risk individuals, blood pressure control, cholesterol and diabetes management. Interviewed 2 professionals (eg, medical director, practice manager) per practice (n = 44) to understand staffing and clinical operations. Analyzed data using an iterative and inductive approach. RESULTS Community Health Centers (CHCs) employed interdisciplinary clinical teams that included a variety of professionals as compared with hospital-health systems (HHS) and clinician-owned practices. Despite this difference, practice members consistently reported a number of functions that may be connected to clinical chronic care quality, including: having engaged leadership; a culture of teamwork; engaging in team-based care; using data to inform quality improvement; empaneling patients; and managing the care of patient panels, with a focus on continuity and comprehensiveness, as well as having a commitment to the community. CONCLUSIONS There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.
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Affiliation(s)
- Deborah J Cohen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
| | - Tamar Wyte-Lake
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Pamela Bonsu
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Stephanie L Albert
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Lorraine Kwok
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Margaret M Paul
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Ann M Nguyen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Carolyn A Berry
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Donna R Shelley
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
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Schwartz GL, Wang G, Kershaw KN, McGowan C, Kim MH, Hamad R. The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans. Health Place 2022; 77:102904. [PMID: 36063651 PMCID: PMC10166594 DOI: 10.1016/j.healthplace.2022.102904] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/10/2023]
Abstract
Residential racial segregation is a key manifestation of anti-Black structural racism, thought to be a fundamental cause of poor health; evidence has shown that it yields neighborhood disinvestment, institutional discrimination, and targeting of unhealthy products like tobacco and alcohol. Yet research on the long-term impacts of childhood exposure to residential racial segregation is limited. Here, we analyzed data on 1823 Black participants in the Panel Study of Income Dynamics, estimating associations between childhood segregation trajectories and young adult health. Black young adults who consistently lived in high-segregation neighborhoods throughout childhood experienced unhealthier smoking and drinking behaviors and higher odds of obesity compared to other trajectory groups, including children who moved into or out of high-segregation neighborhoods. Results were robust to controls for neighborhood and family poverty. Findings underscore that for Black children who grow up in segregated neighborhoods, the roots of structurally-determined health inequities are established early in life.
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Affiliation(s)
- Gabriel L Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States.
| | - Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N Kershaw
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
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Lim JI, Regillo CD, Sadda SR, Ipp E, Bhaskaranand M, Ramachandra C, Solanki K. Artificial Intelligence Detection of Diabetic Retinopathy: Subgroup Comparison of the EyeArt System with Ophthalmologists' Dilated Exams. OPHTHALMOLOGY SCIENCE 2022; 3:100228. [PMID: 36345378 PMCID: PMC9636573 DOI: 10.1016/j.xops.2022.100228] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022]
Abstract
Objective To compare general ophthalmologists, retina specialists, and the EyeArt Artificial Intelligence (AI) system to the clinical reference standard for detecting more than mild diabetic retinopathy (mtmDR). Design Prospective, pivotal, multicenter trial conducted from April 2017 to May 2018. Participants Participants were aged ≥ 18 years who had diabetes mellitus and underwent dilated ophthalmoscopy. A total of 521 of 893 participants met these criteria and completed the study protocol. Testing Participants underwent 2-field fundus photography (macula centered, disc centered) for the EyeArt system, dilated ophthalmoscopy, and 4-widefield stereoscopic dilated fundus photography for reference standard grading. Main Outcome Measures For mtmDR detection, sensitivity and specificity of EyeArt gradings of 2-field, fundus photographs and ophthalmoscopy grading versus a rigorous clinical reference standard comprising Reading Center grading of 4-widefield stereoscopic dilated fundus photographs using the ETDRS severity scale. The AI system provided automatic eye-level results regarding mtmDR. Results Overall, 521 participants (999 eyes) at 10 centers underwent dilated ophthalmoscopy: 406 by nonretina and 115 by retina specialists. Reading Center graded 207 positive and 792 eyes negative for mtmDR. Of these 999 eyes, 26 eyes were ungradable by the EyeArt system, leaving 973 eyes with both EyeArt and Reading Center gradings. Retina specialists correctly identified 22 of 37 eyes as positive (sensitivity 59.5%) and 182 of 184 eyes as negative (specificity 98.9%) for mtmDR versus the EyeArt AI system that identified 36 of 37 as positive (sensitivity 97%) and 162 of 184 eyes as negative (specificity of 88%) for mtmDR. General ophthalmologists correctly identified 35 of 170 eyes as positive (sensitivity 20.6%) and 607 of 608 eyes as negative (specificity 99.8%) for mtmDR compared with the EyeArt AI system that identified 164 of 170 as positive (sensitivity 96.5%) and 525 of 608 eyes as negative (specificity 86%) for mtmDR. Conclusions The AI system had a higher sensitivity for detecting mtmDR than either general ophthalmologists or retina specialists compared with the clinical reference standard. It can potentially serve as a low-cost point-of-care diabetic retinopathy detection tool and help address the diabetic eye screening burden.
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Long-Term Effectiveness of the TIME Intervention to Improve Diabetes Outcomes in Low-Income Settings: a 2-Year Follow-Up. J Gen Intern Med 2022; 37:3062-3069. [PMID: 35132555 PMCID: PMC8821843 DOI: 10.1007/s11606-021-07363-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/16/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND We previously found that a 6-month multidimensional diabetes program, TIME (Telehealth-Supported, Integrated Community Health Workers, Medication-Access) resulted in improved clinical outcomes. OBJECTIVE To follow TIME participant clinical outcomes for 24 months PARTICIPANTS: Low-income Latino(a)s with type 2 diabetes DESIGN AND INTERVENTION: We collected post-intervention clinical data for five cohorts (n = 101, mean n = 20/cohort) who participated in TIME programs from 2018 to 2020 in Houston, Texas. MAIN MEASURES We gathered HbA1c (primary outcome), weight, body mass index (BMI), and blood pressure data at baseline, 6 months (intervention end), and semiannually thereafter until 24 months after baseline to assess sustainability. We also evaluated participant loss to follow-up until 24 months. KEY RESULTS Participants decreased HbA1c levels during the intervention (p < 0.0001) and maintained these improvements at each timepoint from baseline to 24 months (p range: < 0.0001 to 0.015). Participants reduced blood pressure levels during TIME and maintained these changes at each timepoint from baseline until 18 months (systolic p range < 0.0001 to 0.0005, diastolic p range: < 0.0001 to 0.008) but not at 24 months (systolic: p = 0.065; diastolic: p = 0.85). There were no significant weight changes during TIME or post-intervention: weight (p range = 0.07 to 0.77), BMI (p range = 0.11 to 0.71). Attrition rates (loss to follow-up during the post-intervention period) were 5.9% (6 months), 24.8% (12 months), 35.6% (18 months), and 41.8% (24 months). CONCLUSIONS It is possible for vulnerable populations to maintain long-term glycemic and blood pressure improvements using a multiple dimensional intervention. Attrition rates rose over time but show promise given the majority of post-intervention timepoints occurred during the COVID-19 pandemic when low-income populations were most susceptible to suboptimal healthcare access. Future studies are needed to evaluate longitudinal outcomes of diabetes interventions conducted by local clinics rather than research teams.
