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Fadel MA, McCoy JL, Shaffer AD, Kurland KS, Simons JP. Socioeconomic Barriers to Care for Pediatric Airways Utilizing Geographic Information Systems. Laryngoscope 2024; 134:1919-1925. [PMID: 37622670 DOI: 10.1002/lary.30982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Geographic information systems (GIS) provide a unique set of tools to spatially analyze health care and identify patterns of health outcomes to help optimize delivery. Our goal is to create maps of pediatric tracheostomy patients using GIS to assess socioeconomic and other factors that impact postoperative care after discharge to home. METHODS A retrospective study was performed on patients (≤21 years old) who underwent tracheostomy at a tertiary care pediatric hospital from January 1, 2015 to December 31, 2020. Using GIS, we geocoded patient addresses and conducted spatial analyses of the relationship between patients and access to health care providers as well as vulnerable population factors including poverty, educational attainment, and single-parent households. RESULTS A total of 156 patients were included. Patients initially discharged to transitional care (108/156, 69.2%) had significantly higher likelihood of presenting to the ED regardless of socioeconomic status (OR: 2.28, 95% CI: 1.03-5.05; p = 0.042). There was no relationship between ED visit rate and median household income, poverty level, and percentage of uneducated adults (p = 0.490; p = 0.424; p = 0.752). Median distance to the tertiary care pediatric hospital was significantly longer for patients with no ED visit (median = 61.28 miles; SD = 50.90) compared with those with an ED visit (median = 37.75 miles; SD = 35.92) (p = 0.002). CONCLUSION The application of GIS could provide geo-localized data to better understand the healthcare barriers to access for children with tracheostomies. This study uniquely integrates medical record data with socioeconomic factors and social determinants of health. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1919-1925, 2024.
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Affiliation(s)
- Mark A Fadel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Kristen S Kurland
- H. John Heinz III College and School of Architecture, Carnegie Mellon University, Pittsburgh, Pennsylvania, U.S.A
| | - Jeffrey P Simons
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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Corbera-Hincapie MA, Kurland KS, Hincapie MR, Fabio A, Weiner DJ, Kim SC, Kazmerski TM. Geospatial Analysis of Food Deserts and Their Impact on Health Outcomes in Children with Cystic Fibrosis. Nutrients 2021; 13:3996. [PMID: 34836250 PMCID: PMC8621515 DOI: 10.3390/nu13113996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/20/2022] Open
Abstract
Food insecurity (FI) is defined as "the limited or uncertain access to adequate food." One root cause of FI is living in a food desert. FI rates among people with cystic fibrosis (CF) are higher than the general United States (US) population. There is limited data on the association between food deserts and CF health outcomes. We conducted a retrospective review of people with CF under 18 years of age at a single pediatric CF center from January to December 2019 using demographic information and CF health parameters. Using a Geographic Information System, we conducted a spatial overlay analysis at the census tract level using the 2015 Food Access Research Atlas to assess the association between food deserts and CF health outcomes. We used multivariate logistic regression analysis and adjusted for clinical covariates and demographic covariates, using the Child Opportunity Index (COI) to calculate odds ratios (OR) with confidence intervals (CI) for each health outcome. People with CF living in food deserts and the surrounding regions had lower body mass index/weight-for-length (OR 3.18, 95% CI: 1.01, 9.40, p ≤ 0.05 (food desert); OR 4.41, 95% CI: 1.60, 12.14, p ≤ 0.05 (600 ft buffer zone); OR 2.83, 95% CI: 1.18, 6.76, p ≤ 0.05 (1200 ft buffer zone)). Food deserts and their surrounding regions impact pediatric CF outcomes independent of COI. Providers should routinely screen for FI and proximity to food deserts. Interventions are essential to increase access to healthy and affordable food.
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Affiliation(s)
- Montserrat A. Corbera-Hincapie
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Kristen S. Kurland
- School of Architecture, Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA 15213, USA;
| | - Mark R. Hincapie
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh Epidemiology Data Center, Pittsburgh, PA 15260, USA;
| | - Daniel J. Weiner
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Sandra C. Kim
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Traci M. Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
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Rosser F, Forno E, Kurland KS, Han YY, Mair C, Acosta-Pérez E, Canino G, Celedón JC. Annual SO 2 exposure, asthma, atopy, and lung function in Puerto Rican children. Pediatr Pulmonol 2020; 55:330-337. [PMID: 31805225 PMCID: PMC7122992 DOI: 10.1002/ppul.24595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/20/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long-term effects of sulfur dioxide (SO2 ) exposure on children, a vulnerable population, are largely unknown. Further, how long-term SO2 affects Puerto Rican children living in the island of Puerto Rico, a group with high asthma prevalence, is unclear. We evaluated the effects of annual average 1-hour daily maximum SO2 average on asthma, atopy, total immunoglobulin E (IgE), and lung function in Puerto Rican children. METHODS A cohort of 678 children (351 with asthma, 327 without asthma) was recruited in Puerto Rico from 2009 to 2010. Annual average 1-hour daily maximum SO2 exposure was interpolated utilizing publicly available monitoring data. Multivariable logistic and linear regression was used for the analysis of asthma, atopy (defined as an IgE ≥0.35 IU/mL to at least one of five common aero-allergens), total IgE, and lung function measures (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], and FEV1/FVC ratio). RESULTS Annual SO2 exposure (per 1 ppb) was significantly associated with asthma (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.05-1.91) and atopy (OR = 1.35; 95% CI = 1.02-1.78). Such exposure was also significantly associated with lower FEV1/FVC in all children (β = -1.42; 95% CI = -2.78 to -0.08) and in children with asthma (β = -2.39; 95% CI= -4.31 to -0.46). Annual SO2 exposure was not significantly associated with total IgE, FEV1, or FVC. CONCLUSIONS Among Puerto Rican children in Puerto Rico, long-term SO2 exposure is linked to asthma and atopy. In these children, long-term SO2 exposure is also associated with reduced FEV1/FVC, particularly in those with asthma.
