1
|
Egede LE, Walker RJ, Linde S, Williams JS. Identifying Individuals with Highest Social Risk in Adults with Type 2 Diabetes Using Item Response Theory. J Gen Intern Med 2024:10.1007/s11606-024-08742-6. [PMID: 38565767 DOI: 10.1007/s11606-024-08742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this analysis was to create a parsimonious tool to screen for high social risk using item response theory to discriminate across social risk factors in adults with type 2 diabetes. METHODS Cross-sectional data of 615 adults with diabetes recruited from two primary care clinics were used. Participants completed assessments including validated scales on economic instability (financial hardship), neighborhood and built environment (crime, violence, neighborhood rating), education (highest education, health literacy), food environment (food insecurity), social and community context (social isolation), and psychological risk factors (perceived stress, depression, serious psychological distress, diabetes distress). Item response theory (IRT) models were used to understand the association between a participant's underlying level of a particular social risk factor and the probability of that response. A two-parameter logistic IRT model was used with each of the 12 social determinant factors being added as a separate parameter in the model. Higher values in item discrimination indicate better ability of a specific social risk factor in differentiating participants from each other. RESULTS Rate of crime reported in a neighborhood (discrimination 3.13, SE 0.50; item difficulty - 0.68, SE 0.07) and neighborhood rating (discrimination 4.02, SE 0.87; item difficulty - 1.04, SE 0.08) had the highest discrimination. CONCLUSIONS Based on these findings, crime and neighborhood rating discriminate best between individuals with type 2 diabetes who have high social risk and those with low social risk. These two questions can be used as a parsimonious social risk screening tool to identify high social risk.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| |
Collapse
|
2
|
Shah H, Hawks L, Walker RJ, Egede LE. Substance Use Disorders, Mental Illness, and Health Care Utilization Among Adults With Recent Criminal Legal Involvement. Psychiatr Serv 2024; 75:221-227. [PMID: 37674397 DOI: 10.1176/appi.ps.20220491] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. METHODS This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015-2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. RESULTS Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18-1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47-3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38-1.91) and inpatient stays (IRR=4.16, 95% CI=2.98-5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01-1.50). CONCLUSIONS Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement.
Collapse
Affiliation(s)
- Harini Shah
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Laura Hawks
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Rebekah J Walker
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Leonard E Egede
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| |
Collapse
|
3
|
Egede LE, Walker RJ, Campbell JA, Linde S. Historic Redlining and Impact of Structural Racism on Diabetes Prevalence in a Nationally Representative Sample of U.S. Adults. Diabetes Care 2024:dc232184. [PMID: 38387079 DOI: 10.2337/dc23-2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE We investigated direct and indirect relationships between historic redlining and prevalence of diabetes in a U.S. national sample. RESEARCH DESIGN AND METHODS Using a previously validated conceptual model, we hypothesized pathways between structural racism and prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing, education, unemployment, and food access. We combined census tract-level data, including diabetes prevalence from the Centers for Disease Control and Prevention PLACES 2019 database, redlining using historic Home Owners' Loan Corporation (HOLC) maps from the Mapping Inequality project, and census data from the Opportunity Insights database. HOLC grade (a score between 1 [best] and 4 [redlined]) for each census tract was based on overlap with historically HOLC-graded areas. The final analytic sample consisted of 11,375 U.S. census tracts. Structural equation modeling was used to investigate direct and indirect relationships adjusting for the 2010 population. RESULTS Redlining was directly associated with higher crude prevalence of diabetes within a census tract (r = 0.01; P = 0.008) after adjusting for the 2010 population (χ2(54) = 69,900.95; P < 0.001; root mean square error of approximation = 0; comparative fit index = 1). Redlining was indirectly associated with diabetes prevalence via incarceration (r = 0.06; P < 0.001), poverty (r = -0.10; P < 0.001), discrimination (r = 0.14; P < 0.001); substance use (measured by binge drinking: r = -0.65, P < 0.001; and smoking: r = 0.35, P < 0.001), housing (r = 0.06; P < 0.001), education (r = -0.17; P < 0.001), unemployment (r = -0.17; P < 0.001), and food access (r = 0.14; P < 0.001) after adjusting for the 2010 population. CONCLUSIONS Redlining has significant direct and indirect relationships with diabetes prevalence. Incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access may be possible targets for interventions aiming to mitigate the impact of structural racism on diabetes.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Sebastian Linde
- Department of Health Policy and Management, Texas A&M School of Public Health, College Station, TX
| |
Collapse
|
4
|
Egede LE, Walker RJ, Williams JS. Addressing Structural Inequalities, Structural Racism, and Social Determinants of Health: a Vision for the Future. J Gen Intern Med 2024; 39:487-491. [PMID: 37740168 PMCID: PMC10897090 DOI: 10.1007/s11606-023-08426-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
Significant national discourse has focused on the idea of structural inequalities and structural racism within a variety of societal sectors, including healthcare. This perspective provides an understanding of the historic and pervasive nature of structural inequalities and structural racism; uses well-known frameworks in health equity research for conceptualizing structural inequality and structural racism; offers a summary of the consequences of structural inequalities and structural racism on modern-day health outcomes; and concludes with strategies and suggestions for a way forward. Recommended strategies across different sectors of influence include (a) employment and economic empowerment sector: creating capacity for individuals to earn livable wages; (b) education sector: developing new funding structures to ensure equal opportunities are offered to all; (c) healthcare sector: prioritizing universal access to high-quality health care, including mental health treatment; (d) housing sector: improving access to affordable, safe housing through public-private partnerships; (e) criminal justice sector: focusing reform on restorative justice that is people-centric instead of punitive; and (f) environmental sector: creating sustainable systems that alleviate downstream consequences of climate change. The recommended strategies account for the mutually reinforcing and pervasive nature of structural inequalities/structural racism and target key sectors of influence to enhance overall health outcomes and achieve equity regardless of race, ethnicity, or socioeconomic status.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
5
|
Dawson AZ, Hawks L, Walker RJ, Egede LE. Differential Effect of Patient- and Provider-Level Factors on Patient Satisfaction Scores in Academic General Internal Medicine Clinics. J Gen Intern Med 2024:10.1007/s11606-024-08648-3. [PMID: 38302814 DOI: 10.1007/s11606-024-08648-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Determine whether patient-level or provider-level factors have greater influence on patient satisfaction scores in an academic general internal medicine clinic. METHODS Two years of data (2017-2019) from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) surveys from ambulatory internal medicine clinic visits in an academic health center located in the Midwest United States were used. Patient satisfaction was measured using the overall provider satisfaction score (0-10), dichotomized with 9-10 defined as satisfactory and 0-8 as unsatisfactory. Provider-level independent variables included age, sex, race/ethnicity, provider type, service type, clinical effort, academic rank, and years since graduation. Patient-level factors included age, sex, race/ethnicity, education, and Epic Risk Score. Generalized mixed-effects logistic regression models were used to investigate associations between top-box satisfaction score and patient- and provider-level factors, accounting for the nesting of patients within providers. RESULTS Thirty-three providers and 4597 patients were included in the analysis. Male providers (OR, 1.57; 95% CI, 1.00, 2.47), minority group 2 (OR, 3.54; 95% CI, 1.24, 10.07) and minority group 3 (OR, 6.04; 95% CI, 1.45, 25.12), faculty (OR, 3.83; 95% CI, 1.56, 9.36), and primary care providers (OR, 5.60; 95% CI, 1.62, 19.34) had increased odds of having a top-box rating compared with females, minority group 1, advanced practice providers, and perioperative providers respectively. Age was the only patient independent correlate of top-box rating with a 3% increased odds of top-box rating for every year increase in age (OR, 1.03; 95% CI 1.02, 1.03). CONCLUSIONS In this academic general internal medicine clinic, top-box satisfaction scores were more strongly associated with provider-level factors, including provider race/ethnicity, provider type, and service type, as opposed to patient-level factors. Further research is needed to confirm these findings and identify potential system-level interventions.