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Atilano SR, Abedi S, Ianopol NV, Singh MK, Norman JL, Malik D, Falatoonzadeh P, Chwa M, Nesburn AB, Kuppermann BD, Kenney MC. Differential Epigenetic Status and Responses to Stressors between Retinal Cybrids Cells with African versus European Mitochondrial DNA: Insights into Disease Susceptibilities. Cells 2022; 11:2655. [PMID: 36078063 PMCID: PMC9454894 DOI: 10.3390/cells11172655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial (mt) DNA can be classified into haplogroups, which represent populations with different geographic origins. Individuals of maternal African backgrounds (L haplogroup) are more prone to develop specific diseases compared those with maternal European-H haplogroups. Using a cybrid model, effects of amyloid-β (Amyβ), sub-lethal ultraviolet (UV) radiation, and 5-Aza-2'-deoxycytidine (5-aza-dC), a methylation inhibitor, were investigated. Amyβ treatment decreased cell metabolism and increased levels of reactive oxygen species in European-H and African-L cybrids, but lower mitochondrial membrane potential (ΔΨM) was found only in African-L cybrids. Sub-lethal UV radiation induced higher expression levels of CFH, EFEMP1, BBC3, and BCL2L13 in European-H cybrids compared to African-L cybrids. With respect to epigenetic status, the African-L cybrids had (a) 4.7-fold higher total global methylation levels (p = 0.005); (b) lower expression patterns for DNMT3B; and (c) elevated levels for HIST1H3F. The European-H and African-L cybrids showed different transcription levels for CFH, EFEMP1, CXCL1, CXCL8, USP25, and VEGF after treatment with 5-aza-dC. In conclusion, compared to European-H haplogroup cybrids, the African-L cybrids have different (i) responses to exogenous stressors (Amyβ and UV radiation), (ii) epigenetic status, and (iii) modulation profiles of methylation-mediated downstream complement, inflammation, and angiogenesis genes, commonly associated with various human diseases.
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Affiliation(s)
- Shari R. Atilano
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - Sina Abedi
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - Narcisa V. Ianopol
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - Mithalesh K. Singh
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - J Lucas Norman
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - Deepika Malik
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - Payam Falatoonzadeh
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - Marilyn Chwa
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - Anthony B. Nesburn
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Baruch D. Kuppermann
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
| | - M. Cristina Kenney
- Gavin Herbert Eye Institute, Ophthalmology Research Laboratory, University of California Irvine, Hewitt Hall, Room 2028, 843 Health Science Rd., Irvine, CA 92697, USA
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA 92697, USA
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Standen EC, Finch LE, Tiongco-Hofschneider L, Schopp E, Lee KM, Parker JE, Bamishigbin ON, Tomiyama AJ. Healthy versus unhealthy comfort eating for psychophysiological stress recovery in low-income Black and Latinx adults. Appetite 2022; 176:106140. [PMID: 35718313 DOI: 10.1016/j.appet.2022.106140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022]
Abstract
Low-income Black and Latinx individuals are disproportionately vulnerable to chronic stress and metabolic disease. Evidence suggests that these populations engage in elevated levels of comfort eating (i.e., eating comforting food to alleviate stress), which can harm diet quality. For this reason, many interventions discourage comfort eating. However, if comfort eating does indeed buffer stress, it may be a protective health behavior, particularly if healthy foods (e.g., strawberries) buffer stress as effectively as traditional unhealthy comfort foods (e.g., brownies). By choosing healthy foods, people may be able to simultaneously improve their nutrition and reduce their stress levels, both of which have the potential to reduce health disparities among chronically stressed populations. The present study tested the efficacy of healthy and unhealthy comfort eating for improving psychophysiological stress recovery. A sample of low-income Black and Latinx individuals (N = 129) were randomly assigned to consume a healthy food (e.g., grapes), unhealthy comfort food (e.g., chips), or no food after exposure to a laboratory stressor. Throughout, we measured participants' psychophysiological stress responses, including self-reported stress, rumination, autonomic nervous system activation (i.e., electrodermal activity (EDA), heart rate variability (HRV)) and neuroendocrine responses (i.e., salivary cortisol). We compared participants' stress recovery trajectories by condition and found no significant group differences (p = 0.12 for self-reported stress; p = 0.92 for EDA; p = 0.22 for HRV, p = 1.00 for cortisol). Participants in all conditions showed decreases in self-reported stress and in cortisol post-stressor (ps < 0.01), but rates of decline did not differ by condition (i.e., healthy or unhealthy comfort food, brief no-food waiting period). Although null, these results are important because they challenge the widely-held assumption that comfort foods help people decrease stress.
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Affiliation(s)
- Erin C Standen
- University of Minnesota, Twin Cities, 75 E River Road, Minneapolis, MN, 55455, USA.
| | - Laura E Finch
- NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL, 60603, USA.
| | | | - Emma Schopp
- National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892, USA.
| | - Kristen M Lee
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Jordan E Parker
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | | | - A Janet Tomiyama
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
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Nikitin D, Lin GA, Campbell JD, Hansen RN, Brouwer E, Chen Y, Herron-Smith S, Agboola F, Pearson SD. The effectiveness and value of tirzepatide for type 2 diabetes mellitus. J Manag Care Spec Pharm 2022; 28:680-684. [PMID: 35621725 PMCID: PMC10373002 DOI: 10.18553/jmcp.2022.28.6.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Grace A Lin
- Institute for Clinical and Economic Review, Boston, MA
- Department of Medicine and Philip R Lee Institute for Health Policy Studies, University of California, San Francisco
| | | | - Ryan N Hansen
- CHOICE Institute, Department of Pharmacy, University of Washington, Seattle
| | - Elizabeth Brouwer
- CHOICE Institute, Department of Pharmacy, University of Washington, Seattle
| | - Yilin Chen
- CHOICE Institute, Department of Pharmacy, University of Washington, Seattle
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29
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Premji R, Nylen ES, Naser N, Gandhi S, Burman KD, Sen S. Lipid Profile Changes Associated with SGLT-2 Inhibitors and GLP-1 Agonists in Diabetes and Metabolic Syndrome. Metab Syndr Relat Disord 2022; 20:321-328. [PMID: 35452324 DOI: 10.1089/met.2022.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The introduction of sodium glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in type 2 diabetes mellitus treatment has shown an unexpectedly significant improvement in heart disease outcome trials. Although they have very different modes of action, a portion of the salutary cardiovascular disease improvement may be related to their impact on diabetic dyslipidemia. As discussed in this focused review, the sodium glucose transporter-2 inhibitors as a class show a mild increase in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels, while triglycerides (TG) decrease inconsistently. In particular, the rise in LDL appears to be related to the less atherogenic, large buoyant LDL particles. The glucagon-like peptide-1 receptor agonists show more of an impact on weight loss and improvement in the underlying low HDL and high TG dyslipidemia. The effect of sodium glucose transporter-2 inhibitors and glucagon-like peptide 1 receptor agonists when used in combination remains largely unknown. Also unexplored is difference in effect of these medications among various ethnicities and metabolic syndrome.