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Affiliation(s)
- Franziska Rosser
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristen S Kurland
- H John Heinz III College and School of Architecture, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute of Puerto Rico, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute of Puerto Rico, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
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Wallace DJ, Mohan D, Angus DC, Driessen JR, Seymour CM, Yealy DM, Roberts MM, Kurland KS, Kahn JM. Referral Regions for Time-Sensitive Acute Care Conditions in the United States. Ann Emerg Med 2018; 72:147-155. [PMID: 29606286 DOI: 10.1016/j.annemergmed.2018.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/03/2018] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE Regional, coordinated care for time-sensitive and high-risk medical conditions is a priority in the United States. A necessary precursor to coordinated regional care is regions that are actionable from clinical and policy standpoints. The Dartmouth Atlas of Health Care, the major health care referral construct in the United States, uses regions that cross state and county boundaries, limiting fiscal or political ownership by key governmental stakeholders in positions to create incentive and regulate regional care coordination. Our objective is to develop and evaluate referral regions that define care patterns for patients with acute myocardial infraction, acute stroke, or trauma, yet also preserve essential political boundaries. METHODS We developed a novel set of acute care referral regions using Medicare data in the United States from 2011. For acute myocardial infraction, acute stroke, or trauma, we iteratively aggregated counties according to patient home location and treating hospital address, using a spatial algorithm. We evaluated referral political boundary preservation and spatial accuracy for each set of referral regions. RESULTS The new set of referral regions, the Pittsburgh Atlas, had 326 distinct regions. These referral regions did not cross any county or state borders, whereas 43.1% and 98.1% of all Dartmouth Atlas hospital referral regions crossed county and state borders. The Pittsburgh Atlas was comparable to the Dartmouth Atlas in measures of spatial accuracy and identified larger at-risk populations for all 3 conditions. CONCLUSION A novel and straightforward spatial algorithm generated referral regions that were politically actionable and accountable for time-sensitive medical emergencies.
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Affiliation(s)
- David J Wallace
- Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Deepika Mohan
- Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Derek C Angus
- Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Julia R Driessen
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Christopher M Seymour
- Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mark M Roberts
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Kristen S Kurland
- School of Architecture, College of Fine Arts, Heinz College, Carnegie Mellon University, Pittsburgh, PA
| | - Jeremy M Kahn
- Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Rosser F, Forno E, Brehm J, Han YY, Boutaoui N, Colón-Semidey A, Alvarez M, Acosta-Pérez E, Kurland KS, Alcorn JF, Canino G, Celedón JC. Proximity to a Major Road and Plasma Cytokines in School-Aged Children. Pediatr Allergy Immunol Pulmonol 2016; 29:111-117. [PMID: 28265480 PMCID: PMC5314728 DOI: 10.1089/ped.2016.0649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/26/2016] [Indexed: 01/12/2023]
Abstract
Traffic-related air pollution (TRAP) may affect immune responses, including those in the TH2 and TH17 pathways. To examine whether TRAP is associated with plasma level of TH17-, TH1-, and TH2-related cytokines in children with and without asthma, a cross-sectional study of 577 children (ages 6–14 years) with (n = 294) and without (n = 283) asthma in San Juan (Puerto Rico) was performed. Residential distance to a major road was estimated using geocoded home addresses for study participants. A panel of 14 cytokines, enriched for the TH17 pathway, was measured in plasma. Asthma was defined as physician-diagnosed asthma and current wheeze. Multivariable linear regression was used to examine the association of residential distance to a major road (a marker of TRAP), asthma, and cytokine levels. Among all participating children, residential proximity to a major road was significantly associated with increased plasma level of IL-31, even after adjustment for relevant covariates and correction for multiple testing. The presence of asthma modified the estimated effect of the residential distance to a major road on plasma TNF-α (P for interaction = 0.00047). Although living farther from a major road was significantly associated with lower TNF-α level in control subjects, no such decrease was seen in children with asthma. In a direct comparison of cases and control subjects, children with asthma had significantly higher levels of IL-1β, IL-22, and IL-33 than control subjects. TRAP is associated with increased levels of proinflammatory cytokines among Puerto Rican children, who belong to an ethnic group with high risk for asthma.
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Affiliation(s)
- Franziska Rosser
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Brehm
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nadia Boutaoui
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Angel Colón-Semidey
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - María Alvarez
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Edna Acosta-Pérez
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Kristen S. Kurland
- H. John Heinz III College and School of Architecture, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - John F. Alcorn
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Glorisa Canino
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C. Celedón
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
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