Collapse
Affiliation(s)
- Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura Hawks
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
6
|
Egede LE, Dawson AZ, Walker RJ, Garraci E, Knapp RG. Randomized controlled trial of technology-assisted case management in low-income adults with type 2 diabetes: Effect on quality of life and blood pressure. J Telemed Telecare 2024; 30:107-115. [PMID: 34251865 DOI: 10.1177/1357633x211028491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A novel randomized controlled trial tested the efficacy of a technology-assisted case management program in a low income, rural population previously where nurses titrated medication over the phone instead of in a clinic. The primary analysis showed significant improvement in glycemic control at 6 months post-randomization decreasing hemoglobin A1c by 1%. This study aimed to test if the intervention was also effective at decreasing blood pressure without compromising quality of life. METHODS A total of 113 adults with poorly controlled diabetes (hemoglobin A1c ≥ 8%) were randomly assigned to the technology-assisted case management intervention or usual care. Participants received a 2-in-1 telehealth system to monitor glycemic and blood pressure control, which was uploaded daily to a central server. A nurse case manager was trained to titrate medication under physician supervision every 2 weeks based on the readings. Outcomes were blood pressure and quality of life (12-item Short-Form Health Survey) at 6 months. Baseline adjusted mixed models using a random intercept were used to evaluate change at 6 months for the technology-assisted case management intervention group compared to usual care. RESULTS There were no statistically significant differences in systolic blood pressure, physical component of quality of life, or mental component of quality of life between the technology-assisted case management and control group. However, there was a significant change in diastolic blood pressure over time, with the technology-assisted case management group decreasing at 6 months (p = .05), whereas the control group remained stable. CONCLUSIONS Technology-assisted case management by a nurse with medication titration under physician supervision was efficacious in improving diastolic blood pressure without compromising quality of life in low-income rural adults with diabetes.
Collapse
Affiliation(s)
- Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, USA
| | - Emma Garraci
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, USA
| | - Rebecca G Knapp
- Department of Public Health Services, College of Medicine, Medical University of South Carolina, USA
| |
Collapse
|
7
|
Walker RJ, Eisenhauer E, Thompson EL, Butler R, Metheny N, Barroso CS, Marino M. COVID-19 Information, Trust, and Risk Perception Across Diverse Communities in the United States: Initial Findings from a Multistate Community Engagement Alliance (CEAL). Am J Public Health 2024; 114:S112-S123. [PMID: 38207271 PMCID: PMC10785172 DOI: 10.2105/ajph.2023.307504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 01/13/2024]
Abstract
Objectives. To provide initial findings from Community Engagement Alliance (CEAL), a multistate effort funded by the National Institutes of Health, to conduct urgent community-engaged research and outreach focused on COVID-19 awareness, education, and evidence-based response. Methods. We collected survey data (November 2020-November 2022) from 21 CEAL teams from 29 state and regional CEAL sites spanning 19 US states, the District of Columbia, and Puerto Rico, which covered priority populations served and trusted sources of information about COVID-19, including prevention behaviors, vaccination, and clinical trials. Results. A disproportionate number of respondents were Latino (45%) or Black (40%). There was considerable variability between CEAL sites regarding trusted sources of information, COVID-19 prevention, and COVID-19 vaccination. For example, more respondents (70%) reported health care providers as a trusted source of COVID-19 information than any other source (ranging from 6% to 87% by site). Conclusions. CEAL rapidly developed novel infrastructure to engage academic, public health, and community organizations to address COVID-19's impacts on underserved communities. CEAL provides an example of how to respond in future public health emergencies to quickly promote trustworthy, evidence-based information in ways that advance health equity. (Am J Public Health. 2024;114(S1):S112-S123. https://doi.org/10.2105/AJPH.2023.307504).