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Affiliation(s)
- Resmi Premji
- Montage Medical Group, Monterey, California, USA
| | - Eric S Nylen
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Nejat Naser
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Shruti Gandhi
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth D Burman
- Department of Endocrinology, Georgetown University School of Medicine, Washington Hospital Center, Washington, District of Columbia, USA
| | - Sabyasachi Sen
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
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Hill-Briggs F, Ephraim PL, Vrany EA, Davidson KW, Pekmezaris R, Salas-Lopez D, Alfano CM, Gary-Webb TL. Social Determinants of Health, Race, and Diabetes Population Health Improvement: Black/African Americans as a Population Exemplar. Curr Diab Rep 2022; 22:117-128. [PMID: 35239086 PMCID: PMC8891426 DOI: 10.1007/s11892-022-01454-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW To summarize evidence of impact of social determinants of health (SDOH) on diabetes risk, morbidity, and mortality and to illustrate this impact in a population context. RECENT FINDINGS Key findings from the American Diabetes Association's scientific review of five SDOH domains (socioeconomic status, neighborhood and physical environment, food environment, health care, social context) are highlighted. Population-based data on Black/African American adults illustrate persisting diabetes disparities and inequities in the SDOH conditions in which this population is born, grows, lives, and ages, with historical contributors. SDOH recommendations from US national committees largely address a health sector response, including health professional education, SDOH measurement, and patient referral to services for social needs. Fewer recommendations address solutions for systemic racism and socioeconomic discrimination as root causes. SDOH are systemic, population-based, cyclical, and intergenerational, requiring extension beyond health care solutions to multi-sector and multi-policy approaches to achieve future population health improvement.
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Affiliation(s)
- Felicia Hill-Briggs
- grid.250903.d0000 0000 9566 0634Institute of Health System Science, Feinstein Institutes for Medical Research at Northwell Health, 130 E 59th St, Ste 14C, New York, NY 10022 USA
| | - Patti L. Ephraim
- grid.250903.d0000 0000 9566 0634Institute of Health System Science, Feinstein Institutes for Medical Research at Northwell Health, 130 E 59th St, Ste 14C, New York, NY 10022 USA
| | - Elizabeth A. Vrany
- grid.250903.d0000 0000 9566 0634Institute of Health System Science, Feinstein Institutes for Medical Research at Northwell Health, 130 E 59th St, Ste 14C, New York, NY 10022 USA
| | - Karina W. Davidson
- grid.250903.d0000 0000 9566 0634Institute of Health System Science, Feinstein Institutes for Medical Research at Northwell Health, 130 E 59th St, Ste 14C, New York, NY 10022 USA
| | - Renee Pekmezaris
- grid.250903.d0000 0000 9566 0634Institute of Health System Science, Feinstein Institutes for Medical Research at Northwell Health, 130 E 59th St, Ste 14C, New York, NY 10022 USA
| | - Debbie Salas-Lopez
- grid.416477.70000 0001 2168 3646Department of Community and Population Health at Northwell Health, Manhasset, NY USA
| | - Catherine M. Alfano
- grid.250903.d0000 0000 9566 0634Institute of Health System Science, Feinstein Institutes for Medical Research at Northwell Health, 130 E 59th St, Ste 14C, New York, NY 10022 USA
- grid.250903.d0000 0000 9566 0634Institute of Cancer Research, Feinstein Institutes for Medical Research at Northwell Health, NY Manhasset, USA
| | - Tiffany L. Gary-Webb
- grid.21925.3d0000 0004 1936 9000Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA USA
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Prevalence and predictors of stroke among individuals with prediabetes and diabetes in Florida. BMC Public Health 2022; 22:243. [PMID: 35125102 PMCID: PMC8818177 DOI: 10.1186/s12889-022-12666-3] [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: 10/06/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of both prediabetes and diabetes have been increasing in Florida. These increasing trends will likely result in increases of stroke burden since both conditions are major risk factors of stroke. However, not much is known about the prevalence and predictors of stroke among adults with prediabetes and diabetes and yet this information is critical for guiding health programs aimed at reducing stroke burden. Therefore, the objectives of this study were to estimate the prevalence and identify predictors of stroke among persons with either prediabetes or diabetes in Florida. Methods The 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey data were obtained from the Florida Department of Health and used for the study. Weighted prevalence estimates of stroke and potential predictor variables as well as their 95% confidence intervals were computed for adults with prediabetes and diabetes. A conceptual model of predictors of stroke among adults with prediabetes and diabetes was constructed to guide statistical model building. Two multivariable logistic models were built to investigate predictors of stroke among adults with prediabetes and diabetes. Results The prevalence of stroke among respondents with prediabetes and diabetes were 7.8% and 11.2%, respectively. The odds of stroke were significantly (p ≤ 0.05) higher among respondents with prediabetes that were ≥ 45 years old (Odds ratio [OR] = 2.82; 95% Confidence Interval [CI] = 0.74, 10.69), had hypertension (OR = 5.86; CI = 2.90, 11.84) and hypercholesterolemia (OR = 3.93; CI = 1.84, 8.40). On the other hand, the odds of stroke among respondents with diabetes were significantly (p ≤ 0.05) higher if respondents were non-Hispanic Black (OR = 1.79; CI = 1.01, 3.19), hypertensive (OR = 3.56; CI = 1.87, 6.78) and had depression (OR = 2.02; CI = 1.14, 3.59). Conclusions Stroke prevalence in Florida is higher among adults with prediabetes and diabetes than the general population of the state. There is evidence of differences in the importance of predictors of stroke among populations with prediabetes and those with diabetes. These findings are useful for guiding health programs geared towards reducing stroke burden among populations with prediabetes and diabetes.