Collapse
Affiliation(s)
- Rebekah J Walker
- Rebekah J. Walker is with the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. Elizabeth Eisenhauer is with Westat, Rockville, MD. Erika L. Thompson is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth. Robin Butler is with the School of Community Health and Policy, Morgan State University, Baltimore, MD. Nicholas Metheny is with the School of Nursing and Health Studies, University of Miami, Coral Gables, FL. Cristina S. Barroso is with the College of Nursing, University of Tennessee, Knoxville. Miguel Marino is with the Department of Family Medicine, Oregon Health & Science University, Portland
| | - Elizabeth Eisenhauer
- Rebekah J. Walker is with the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. Elizabeth Eisenhauer is with Westat, Rockville, MD. Erika L. Thompson is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth. Robin Butler is with the School of Community Health and Policy, Morgan State University, Baltimore, MD. Nicholas Metheny is with the School of Nursing and Health Studies, University of Miami, Coral Gables, FL. Cristina S. Barroso is with the College of Nursing, University of Tennessee, Knoxville. Miguel Marino is with the Department of Family Medicine, Oregon Health & Science University, Portland
| | - Erika L Thompson
- Rebekah J. Walker is with the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. Elizabeth Eisenhauer is with Westat, Rockville, MD. Erika L. Thompson is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth. Robin Butler is with the School of Community Health and Policy, Morgan State University, Baltimore, MD. Nicholas Metheny is with the School of Nursing and Health Studies, University of Miami, Coral Gables, FL. Cristina S. Barroso is with the College of Nursing, University of Tennessee, Knoxville. Miguel Marino is with the Department of Family Medicine, Oregon Health & Science University, Portland
| | - Robin Butler
- Rebekah J. Walker is with the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. Elizabeth Eisenhauer is with Westat, Rockville, MD. Erika L. Thompson is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth. Robin Butler is with the School of Community Health and Policy, Morgan State University, Baltimore, MD. Nicholas Metheny is with the School of Nursing and Health Studies, University of Miami, Coral Gables, FL. Cristina S. Barroso is with the College of Nursing, University of Tennessee, Knoxville. Miguel Marino is with the Department of Family Medicine, Oregon Health & Science University, Portland
| | - Nicholas Metheny
- Rebekah J. Walker is with the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. Elizabeth Eisenhauer is with Westat, Rockville, MD. Erika L. Thompson is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth. Robin Butler is with the School of Community Health and Policy, Morgan State University, Baltimore, MD. Nicholas Metheny is with the School of Nursing and Health Studies, University of Miami, Coral Gables, FL. Cristina S. Barroso is with the College of Nursing, University of Tennessee, Knoxville. Miguel Marino is with the Department of Family Medicine, Oregon Health & Science University, Portland
| | - Cristina S Barroso
- Rebekah J. Walker is with the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. Elizabeth Eisenhauer is with Westat, Rockville, MD. Erika L. Thompson is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth. Robin Butler is with the School of Community Health and Policy, Morgan State University, Baltimore, MD. Nicholas Metheny is with the School of Nursing and Health Studies, University of Miami, Coral Gables, FL. Cristina S. Barroso is with the College of Nursing, University of Tennessee, Knoxville. Miguel Marino is with the Department of Family Medicine, Oregon Health & Science University, Portland
| | - Miguel Marino
- Rebekah J. Walker is with the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee. Elizabeth Eisenhauer is with Westat, Rockville, MD. Erika L. Thompson is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth. Robin Butler is with the School of Community Health and Policy, Morgan State University, Baltimore, MD. Nicholas Metheny is with the School of Nursing and Health Studies, University of Miami, Coral Gables, FL. Cristina S. Barroso is with the College of Nursing, University of Tennessee, Knoxville. Miguel Marino is with the Department of Family Medicine, Oregon Health & Science University, Portland
| |
Collapse
|
8
|
Jue MD, Hawks LC, Walker RJ, Akinboboye O, Thorgerson A, Egede LE. The Associations Between Medical and Mental Health Conditions and Health Care Utilization in US Adults with Past-Year Criminal Legal Involvement. J Gen Intern Med 2024; 39:77-83. [PMID: 37648953 PMCID: PMC10817859 DOI: 10.1007/s11606-023-08362-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Every year, millions of US adults return home from prison or jail, and they visit the emergency department and experience hospitalizations at higher rates than the general population. Little is known about the primary conditions that drive this acute care use. OBJECTIVE To determine the individual and combined associations between medical and mental health conditions and acute health care utilization among individuals with recent criminal legal involvement in a nationally representative sample of US adults. DESIGN We examined the association between having medical or mental, or both, conditions (compared to none), and acute care utilization using negative binomial regression models adjusted for relevant socio-demographic covariates. PARTICIPANTS Adult respondents to the National Survey of Drug Use and Health (2015-2019) who reported past year criminal legal involvement. MAIN MEASURES Self-reported visits to the emergency department and nights spent hospitalized. RESULTS Among 9039 respondents, 12.4% had a medical condition only, 34.6% had a mental health condition only, and 19.2% had both mental and medical conditions. In adjusted models, incident rate ratio (IRR) for ED use for medical conditions only was 1.32 (95% CI 1.05, 1.66); for mental conditions only, the IRR was 1.36 (95% CI 1.18, 1.57); for both conditions, the IRR was 2.13 (95% CI 1.81, 2.51). For inpatient use, IRR for medical only: 1.73 (95% CI 1.08, 2.76); for mental only, IRR: 2.47 (95% CI 1.68, 3.65); for both, IRR: 4.26 (95% CI 2.91, 6.25). CONCLUSION Medical and mental health needs appear to contribute equally to increased acute care utilization among those with recent criminal legal involvement. This underscores the need to identify and test interventions which comprehensively address both medical and mental health conditions for individuals returning to the community to improve both health care access and quality.
Collapse
Affiliation(s)
- Maria D Jue
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura C Hawks
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olaitan Akinboboye
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Institute of Health and Equity, Milwaukee, WI, USA
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
9
|
Anguzu R, Walker RJ, Babikako HM, Beyer KMM, Dickson-Gomez J, Zhou Y, Cassidy LD. Intimate partner violence and antenatal care utilization predictors in Uganda: an analysis applying Andersen's behavioral model of healthcare utilization. BMC Public Health 2023; 23:2276. [PMID: 37978467 PMCID: PMC10656909 DOI: 10.1186/s12889-023-16827-w] [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: 02/27/2023] [Accepted: 09/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Optimal utilization of antenatal care (ANC) services improves positive pregnancy experiences and birth outcomes. However, paucity of evidence exists on which factors should be targeted to increase ANC utilization among women experiencing intimate partner violence (IPV) in Uganda. OBJECTIVE To determine the independent association between IPV exposure and ANC utilization as well as the predictors of ANC utilization informed by Andersen's Behavioral Model of Healthcare Utilization. METHODS We analyzed 2016 Uganda Demographic and Health Survey data that included a sample of 1,768 women with children aged 12 to 18 months and responded to both ANC utilization and IPV items. Our outcome was ANC utilization, a count variable assessed as the number of ANC visits in the last 12 months preceding the survey. The key independent variable was exposure to any IPV form defined as self-report of having experienced physical, sexual and/or emotional IPV. Covariates were grouped into predisposing (age, formal education, religion, problem paying treatment costs), enabling (women's autonomy, mass media exposure), need (unintended pregnancy, parity, history of pregnancy termination), and healthcare system/environmental factors (rural/urban residence, spatial accessibility to health facility). Poisson regression models tested the independent association between IPV and ANC utilization, and the predictors of ANC utilization after controlling for potential confounders. RESULTS Mean number of ANC visits (ANC utilization) was 3.71 visits with standard deviation (SD) of ± 1.5 respectively. Overall, 60.8% of our sample reported experiencing any form of IPV. Any IPV exposure was associated with lower number of ANC visits (3.64, SD ± 1.41) when compared to women without IPV exposure (3.82, SD ± 1.64) at p = 0.013. In the adjusted models, any IPV exposure was negatively associated with ANC utilization when compared to women with no IPV exposure after controlling for enabling factors (Coef. -0.03; 95%CI -0.06,-0.01), and healthcare system/environmental factors (Coef. -0.06; 95%CI -0.11,-0.04). Predictors of ANC utilization were higher education (Coef. 0.27; 95%CI 0.15,0.39) compared with no education, high autonomy (Coef. 0.12; 95%CI 0.02,0.23) compared to low autonomy, and partial media exposure (Coef. 0.06; 95%CI 0.01,0.12) compared to low media exposure. CONCLUSION Addressing enabling and healthcare system/environmental factors may increase ANC utilization among Ugandan women experiencing IPV. Prevention and response interventions for IPV should include strategies to increase girls' higher education completion rates, improve women's financial autonomy, and mass media exposure to improve ANC utilization in similar populations in Uganda.
Collapse
Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US.
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, US.
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, US
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, US
| | - Harriet M Babikako
- Department of Child Health and Development Center, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, US
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| |
Collapse
|
10
|
Anguzu R, Cassidy LD, Nakimuli AO, Kansiime J, Babikako HM, Beyer KMM, Walker RJ, Wandira C, Kizito F, Dickson-Gomez J. Healthcare provider experiences interacting with survivors of intimate partner violence: a qualitative study to inform survivor-centered approaches. BMC Womens Health 2023; 23:584. [PMID: 37940914 PMCID: PMC10634177 DOI: 10.1186/s12905-023-02700-w] [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: 03/27/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) remains a pervasive form of gender-based violence (GBV) that is largely undisclosed, especially among women seeking healthcare services in Uganda. Prioritizing survivor needs may improve IPV disclosure. This study explores healthcare worker experiences from provider-patient interactions with survivors seeking antenatal care services (ANC) in Uganda. METHODS In-depth interviews were conducted among twenty-eight experienced healthcare providers in a rural and an urban-based ANC clinic in Eastern and Central Uganda. Providers were asked what they viewed as the needs and fears of women identified as having experienced any form of IPV. Iterative, inductive/deductive thematic analysis was conducted to discover themes regarding perceived needs, fears, and normalizing violence experienced by IPV survivors. RESULTS According to healthcare providers, IPV survivors are unaware of available support services, and have need for support services. Providers reported that some survivors were afraid of the consequences of IPV disclosure namely, community stigma, worries about personal and their children's safety, retaliatory abuse, fear of losing their marriage, and partners' financial support. Women survivors also blamed themselves for IPV. Contextual factors underlying survivor concerns included the socio-economic environment that 'normalizes' violence, namely, some cultural norms condoning violence, and survivors' unawareness of their human rights due to self-blame and shame for abuse. CONCLUSIONS We underscore a need to empower IPV survivors by prioritizing their needs. Results highlight opportunities to create a responsive healthcare environment that fosters IPV disclosure while addressing survivors' immediate medical and psychosocial needs, and safety concerns. Our findings will inform GBV prevention and response strategies that integrate survivor-centered approaches in Uganda.
Collapse
Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US.
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| | - Annettee O Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Harriet M Babikako
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Makerere University College of Health Sciences, New Mulago Gate Road, Mulago, Kampala, Uganda
- Department of Child Health and Development Center, School of Medicine, College of Health Sciences, Makerere University, Hospital Complex, P.O. Box 7072, Mulago Hill, Kampala, Kampala, Uganda
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, WI, US
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, US
| | | | - Felix Kizito
- District Health Office, Luuka District Local Government, Iganga, Uganda
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| |
Collapse
|
11
|
Anguzu R, Walker RJ, Beyer KMM, Zhou Y, Babikako HM, Dickson-Gomez J, Cassidy LD. Spatial accessibility to health facilities among pregnant women with and without exposure to intimate partner violence in Uganda. BMC Pregnancy Childbirth 2023; 23:767. [PMID: 37924014 PMCID: PMC10623746 DOI: 10.1186/s12884-023-06084-5] [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: 03/24/2021] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Poor physical access to health facilities could increase the likelihood of undetected intimate partner violence (IPV) during pregnancy. We aimed to determine sub-regional differences and associations between spatial accessibility to health facilities and IPV among pregnant women in Uganda. METHOD Weighted cross-sectional analyses were conducted using merged 2016 Uganda Demographic and Health Survey and 2014 Uganda Bureau of Statistics health facility datasets. Our study population were 986 women who self-reported being currently pregnant and responded to IPV items. Outcome was spatial accessibility computed as the near point linear distance [< 5 km (optimal) vs. ≥ 5 km (low)] between women's enumeration area and health facility according to government reference cutoffs. Primary independent variable (any IPV) was defined as exposure to at least one of physical, emotional, and sexual IPV forms. Logistic regression models were sequentially adjusted for covariates in blocks based on Andersen's behavioral model of healthcare utilization. Covariates included predisposing (maternal age, parity, residence, partner controlling behavior), enabling (wealth index, occupation, education, economic empowerment, ANC visit frequency), and need (wanted current pregnancy, difficulty getting treatment money, afraid of partner, and accepted partner abuse) factors. RESULTS Respondents' mean age was 26.1 years with ± 9.4 standard deviations (SD), mean number of ANC visits was 3.8 (± 1.5 SD) and 492/986 (49.9%) pregnant women experienced IPV. Median spatial accessibility to the nearest health facility was 4.1 km with interquartile range (IQR) from 0.2 to 329.1 km. Southwestern, and Teso subregions had the highest average percentage of pregnant women experiencing IPV (63.8-66.6%) while Karamoja subregion had the highest median spatial accessibility (7.0 to 9.3 km). In the adjusted analysis, pregnant women exposed to IPV had significantly higher odds of low spatial accessibility to nearest health facilities when compared to pregnant women without IPV exposure after controlling for enabling factors in Model 2 (aOR 1.6; 95%CI 1.2, 2.3) and need factors in Model 3 (aOR 1.5; 95%CI 1.1, 3.8). CONCLUSIONS Spatial accessibility to health facilities were significantly lower among pregnant women with IPV exposure when compared to those no IPV exposure. Improving proximity to the nearest health facilities with ANC presents an opportunity to intervene among pregnant women experiencing IPV. Focused response and prevention interventions for violence against pregnant women should target enabling and need factors.