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Torres HA, Schmidt VA. Maximizing diabetes education efforts in vulnerable populations - newer delivery concepts. Curr Opin Endocrinol Diabetes Obes 2022; 29:23-28. [PMID: 34864758 DOI: 10.1097/med.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients from ethnic/minority backgrounds or low socioeconomic status face numerous barriers to achieving ideal diabetes care goals. The purpose of this review is to describe the burden of diabetes in vulnerable populations; discuss the etiologic factors leading to health disparities in diabetes; and present challenges and solutions to improving diabetes care through novel diabetes self-management education and support interventions. RECENT FINDINGS Recent interventions to alleviate health disparities utilize a combination of community health workers, peer leaders and technology-based approaches to provide diabetes self-management education and support and overcome barriers to diabetes control such as low literacy, difficulty with transportation, and cultural beliefs. These interventions achieve clinically meaningful improvements in blood glucose control as measured by haemoglobin A1C and are effective in addressing psychosocial outcomes such as diabetes distress. Research is underway to address food insecurity through food delivery and use behavioural economics principles to provide financial incentives to diabetes control. SUMMARY Combining human interaction through peer or community health worker led diabetes educational efforts and support with technology-based interventions shows promise in improving diabetes outcomes for vulnerable populations.
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Affiliation(s)
- Hugo A Torres
- Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Elhussein A, Anderson A, Bancks MP, Coday M, Knowler WC, Peters A, Vaughan EM, Maruthur NM, Clark JM, Pilla S. Racial/ethnic and socioeconomic disparities in the use of newer diabetes medications in the Look AHEAD study. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100111. [PMID: 35291207 PMCID: PMC8920048 DOI: 10.1016/j.lana.2021.100111] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022]
Abstract
Background Among patients with type 2 diabetes, minority racial/ethnic groups have a higher burden of cardiovascular disease, chronic kidney disease, and hypoglycaemia. These groups may especially benefit from newer diabetes medication classes, but high cost may limit access. We examined the association of race/ethnicity with the initiation of newer diabetes medications (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors). Methods We conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) trial including participants with at least one study visit after April 28, 2005. Cox proportional hazards models were used to estimate the association between race/ethnicity and socioeconomic factors with time to initiation of any newer diabetes medication from April 2005 to February 2020. Models were adjusted for demographic and clinical characteristics. Findings Among 4,892 participants, 63.6%, 15.7%, 12.6%, 5.2%, and 2.9% were White, Black, Hispanic, American Indian or Alaskan Native (AI/AN), or other race/ethnicity, respectively. During a median follow-up of 8.3 years, 2,180 (45.2%) participants were initiated on newer diabetes medications. Race/ethnicity was associated with newer diabetes medication initiation (p=.019). Specifically, initiation was lower among Black (HR 0.81, 95% CI 0.70 -0.94) and AI/AN participants (HR 0.51, 95% CI 0.26-0.99). Yearly family income was inversely associated with initiation of newer diabetes medications (HR 0.78, 95% CI 0.62-0.98) comparing the lowest and highest income groups. Findings were mostly driven by GLP-1 receptor agonists. Interpretation These findings provide evidence of racial/ethnic disparities in the initiation of newer diabetes medications, independent of socioeconomic factors, which may contribute to worse health outcomes.
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Affiliation(s)
- Ahmed Elhussein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Anderson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mace Coday
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Anne Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Nisa M. Maruthur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Jeanne M Clark
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Scott Pilla
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - The Look AHEAD Research Group
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
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McRae J, Onukwugha E. Why the Gap in Evaluating the Social Constructs and the Value of Medicines? PHARMACOECONOMICS 2021; 39:1365-1372. [PMID: 34458963 PMCID: PMC8403521 DOI: 10.1007/s40273-021-01075-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 05/07/2023]
Abstract
The compounding effects of occupying two or more social identities, such as being "Black" and "female" have been described in intersectionality theory. Intersectionality, a term coined by legal scholar and activist Kimberlé Crenshaw, is a framework to consider race and other social identities as overlapping, dynamic, and interdependent identities. Since its inception, intersectionality has made significant in-roads to inform the conceptualization and empirical investigations of race, gender, and other social identities in sociology, critical race theory, anthropology, feminist theory, and other disciplines. However, to date, cost effectiveness research has not systematically examined race intersecting with other social identities in the valuation of medicines using social theory, such as intersectionality. Consequently, cost effectiveness analysis, which is a method to study the value of medicines in diverse populations, has not been subject to sufficient examination through an intersectionality framework. In the US context, the racial injustices experienced and documented within diverse communities highlight that health outcomes cannot be examined in a vacuum; overlapping social identities such as race and class in relation to context have real effects on health behaviors, measured preferences, and economic costs. Failure to examine the effects of overlapping social identities on heterogeneity in benefits and costs can result in inadequate information for decision makers to evaluate the value of treatments. Without consideration of the overlapping social identities in diverse populations, there is a risk that cost effectiveness analysis results will not accurately reflect the value of treatments in socially disadvantaged populations. In this Current Opinion, we provide an outline for conducting socially conscious cost effectiveness analyses, using intersectionality as one example.
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Affiliation(s)
- Jacquelyn McRae
- Department of Pharmaceutical Health Services Research, University of Maryland, 220 N. Arch St, 12th Floor, Baltimore, MD, 21201, USA.
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland, 220 N. Arch St, 12th Floor, Baltimore, MD, 21201, USA
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Chin MH. New Horizons-Addressing Healthcare Disparities in Endocrine Disease: Bias, Science, and Patient Care. J Clin Endocrinol Metab 2021; 106:e4887-e4902. [PMID: 33837415 PMCID: PMC8083316 DOI: 10.1210/clinem/dgab229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.