Collapse
Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Harriet M Babikako
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, New Mulago Gate Road, Kampala, Uganda
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| |
Collapse
|
12
|
Linde S, Walker RJ, Campbell JA, Egede LE. Historic Residential Redlining and Present-Day Social Determinants of Health, Home Evictions, and Food Insecurity within US Neighborhoods. J Gen Intern Med 2023; 38:3321-3328. [PMID: 37296361 PMCID: PMC10255945 DOI: 10.1007/s11606-023-08258-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Examine the association between historic residential redlining and present-day racial/ethnic composition of neighborhoods, racial/ethnic differences in social determinant of health domains, and risk of home evictions and food insecurity. RESEARCH DESIGN AND METHODS We examined data on 12,334 (for eviction sample), and 8996 (for food insecurity sample), census tracts in 213 counties across 37 states in the USA with data on exposure to historic redlining. First, we examined relationships between Home Owners' Loan Corporation (HOLC) redlining grades (A="Best", B="Still Desirable", C="Definitely Declining", D="Hazardous") and present-day racial/ethnic composition and racial/ethnic differences in social determinant of health domains of neighborhoods. Second, we examined whether historic redlining is associated with present-day home eviction rates (measured across eviction filings rates, and eviction judgment rates for 12,334 census tracts in 2018) and food insecurity (measured across low supermarket access, low supermarket access and income, low supermarket access and low car ownership for 8996 census tracts in 2019). Multivariable regression models were adjusted for census tract population, urban/rural designation, and county level fixed effects. RESULTS Relative to areas with a historic HOLC grading of "A (Best)", areas with a "D (Hazardous)" grading had a 2.59 (95%CI=1.99-3.19; p-value<0.01) higher rate of eviction filings, and a 1.03 (95%CI=0.80-1.27; p-value<0.01) higher rate of eviction judgments. Compared to areas with a historic HOLC grading of "A (Best)", areas rated with a "D (Hazardous)" had a 16.20 (95%CI=15.02-17.79; p-value<0.01) higher rate of food insecurity based on supermarket access and income, and a 6.15 (95%CI =5.53-6.76; p-value<0.01) higher rate of food insecurity based on supermarket access and car ownership. CONCLUSIONS Historic residential redlining is significantly associated with present-day home evictions and food insecurity, highlighting persistent associations between structural racism and present-day social determinants of health.
Collapse
Affiliation(s)
- Sebastian Linde
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebekah J Walker
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer A Campbell
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leonard E Egede
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA.
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| |
Collapse
|
13
|
Anderson KJ, Walker RJ, Lynch JM, Middleton RG. A qualitative evaluation of internet information on hip and knee osteoarthritis. Ann R Coll Surg Engl 2023; 105:729-733. [PMID: 37489520 PMCID: PMC10618034 DOI: 10.1308/rcsann.2023.0007] [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] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hip and knee arthritis are two of the most common conditions that result in referral to orthopaedic outpatient clinics. Many patients now use the internet to research their condition and to inform their decision about treatment options. This has implications for the process of informed consent. AIM To assess the quality of patient information on the internet regarding hip and knee arthritis. METHODS 'Hip arthritis' and 'Knee arthritis' were entered as search terms into a popular search engine. To adjust for temporal variation, the process was repeated one month and one year later. Of the 200 results analysed, 83 websites met the inclusion criteria. The quality of patient information presented on these websites was assessed using a validated scoring instrument by two independent observers. RESULTS Most websites assessed were of poor quality; nearly half of all websites did not mention any risks or complications associated with surgical intervention for these conditions. CONCLUSIONS As part of their professional obligation to provide a robust process of informed consent, clinicians should be aware of the variable quality of patient information available on the internet. As such, they should be prepared to advise their patients about quality websites where reliable information can be sought.
Collapse
Affiliation(s)
| | | | - J M Lynch
- University Hospital Dorset NHS Foundation Trust, UK
| | | |
Collapse
|
14
|
Walker RJ, Thorgerson AM, Yan A, Williams JS, Campbell JA, Dawson AZ, Renta V, Egede LE. Prevalence and correlates of pre-diabetes in Sub-Saharan Africa using Demographic and Health Survey Data: a cross-sectional study. BMJ Open 2023; 13:e069640. [PMID: 37852767 PMCID: PMC10603485 DOI: 10.1136/bmjopen-2022-069640] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/04/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE The objective is to investigate the prevalence of pre-diabetes in Namibia and South Africa and to determine sociodemographic correlates of disease using population data. DESIGN Cross-sectional study. SETTING Demographic and Health Survey for emerging (Namibia) and established (South Africa) economies in Sub-Saharan Africa collected laboratory data that allowed determination of pre-diabetes status. PARTICIPANTS 3141 adults over age 18 from the 2013 Namibia survey, weighted to a population of 2176, and 4964 adults over age 18 from the 2016 South Africa survey, weighted to a population of 4627 had blood glucose/glycated haemoglobin (HbA1c) and diabetes information were included in the analysis. OUTCOME MEASURES Pre-diabetes was defined as not being diagnosed with diabetes and having a blood sugar measurement of 100-125 mg/dL in Namibia or an HbA1c measurement of 5.7%-6.4%. Logistic models were run for each country separately, with pre-diabetes as the outcome and a series of sociodemographic variables (age, gender, urban/rural residence, number of children, employment status, wealth index, education level, and ethnicity (in South Africa) or religion (in Namibia)) entered as variables to investigate the independent relationship of each. RESULTS The weighted prevalence of pre-diabetes was 18.7% in Namibia and 70.1% in South Africa. Rural residence was independently associated with higher odds of pre-diabetes in Namibia (1.47, 95% CI 1.05 to 2.06), while both younger age (0.98, 95% CI 0.97 to 0.99) and urban residence (0.80, 95% CI 0.66 to 0.99) were independently associated with odds of pre-diabetes in South Africa. CONCLUSIONS The prevalence of pre-diabetes was 18.7% in Namibia and 70.1% in South Africa. Correlates of pre-diabetes differed between the two countries with rural residents having higher odds of pre-diabetes in Namibia and urban residents with higher odds in South Africa. Aggressive interventions, including population level education and awareness programmes, and individual level education and lifestyle interventions that account for country-specific contextual factors are urgently needed to prevent progression to diabetes.