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Affiliation(s)
- Marshall H Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago
- Corresponding author contact information: Marshall H. Chin, MD, MPH, University of Chicago, Section of General Internal Medicine, 5841 South Maryland Avenue, MC2007, Chicago, Illinois 60637 USA, (773) 702-4769 (telephone), (773) 834-2238 (fax), (e-mail)
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Modica C, Lewis JH, Bay RC. The Value Transformation Framework: Applied to Diabetes Control in Federally Qualified Health Centers. J Multidiscip Healthc 2021; 14:3005-3014. [PMID: 34737572 PMCID: PMC8558033 DOI: 10.2147/jmdh.s284885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/12/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Diabetes and pre-diabetes impact more than 114 million Americans. Federally qualified health centers (FQHCs) provide care to some of the most high-risk and underinsured individuals throughout the US, twenty-one percent of whom report being told they have diabetes, compared to 11% of the general adult population. It is widely agreed our health care system requires a transformation to effectively address diabetes and its complications. Objective By applying the Value Transformation Framework (VTF) in health centers, the National Association of Community Health Centers (NACHC) aims to show improvements in diabetes control. This systematic strategy to transform the way health centers operate can lead to improvements in health outcomes, patient and staff experiences, costs, and equity (Quintuple Aim). Special attention is paid to the health centers’ infrastructure, people systems and care delivery systems. Methods Evidence-based diabetes interventions, the learning community model, and the VTF were used together to drive system improvements and activate proven diabetes control practices within eight health centers. Multidisciplinary teams at select health centers in Georgia and Iowa, with their partner primary care associations, participated in this NACHC-led quality improvement project. Results During the one-year intervention (January 2017–December 2017), the mean raw percentage of patients with HbA1c Poor Control decreased from 50.9% (range, 23.7–70.4%) in January to 27.5% (range, 13.6–37.4%) in December. This represents a relative improvement in diabetes control of 46%. The 1-year-intervention data also showed trends in the desired direction with statistically significant improvements related to the following interventions: a formal written clinical policy, standing orders, patient recall/outreach, performance data shared at the provider/team-level, and performance data shared at the site/organization level. Conclusion A conceptual model focused on transforming health center systems, organized by the NACHC Value Transformation Framework and supported by a strong learning community, can lead to better diabetes control outcomes among patients seen at health centers.
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Affiliation(s)
- Cheryl Modica
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Joy H Lewis
- Medicine and Public Health, SOMA Department of Public Health, School of Osteopathic Medicine in Arizona, A.T. Still University, Meza, AZ, USA
| | - R Curtis Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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Yan D, Wang S, Temkin-Greener H, Cai S. HCBS Service Spending and Nursing Home Placement for Patients With Alzheimer's Disease and Related Dementias: Does Race Matter? J Appl Gerontol 2021; 41:638-649. [PMID: 34615409 DOI: 10.1177/07334648211048187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We examined the extent to which home and community-based services (HCBS) spending affected the likelihood of nursing home (NH) placement among black and white HCBS users with Alzheimer's disease and related dementias (ADRD). METHODS The study population included new HCBS users with ADRD between 2010 and 2013 (N = 1,046,200). RESULTS We found that a one hundred dollar increase in monthly HCBS spending was associated with a 0.3 percentage points decrease in the NH placement rate among Whites, but a 0.3 percentage points increase in the NH placement rate among Blacks. The overall NH placement rate was 68.2% and 56.7% for Whites and Blacks, respectively. DISCUSSION A higher HCBS spending was associated with a decreased likelihood of NH placements for Whites but not for Blacks. It is important to understand how states' HCBS expansion efforts influence Blacks and Whites with ADRD so that resources can be tailored to communities with different race-mix.
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Affiliation(s)
- Di Yan
- Department of Public Health Sciences, 6923University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sijiu Wang
- Department of Public Health Sciences, 123964University of Chicago, Chicago, IL, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, 6923University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, 6923University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Antonio-Villa NE, García-Tuomola A, Almeda-Valdes P, Vidrio-Velázquez M, Islas-Ortega L, Madrigal-Sanromán JR, Zaballa-Lasso C, Martínez-Ramos-Méndez A, De la Garza-Hernández NE, Bustamante-Martínez JF, González-Galvez G, Valadez-Capetillo M, Sanchez-Ruiz KL, Castillo-Galindo C, Yepez-Rodríguez AE, Polanco-Preza MA, Ceballos-Macías JJ, Valenzuela-Montoya JC, Escobedo-Ortiz AR, Ferreira-Hermosillo A, Rodríguez-Sanchez E, Romero-Zazueta A, Miracle-López S, Figueroa-Andrade MH, Faradji RN. Glycemic control, treatment and complications in patients with type 1 diabetes amongst healthcare settings in Mexico. Diabetes Res Clin Pract 2021; 180:109038. [PMID: 34487758 DOI: 10.1016/j.diabres.2021.109038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1). METHODS Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up. RESULTS We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p < 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control. CONCLUSIONS Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.
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Affiliation(s)
- Neftali Eduardo Antonio-Villa
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aili García-Tuomola
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico
| | | | - Laura Islas-Ortega
- Pediatric Endocrinology, Hospital del Niño DIF Hidalgo, Pachuca, Hidalgo, Mexico
| | | | | | | | | | - Jorge F Bustamante-Martínez
- Internal Medicine Department, Servicios de Salud de Nayarit, Hospital General de Tepic, Tepic, Nayarit, Mexico
| | - Guillermo González-Galvez
- Endocrinology, Instituto Jalisciense de Investigación en Diabetes y Obesidad S. C, Guadalajara, Jalisco, Mexico
| | | | - Karla L Sanchez-Ruiz
- Clínica de Diabetes, Secretaría de Salud del Estado de Durango, Durango, Durango, Mexico
| | | | | | - Miguel A Polanco-Preza
- Endocrinology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Julio C Valenzuela-Montoya
- Pediatric Endocrinology, Hospital De Gineco-Pediatría No. 31 IMSS, Mexicali, Baja California Norte, Mexico
| | - Ana R Escobedo-Ortiz
- Endocrinology, Hospital General Dr. Miguel Silva, Secretaria de Salud, Morelia, Michoacán, Mexico
| | - Aldo Ferreira-Hermosillo
- Endocrinology, Unidad de Investigación Médica en Enfermedades Endocrinas. Centro Médico Nacional Siglo XXI, IMSS, Mexico
| | | | | | - Sigfrido Miracle-López
- Endocrinology, Hospital Angeles Lomas, Huixquilucan, México; Associate Investigator, Centro de Investigación en Ciencias de la Salud (CICSA) Universidad, Anáhuac, Mexico
| | | | - Raquel N Faradji
- Endocrinology and Diabetes, Clinica EnDi, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico.