Collapse
Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Abigail M Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alice Yan
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joni S Williams
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aprill Z Dawson
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vincent Renta
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
15
|
Walker RJ, Dawson AZ, Thorgerson A, Campbell JA, Engel S, Kastner M, Egede LE. Relationship between Satisfaction Scores and Racial/Ethnic and Sex Concordance in Primary Care. Healthcare (Basel) 2023; 11:2276. [PMID: 37628474 PMCID: PMC10454330 DOI: 10.3390/healthcare11162276] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Racial/ethnic and sex concordance between patients and providers has been suggested as an important consideration in improving satisfaction and increasing health equity. We aimed to guide local efforts by understanding the relationship between satisfaction with care and patient-provider racial/ethnic and sex concordance within our academic medical center's primary care clinic. METHODS Satisfaction data for encounters from August 2016 to August 2019 were matched to data from the medical record for patient demographics and comorbidities. Data on 33 providers were also obtained, and racial/ethnic and sex concordance between patients and providers was determined for each of the 3672 unique encounters. The primary outcome was top-box scoring on the CGCAHPS overall satisfaction scale (0-8 vs. 9-10). Generalized mixed-effects logistic regression, including provider- and patient-level factors as fixed effects and a random intercept effect for providers, were used to determine whether concordance had an independent relationship with satisfaction. RESULTS 89.0% of the NHW-concordant pairs and 90.4% of the Minority Race/Ethnicity-concordant pairs indicated satisfaction, while 90.1% of the male-concordant and 85.1% of the female-concordant pairs indicated satisfaction. When fully adjusted, the female-concordant (OR = 0.58, 95% CI 0.35-0.94) and male-discordant (OR = 0.68, 95% CI 0.51-0.91) pairs reported significantly lower top-box satisfaction compared to the male-concordant pairs. Significant differences did not exist in racial/ethnic concordance. CONCLUSIONS In this sample, differences in sex concordance were noted; however, patient- and provider-level factors may be more influential in driving patient satisfaction than race/ethnicity in this health system.
Collapse
Affiliation(s)
- Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (R.J.W.); (A.Z.D.); (J.A.C.)
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (R.J.W.); (A.Z.D.); (J.A.C.)
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (R.J.W.); (A.Z.D.); (J.A.C.)
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Sara Engel
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Mandy Kastner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (R.J.W.); (A.Z.D.); (J.A.C.)
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| |
Collapse
|
16
|
Walker SL, Walker RJ, Palatnik A, Dawson AZ, Williams JS, Egede LE. Examining the Relationship between Social Determinants of Health and Adverse Pregnancy Outcomes in Black Women. Am J Perinatol 2023:10.1055/s-0043-1771256. [PMID: 37494588 PMCID: PMC10799964 DOI: 10.1055/s-0043-1771256] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Our objective was to examine associations between social determinants of health (cultural, neighborhood, and psychosocial factors) and adverse pregnancy outcomes (gestational age at birth [GAB], preterm birth [PTB], and preeclampsia) in Black women. STUDY DESIGN Cross-sectional data (n = 204) comprised adult Black women aged ≥18 years who delivered between 2013 and 2022 in Milwaukee,Wisconsin. Sequential unadjusted linear and logistic regression models were run to evaluate associations between social determinants of health and pregnancy outcomes. Stepwise regressions with forward selection were run to test the contribution of the social determinants of health to adverse pregnancy outcomes, independent of the contribution of established risk factors. RESULTS Mean GAB was 37.9 weeks, 19.6% had a PTB and 17.7% had preeclampsia. In all fully adjusted models, education (β0.15, 95% confidence interval [CI]: 0.005, 0.29), nulliparity (β -1.26, 95%CI: -2.08, -0.44), multifetal gestation (β -2.67, 95% CI: -4.29, -1.05), and exposure to neighborhood violence (β -0.13, 95%CI: -0.25, -0.005) were associated with shortened GAB. Education (adjusted odds ratio [aOR]: 0.83, 95%CI: 0.69, 0.99), provider trust (aOR: 0.94, 95%CI: 0.88, 0.99), chance health locus of control (aOR: 0.88, 95%CI: 0.78, 0.99), and anxiety (aOR: 0.81, 95%CI: 0.69, 0.95) were associated with reduced odds of PTB. Powerful others health locus of control (aOR: 1.16, 95%CI: 1.03, 1.32), depression (aOR: 1.17, 95%CI: 1.01, 1.34), nulliparity (aOR: 4.73, 95%CI: 1.79, 12.55), multifetal gestation (aOR: 17.78, 95%CI: 3.49, 90.50), diabetes (aOR: 4.71, 95%CI: 1.17, 19.00), and obstructive sleep apnea (aOR: 44.28, 95%CI: 2.50, 783.12) were associated with increased odds of PTB. Internal health locus of control (aOR: 1.13, 95%CI: 1.01, 1.25), depression (aOR: 1.09, 95%CI: 1.01, 1.17), preeclampsia in a previous pregnancy (aOR: 5.96, 95% CI: 2.22, 16.01), and kidney disease (aOR: 34.27, 95% CI: 1.54, 763.75) were associated with preeclampsia. CONCLUSION Provider trust, health locus of control, neighborhood violence, depression, and anxiety were associated with adverse pregnancy outcomes in Black women, independent of demographic and clinical risk factors. KEY POINTS · We identified associations between exposure to neighborhood violence and gestational age at birth.. · Trust, locus of control, depression, and anxiety were associated with preterm birth and preeclampsia.. · Future research should focus on interventions that address social and clinical factors..