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Khatib R, Glowacki N, Lauffenburger J, Siddiqi A. Race/Ethnic Differences in Atherosclerotic Cardiovascular Disease Risk Factors Among Patients With Hypertension: Analysis From 143 Primary Care Clinics. Am J Hypertens 2021; 34:948-955. [PMID: 33876823 PMCID: PMC8457428 DOI: 10.1093/ajh/hpab053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/13/2020] [Accepted: 04/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND While it is known that sex and race/ethnic disparities persist for atherosclerotic cardiovascular disease (ASCVD), disparities in risk factor control have not been well-described in primary care where ASCVD can be prevented. METHODS Adult patients with a hypertension diagnosis without ASCVD were included in this analysis of electronic health records from a large US healthcare system from 2018. Patients were categorized based on risk factor control defined as blood pressure (BP) <130/80 mm Hg; statin prescription among patients with indications, HbA1c of <7%, and not smoking. Multivariable Poisson regressions were developed to explore associations with race/ethnicity. Results are presented as relative risk (RR), 95% confidence intervals (CIs). RESULTS Among 5,227 patients, 55.8% women and 60.0% men had uncontrolled BP, 47.3% women and 46.4% men with statin therapy indication did not have a prescription, 34.9% women and 40.9% men had uncontrolled HbA1c values, and 9.3% women and 13.7% men were smokers. African Americans were more likely to have uncontrolled BP (women: RR 1.18, 95% CI 1.07-1.30; men: RR 1.20, 95% CI 1.05-1.34) and more likely to lack a statin prescription (women: RR 1.23, 95% CI 1.05-1.45; men: RR 1.25, 95% CI 1.03-1.51) compared to Caucasians. Differences in HbA1c control were not statistically significant among Hispanic/Latino compared to Caucasians (women: RR 1.28, 95% CI 0.86-1.90; men: RR 1.20, 95% CI 0.72-1.97). CONCLUSIONS Disparities in controlling ASCVD risk factors in primary care persist and were not fully explained by demographic or clinical characteristics. Monitoring changes in disparities is important to ensure equity as interventions to prevent ASCVD in primary care are developed and implemented.
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Affiliation(s)
- Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois, USA
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois, USA
| | - Julie Lauffenburger
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Aurora Health, Downers Grove, Illinois, USA
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Nightingale G, Scopelliti EM, Casten R, Woloshin M, Xiao S, Kelley M, Chang AM, Hollander JE, Leiby BE, Peterson AM, Pizzi LT, Rising KL, White N, Rovner B. Polypharmacy and Potentially Inappropriate Medication Use in Older Blacks with Diabetes Mellitus Presenting to the Emergency Department. J Aging Health 2021; 34:499-507. [PMID: 34517775 DOI: 10.1177/08982643211045546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Medication-related problems in older Blacks with diabetes mellitus (DM) are not well established. Objectives: To describe the frequency of medication-related problems in older Blacks with DM presenting to the emergency department (ED). Methods: The study was a cross-sectional analysis of baseline data from a randomized controlled trial evaluating Blacks aged ≥60 years of age presenting to the ED. Polypharmacy, potentially inappropriate medication (PIM) use, and anticholinergic score were evaluated. Results: Of 168 patients (median age = 68, range 60-92), most (n = 164, 98%) were taking ≥5 medications, and 67 (39.9%) were taking a PIM. A majority (n = 124, 74%) were taking a medication with an anticholinergic score ≥1. Number of medications was correlated with number of PIMs (r = .22, p = .004) and anticholinergic score (r = .50, p < .001). Conclusion: Polypharmacy and PIM use was common in older Blacks with DM.
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Affiliation(s)
- Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Emily M Scopelliti
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Monica Woloshin
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Shu Xiao
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Megan Kelley
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Judd E Hollander
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew M Peterson
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura T Pizzi
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Kristin L Rising
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Neva White
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry Rovner
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
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Williamson G, Osa ML, Budd E, Kelly NR. Weight-related teasing is associated with body concerns, disordered eating, and health diagnoses in racially and ethnically diverse young men. Body Image 2021; 38:37-48. [PMID: 33831652 DOI: 10.1016/j.bodyim.2021.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
Research suggests that weight-related teasing is associated with body concerns and disordered eating in male and female adolescents and women. Yet, little is known about these associations for young men with diverse racial and ethnic identities. This study examined the association of weight-related teasing frequency and distress with body concerns, loss of control (LOC) eating, dietary restraint, and history of psychiatric and medical diagnoses in racially and ethnically diverse young men. Racial and ethnic identity was examined as a potential moderator. Participants (N = 1,069; 18-30 years; Mage = 24.1 ± 3.6 years) completed an online survey and reported on general demographics; weight-related teasing; body concerns; LOC eating frequency in the last 28 days; dietary restraint; and history of psychiatric and medical diagnoses. All models adjusted for BMI, income, education, and history of psychiatric diagnoses (when not the dependent variable). Both weight-related teasing frequency and distress were significantly and positively linked with all dependent variables, and these associations did not significantly vary by racial and ethnic identity. These findings suggest that, much like in prior research with adolescents and women, experiences with weight-related teasing are associated with body concerns, disordered eating, and poorer health in racially and ethnically diverse young men, regardless of body size.
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Affiliation(s)
- Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Maggie L Osa
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Elizabeth Budd
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States.
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Rising KL, Kemp M, Davidson P, Hollander JE, Jabbour S, Jutkowitz E, Leiby BE, Marco C, McElwee I, Mills G, Pizzi L, Powell RE, Chang AM. Assessing the impact of medically tailored meals and medical nutrition therapy on type 2 diabetes: Protocol for Project MiNT. Contemp Clin Trials 2021; 108:106511. [PMID: 34314856 PMCID: PMC8453110 DOI: 10.1016/j.cct.2021.106511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research has shown that among people with type 2 diabetes mellitus, reduction in hemoglobin A1c (HbA1c) prevents long term complications. Medically tailored meals (MTM) and telehealth-delivered medical nutrition therapy (tele-MNT) are promising strategies for patient-centered diabetes care. OBJECTIVES Project MiNT will determine whether provision of MTM with and without the addition of telehealth-delivered medical nutrition therapy improves HbA1c and is cost effective for patients with type 2 diabetes mellitus. METHODS Patients with poorly controlled type 2 diabetes mellitus (HbA1c >8%) will be recruited from Jefferson Health. Eligible patients will be randomized to one of three arms: 1) usual care, 2) 12 weeks of home-delivered MTM, or 3) MTM + 12 months of tele-MNT. All participants (n = 600) will complete three follow-up assessments at 3, 6, and 12 months. The primary outcome is change in HbA1c at 6 months. Secondary outcomes include change in HbA1c at 3 and 12 months and cost-effectiveness of the intervention at 6 and 12 months. Conclusion Findings from Project MiNT will inform MTM coverage and financing decisions, how to structure services for scalability and system-wide integration, and the role of these services in reducing health disparities.
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Affiliation(s)
- Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA 19107, USA; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St, Suite 704, Philadelphia, PA 19107, USA; College of Nursing, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, USA.
| | - Mackenzie Kemp
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA 19107, USA; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St, Suite 704, Philadelphia, PA 19107, USA
| | - Patricia Davidson
- College of Health Sciences, Nutrition Department, West Chester University, 855 South New Street, West Chester, PA 19383, USA
| | - Judd E Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA 19107, USA; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St, Suite 704, Philadelphia, PA 19107, USA
| | - Serge Jabbour
- Department of Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University, 211 S 9(th) St, Unit 600, Philadelphia, PA 19107, USA
| | - Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Providence Veterans Affairs (VA) Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI 02908, USA
| | - Benjamin E Leiby
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Chestnut Street, Suite 401, Philadelphia, PA 19107, USA
| | - Cheryl Marco
- Department of Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University, 211 S 9(th) St, Unit 600, Philadelphia, PA 19107, USA
| | - Ian McElwee
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA 19107, USA
| | - Geoffrey Mills
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA 19107, USA
| | - Laura Pizzi
- Center for Health Outcomes, Policy, & Economics, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Rhea E Powell
- Division of Internal Medicine, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Suite 701, Philadelphia, PA 19107, USA; Mathematica, 600 Alexander Park, Suite 100, Princeton, NJ 08543, USA
| | - Anna Marie Chang
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA 19107, USA; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St, Suite 704, Philadelphia, PA 19107, USA
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Racial Disparities in Guideline-Concordant Insulin Infusions during Critical Illness. Ann Am Thorac Soc 2021; 18:368-371. [PMID: 33001705 DOI: 10.1513/annalsats.202007-893rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gonzales KL, Jiang L, Garcia-Alexander G, Jacob MM, Chang J, Williams DR, Bullock A, Manson SM. Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention. J Aging Health 2021; 33:18S-30S. [PMID: 34167349 PMCID: PMC8647809 DOI: 10.1177/08982643211013188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To examine the association of perceived discrimination with participant retention and diabetes risk among American Indians and Alaska Natives. Methods: Data were drawn from the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project (N = 2553). Results: Perceived discrimination was significantly and negatively associated with short-term and long-term retention and diabetes risk without adjusting. After controlling for socioeconomic characteristics and clinical outcomes, perceived discrimination was not associated with retention but was significantly associated with less improvement in body mass index (BMI) and high-density lipoprotein (HDL) cholesterol. Every unit increase in the perceived discrimination score was associated with 0.14 kg/m2 less BMI reduction (95% CI: [0.02, 0.26], p = 0.0183) and 1.06 mg/dl lower HDL at baseline (95% CI: [0.36, 1.76], p = 0.0028). Discussion: Among racialized groups, improving retention and health in lifestyle interventions may require investigating perceived discrimination and the broader context of structural racism and colonialism.
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Affiliation(s)
- Kelly L. Gonzales
- Oregon Health & Science University-Portland State University joint School of Public Health, Portland, OR, USA
| | - Luohua Jiang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | | | | | - Jenny Chang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - David R. Williams
- Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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45
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Khalid SI, Maasarani S, Shanker RM, Becerra AZ, Omotosho P, Torquati A. Social determinants of health and their impact on rates of postoperative complications among patients undergoing vertical sleeve gastrectomy. Surgery 2021; 171:447-452. [PMID: 34303546 DOI: 10.1016/j.surg.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Vertical sleeve gastrectomy is one of the most common bariatric procedures worldwide, but the impact of social determinants of health on postoperative outcomes for this procedure has not been well characterized. The objective of this study was to analyze the impact that social determinants of health have on postoperative outcomes after vertical sleeve gastrectomy. METHOD This was a population-based study using the MARINER-15 database, an all-payer claims database. The primary endpoint of this study was the development of any complication, including cardiac complication, acute kidney injury, deep vein thrombosis, wound complication, hematoma, pneumonia, pulmonary embolism, transfusion, or urinary tract infection within 60 days, 30- and 90-day all-cause mortality, or readmission within 30 or 90 days in patients undergoing vertical sleeve gastrectomy procedures. RESULTS Individuals in the social determinants of health cohort had a significantly longer length of stay when compared with those without social determinants of health (3.07 days vs 1.582 days, P < .001). These patients were more likely to develop any complication within 60 days after surgery (hazard ratio 1.20, 95% confidence interval 1.03-1.40) but were less likely to return for readmission within 30 and 90 days (hazard ratio 0.80, 95% confidence interval 0.66-0.96; hazard ratio 0.85 95% confidence interval 0.72-0.99). CONCLUSION Vertical sleeve gastrectomy is an effective treatment for morbid obesity and its associated comorbidities. Although patients with social determinants of health are more likely to develop any of the analyzed postoperative complications within 60 days, they are less likely to return for readmission, highlighting the importance of focused follow-up and other measures to avoid lapses in care and eliminate further barriers to care in this population.
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Affiliation(s)
- Syed I Khalid
- Department of Surgery, Rush University Medical Center, Chicago, IL; Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
| | - Samantha Maasarani
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. https://twitter.com/smaasarani
| | - Rachyl M Shanker
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL. https://twitter.com/AdanZBecerra1
| | - Philip Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, IL. https://twitter.com/RushBariatrics
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, Chicago, IL. https://twitter.com/RushSurgery
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Cannon JS, Farkouh EK, Winett LB, Dorfman L, Ramírez AS, Lazar S, Niederdeppe J. Perceptions of Arguments in Support of Policies to Reduce Sugary Drink Consumption Among Low-Income White, Black and Latinx Parents of Young Children. Am J Health Promot 2021; 36:84-93. [PMID: 34269101 PMCID: PMC8669211 DOI: 10.1177/08901171211030849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: To test for racial/ethnic differences in perceived argument strength in favor of structural interventions to curb childhood obesity among lower-income parents of young children. Design: Cross-sectional, self-report. Setting: Online research panel, national sample of 1485 US adults in Fall 2019. Participants: Parents of children (age 0-5 years) with an annual income <$40,000, stratified by White, Black and/or Latinx race/ethnicity. Measures: SSB consumption, policy support, and strength of arguments in favor of marketing restrictions and a penny-per-ounce tax. Analysis: Descriptive statistics, multivariable OLS models. Results: Race/ethnicity was not a significant predictor of the perceived strength of a composite of marketing arguments (pBlack = 0.07; pLatinx = 0.10), however it was a significant predictor of the perceived strength of tax arguments (pBlack = 0.01; pLatinx = 0.01). Perceptions of strength of 12 of 35 discrete SSB tax arguments differed by race/ethnicity (p < .05). Arguments regarding industry targeting of Black children (marketing: pBlack < .001; pLatinx = .001; tax: pBlack < .001; pLatinx = .001), were particularly demonstrative of this difference. In contrast, arguments that these policies would provide support for parents (marketing: pBlack = 0.20; pLatinx = 0.84) and communities (tax: pBlack = 0.24; pLatinx = 0.58) were seen as strong arguments across groups. Conclusions: Black and Hispanic/Latinx parents may be more prepared to move toward SSB policy support than white parents. Emphasizing community benefits of policy may be effective in moving constituents toward policy support across groups.