Collapse
Affiliation(s)
- Shannon L. Walker
- Institute for Health and Equity (IHE), Medical College of Wisconsin, Milwaukee, Wisconsin
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebekah J. Walker
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
| | - Anna Palatnik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Froedtert and The Medical College of Wisconsin
| | - Aprill Z. Dawson
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
| | - Joni S. Williams
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
| | - Leonard E. Egede
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
| |
Collapse
|
17
|
Agarwal S, Wade AN, Mbanya JC, Yajnik C, Thomas N, Egede LE, Campbell JA, Walker RJ, Maple-Brown L, Graham S. The role of structural racism and geographical inequity in diabetes outcomes. Lancet 2023; 402:235-249. [PMID: 37356447 DOI: 10.1016/s0140-6736(23)00909-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.
Collapse
Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| |
Collapse
|
18
|
Walker AF, Graham S, Maple-Brown L, Egede LE, Campbell JA, Walker RJ, Wade AN, Mbanya JC, Long JA, Yajnik C, Thomas N, Ebekozien O, Odugbesan O, DiMeglio LA, Agarwal S. Interventions to address global inequity in diabetes: international progress. Lancet 2023; 402:250-264. [PMID: 37356448 PMCID: PMC10726974 DOI: 10.1016/s0140-6736(23)00914-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis.
Collapse
Affiliation(s)
- Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Judith A Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
19
|
Egede LE, Walker RJ, Campbell JA, Linde S, Hawks LC, Burgess KM. Modern Day Consequences of Historic Redlining: Finding a Path Forward. J Gen Intern Med 2023; 38:1534-1537. [PMID: 36746831 PMCID: PMC9901820 DOI: 10.1007/s11606-023-08051-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
There is emerging evidence that structural racism is a major contributor to poor health outcomes for ethnic minorities. Structural racism captures upstream historic racist events (such as slavery, black code, and Jim Crow laws) and more recent state-sanctioned racist laws in the form of redlining. Redlining refers to the practice of systematically denying various services (e.g., credit access) to residents of specific neighborhoods, often based on race/ethnicity and primarily within urban communities. Historical redlining is linked to increased risk of diabetes, hypertension, and early mortality due to heart disease with evidence suggesting it impacts health through suppressing economic opportunity and human capital, or the knowledge, skills, and value one contributes to society. Addressing structural racism has been a rallying call for change in recent years-drawing attention to the racialized impact of historical policies in the USA. Unfortunately, the enormous scope of work has also left people feeling incapable of effecting the very change they seek. This paper highlights a path forward by briefly discussing the origins of historical redlining, highlighting the modern-day consequences both on health and at the societal level, and suggest promising initiatives to address the impact.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sebastian Linde
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura C Hawks
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaylin M Burgess
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
20
|
Egede LE, Campbell JA, Walker RJ, Linde S. Structural Racism as an Upstream Social Determinant of Diabetes Outcomes: A Scoping Review. Diabetes Care 2023; 46:667-677. [PMID: 36952609 PMCID: PMC10090912 DOI: 10.2337/dci22-0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/24/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To evaluate the evidence on the role of structural racism as an upstream factor impacting diabetes outcomes, identify current gaps, and recommend areas for future work. RESEARCH DESIGN AND METHODS A reproducible search of Medline and Ovid was used. Structural factors based on the World Health Organization social determinants of health framework (governance, macroeconomic policy, social policy, public policy, and cultural and societal values) had to be included as measured variables or contextual factors discussed as upstream influences. Outcomes included 1) hemoglobin A1c (HbA1c), 2) LDL, 3) BMI, 4) quality of life, 5) self-efficacy, 6) mortality, 7) years of life lost, and 8) self-care behaviors. RESULTS Thirteen articles were included for final synthesis. Ten studies focused on governance, two on social policies, one on public policies, and one on cultural and societal values. Results highlight significant associations between structural racism and poorer clinical outcomes (HbA1c and blood pressure), worse self-care behaviors (diet and physical activity), lower standards of care, higher mortality, and more years of life lost for adults with diabetes. CONCLUSIONS There is a paucity of work investigating the relationship between structural racism and diabetes outcomes. Five areas for future work include 1) more rigorous research on the relationship between structural racism, downstream social determinants, and health outcomes in diabetes, 2) policy assessments specific to diabetes outcomes, 3) research designed to examine pathways and mechanisms of influence, 4) intervention development to mitigate the impact of structural racism, and 5) tracking and monitoring of change over time.
Collapse
Affiliation(s)
- Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A. Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sebastian Linde
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
21
|
Hawks LC, Walker RJ, Egede LE. Relationship between criminal legal system exposure and health care utilization in US adults with diabetes: A cross-sectional study. J Natl Med Assoc 2023; 115:244-253. [PMID: 36803852 PMCID: PMC10121761 DOI: 10.1016/j.jnma.2023.01.015] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Black Americans have a higher prevalence of diabetes compared to White Americans and have higher rates of complications and death. Exposure to the criminal legal system (CLS) is a social risk factor for chronic disease morbidity and mortality with significant overlap with populations most likely to experience poor diabetes outcomes. However, little is known about the association between CLS exposure and healthcare utilization patterns among U.S. adults with diabetes. METHODS Using data from the National Survey of Drug Use and Health (2015-2018) a cross-sectional, nationally representative sample of U.S. adults with diabetes was created. Negative binomial regression was used to test the association between lifetime CLS exposure and three utilization types (emergency department (ED), inpatient, and outpatient) controlling for relevant socio-demographic and clinical covariates. RESULTS Of 11,562 (weighted to represent 25,742,034 individuals) adults with diabetes, 17.1% reported lifetime CLS exposure. In unadjusted analyses, exposure was associated with increased ED (IRR 1.30 95% CI 1.17-1.46) and inpatient utilization (IRR 1.23, 95% CI 1.01-1.50), but not outpatient visits (IRR 0.99 95% CI 0.94-1.04). The association between CLS exposure and ED (IRR 1.02, p=0.70) and inpatient utilization (IRR 1.18, p=0.12) was attenuated in adjusted analyses. Low socioeconomic status, comorbid substance use disorder, and comorbid mental illness were independently associated with health care utilization in this population. CONCLUSIONS Among those with diabetes, lifetime CLS exposure is associated with higher ED and inpatient visits in unadjusted analyses. Adjusting for socioeconomic status and clinical confounders attenuated these relationships, thus more research is needed to understand how CLS exposure interacts with poverty, structural racism, addiction and mental illness to influence health care utilization for adults with diabetes.