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Affiliation(s)
- Julie S Cannon
- Communication Department, Cornell University, Ithaca, NY, USA
| | | | | | - Lori Dorfman
- Berkeley Media Studies Group, a program at the Public Health Institute, Berkeley, CA, USA
| | | | - Spencer Lazar
- Communication Department, Cornell University, Ithaca, NY, USA
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Lin OM, Reid HW, Fabbro RL, Johnson KS, Batch BC, Olsen MK, Matsouaka RA, Sanders LL, Chung ST, Svetkey LP. Association of Provider Perspectives on Race and Racial Health Care Disparities with Patient Perceptions of Care and Health Outcomes. Health Equity 2021; 5:466-475. [PMID: 34316530 PMCID: PMC8309434 DOI: 10.1089/heq.2021.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Research suggests that providers contribute to racial disparities in health outcomes. Identifying modifiable provider perspectives that are associated with decreased racial disparities will help in the design of effective educational interventions for providers. Methods: This cross-sectional study investigated the association between primary care provider (PCP) perspectives on race and racial disparities with patient outcomes. Results: Study participants included 40 PCPs (70% White, 30% racial minority) caring for 55 patients (45% White, 55% Black) with type 2 diabetes mellitus. Associations of provider perspectives on race and racial disparities with patient variables (Interpersonal Processes of Care [IPC] Survey, which measures patient's ratings of their provider's interpersonal skills; medication adherence; glycemic control) were measured using Spearman correlation coefficients. Results suggest that Black patients of providers who reported greater skill in caring for Black patients had more positive perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of -0.43, 0.44, 0.46, all with p<0.05); however, Black patients of providers who believe that racial disparities are highly prevalent had more negative perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of 0.38, -0.53, -0.51, all with p<0.05). These same provider characteristics had no correlation with outcomes of medication adherence and hemoglobin A1c (HbA1c) or among White patients. Conclusion: Findings suggest that Black patients of providers who felt better equipped to take care of Black patients had a better experience. Therefore, educational interventions for providers may be most effective if they focus on skill development rather than increasing awareness about racial disparities alone.
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Affiliation(s)
- Olivia M Lin
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Hadley W Reid
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Kimberly S Johnson
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine Durham, North Carolina, USA.,Center for Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA.,Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Bryan C Batch
- Division of Endocrinology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Roland A Matsouaka
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Linda L Sanders
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sangyun Tyler Chung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Low CM, Balakrishnan K, Smith BM, Stokken JK, O'Brien EK, Van Gompel JJ, Rowan NR, Choby G. Sinonasal adenocarcinoma: Population-based analysis of demographic and socioeconomic disparities. Head Neck 2021; 43:2946-2953. [PMID: 34117674 DOI: 10.1002/hed.26783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/22/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sinonasal adenocarcinoma (SNAC) is a rare tumor. The impact of health disparities on survival, stage at presentation, and utilization of surgery is not well understood in patients with SNAC. METHODS The Surveillance, Epidemiology, and End Results database was queried for cases of SNAC from 1973 to 2015. Cases were analyzed to assess for disparities in presentation, treatment, and survival. RESULTS SNAC was identified in 630 patients. In a multivariate model of overall survival, an age increase of 10 years (Hazard Ratio (HR) = 1.37, p < 0.001), male sex (HR = 1.26, p = 0.045), and more recent decade of diagnosis (HR = 0.74, p < 0.001) were significantly related to time-to-death. There is a higher rate of SNAC-related death in counties with more rural populations (p = 0.027). CONCLUSION Future interventions targeting rural and less well-educated populations may improve care with the goal of increasing the span of healthy life and reducing survival disparities related to SNAC.
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Affiliation(s)
- Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Byron M Smith
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Madsen Beau De Rochars VE, Keys H, Samuels SK, Jo A, Noland GS, Gonzales M, Blount S, Mainous AG. Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic. Am J Trop Med Hyg 2021; 104:2241-2250. [PMID: 33872205 PMCID: PMC8176474 DOI: 10.4269/ajtmh.19-0942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/11/2021] [Indexed: 01/03/2023] Open
Abstract
This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country's three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7-6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2-11.8%) and 20.4% (95% CI, 17.9-23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2-96 years), and 10.0% (95% CI, 7.2-13.8%) and 20.0% (95% CI, 17.4-23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.
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Affiliation(s)
- Valery E. Madsen Beau De Rochars
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Hunter Keys
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- The Carter Center, Atlanta, Georgia
| | - Shenae K. Samuels
- Memorial Healthcare System, Office of Human Research, Hollywood, Florida
| | - Ara Jo
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | | | - Manuel Gonzales
- Centro Nacional para el Control de Enfermedades Tropicales (CENCET), Santo Domingo, Dominican Republic
| | | | - Arch G. Mainous
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
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50
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Roura M, LeMaster JW, Hannigan A, Papyan A, McCarthy S, Nurse D, Villarroel N, MacFarlane A. 'If relevant, yes; if not, no': General practitioner (GP) users and GP perceptions about asking ethnicity questions in Irish general practice: A qualitative analysis using Normalization Process Theory. PLoS One 2021; 16:e0251192. [PMID: 33979383 PMCID: PMC8115799 DOI: 10.1371/journal.pone.0251192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Context The use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched. Objective This study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way. Methods Qualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about ‘sense’ making and ‘engagement’. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT. Results The link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as ‘ethnicity’ in the limited time available in consultations was also worrying. Conclusions Implementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants’ views and the EU GDPR.
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Affiliation(s)
- Maria Roura
- School of Public Health, University College Cork, Cork, Ireland
| | - Joseph W. LeMaster
- Kansas University Family Medicine Research, University of Kansas Medical Centre, The University of Kansas, Kansas City, Kansas, United States of America
| | - Ailish Hannigan
- School of Medicine & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anna Papyan
- Shannon Family Resource Centre, Shannon, Ireland
| | | | - Diane Nurse
- National Office for Social Inclusion, Health Service Executive, Dublin, Ireland
| | - Nazmy Villarroel
- Department of Sociological Studies, University of Sheffield, Sheffield, England
| | - Anne MacFarlane
- School of Medicine & Health Research Institute, University of Limerick, Limerick, Ireland
- * E-mail:
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