Collapse
Affiliation(s)
- Laura C Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Rebekah J Walker
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Leonard E Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.
| |
Collapse
|
22
|
Bhandari S, Campbell JA, Walker RJ, Thorgerson A, Dawson AZ, Egede LE. Dose response relationship between food insecurity and quality of life in United States adults: 2016-2017. Health Qual Life Outcomes 2023; 21:21. [PMID: 36890499 PMCID: PMC9997014 DOI: 10.1186/s12955-023-02103-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Food insecurity is associated with worse general health rating, but little research exists investigating whether there is a dose response relationship across levels of food security and mental and physical health domains at the population level. METHODS Data from the Medical Expenditure Panel Survey (2016-2017) with US adults aged 18 years and older was used. The physical component score (PCS) and mental component score (MCS) of Quality of Life, served as the outcome measures. Four categories of food insecurity (high, marginal, low, very low food security) served as the primary independent variable. Linear regression was used to run unadjusted followed by adjusted models. Separate models were run for PCS and MCS. RESULTS In a sample of US adults, 16.1% reported some degree of food insecurity. For PCS, marginal (β = - 2.54 (p < 0.001), low (β = - 3.41, (p < 0.001), and very low (β = - 5.62, (p < 0.001) food security was associated with worse PCS scores, compared to adults with high food security. For MCS, marginal (β = - 3.90 (p < 0.001), low (β = - 4.79, (p < 0.001), and very low (β = - 9.72, (p < 0.001) food security was associated with worse MCS scores, compared to adults with high food security. CONCLUSION Increasing levels of food insecurity were associated with decreased physical and mental health quality of life scores. This relationship was not explained by demographic factors, socioeconomic factors, insurance, or comorbidity burden. This study suggests work is needed to mitigate the impact of social risk, such as food insecurity, on quality of life in adults, and understand pathways and mechanisms for this relationship.
Collapse
Affiliation(s)
- Sanjay Bhandari
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| |
Collapse
|
23
|
Williams JS, Walker RJ, Peek ME, Chin MH. Integrating Medical and Social Care to Reduce Diabetes Inequities: Lessons from the Bridging the Gap Program. J Gen Intern Med 2023; 38:1-3. [PMID: 36864265 PMCID: PMC10043067 DOI: 10.1007/s11606-022-07977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Monica E Peek
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for Diabetes Translation Research, Chicago, IL, USA
| | - Marshall H Chin
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for Diabetes Translation Research, Chicago, IL, USA
| |
Collapse
|
24
|
Egede C, Dawson AZ, Walker RJ, Garacci E, Campbell JA, Egede LE. Relationship between mental health diagnoses and COVID-19 test positivity, hospitalization, and mortality in Southeast Wisconsin. Psychol Med 2023; 53:927-935. [PMID: 34034845 PMCID: PMC8185414 DOI: 10.1017/s0033291721002312] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/30/2021] [Accepted: 05/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a paucity of literature on the relationship between pre-existing mental health conditions and coronavirus disease-2019 (COVID-19) outcomes. The aim was to examine the association between pre-existing mental health diagnosis and COVID-19 outcomes (positive screen, hospitalization, mortality). METHODS Electronic medical record data for 30 976 adults tested for COVID-19 between March 2020 and 10th July 2020 was analyzed. COVID-19 outcomes included positive screen, hospitalization among screened positive, and mortality among screened positive and hospitalized. Primary independent variable, mental health disorders, was based on ICD-10 codes categorized as bipolar, internalizing, externalizing, and psychoses. Descriptive statistics were calculated, unadjusted and adjusted logistic regression and Cox proportional hazard models were used to investigate the relationship between each mental health disorder and COVID-19 outcomes. RESULTS Adults with externalizing (odds ratio (OR) 0.67, 95%CI 0.57-0.79) and internalizing disorders (OR 0.78, 95% CI 0.70-0.88) had lower odds of having a positive COVID-19 test in fully adjusted models. Adults with bipolar disorder had significantly higher odds of hospitalization in fully adjusted models (OR 4.27, 95% CI 2.06-8.86), and odds of hospitalization were significantly higher among those with externalizing disorders after adjusting for demographics (OR 1.71, 95% CI 1.23-2.38). Mortality was significantly higher in the fully adjusted model for patients with bipolar disorder (hazard ratio 2.67, 95% CI 1.07-6.67). CONCLUSIONS Adults with mental health disorders, while less likely to test positive for COVID-19, were more likely to be hospitalized and to die in the hospital. Study results suggest the importance of developing interventions that incorporate elements designed to address smoking cessation, nutrition and physical activity counseling and other needs specific to this population to improve COVID-19 outcomes.
Collapse
Affiliation(s)
- Christine Egede
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226, USA
| | - Aprill Z. Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI53226, USA
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI53226, USA
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI53226, USA
| | - Jennifer A. Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI53226, USA
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI53226, USA
| |
Collapse
|
25
|
Williams JS, Walker RJ, Egede LE. Gender invariance in the relationship between social support and glycemic control. PLoS One 2023; 18:e0285373. [PMID: 37155683 PMCID: PMC10166517 DOI: 10.1371/journal.pone.0285373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/21/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Social support (SS) is important in diabetes self-management; however, little is known about how different types of SS influence diabetes outcomes in men and women with type 2 diabetes mellitus (T2DM). Therefore, the aims of this study were to investigate the relationships between types of SS and glycemic control and self-care behaviors and assess whether the relationships differ by gender. METHODS Cross-sectional study of 615 adults from two primary care clinics in the southeastern U.S. Outcomes were hemoglobin A1c (HbA1c) extracted from the medical records, and self-management behaviors (general diet, specific diet, exercise, blood glucose testing, foot care) measured using the Summary of Diabetes Self-Care Activities (SDSCA). Independent variable was SS (emotional/informational, tangible, affectionate, positive social interaction) measured using the Medical Outcomes Study (MOS) SS Scale. Structural equation modeling (SEM) was used to understand pathways between SS and glycemic control based on a theoretical model. RESULTS Tangible support was significantly associated with self-care (r = 0.16; p = 0.046) and affectionate support was marginally associated with glycemic control (r = 0.15; p = 0.08) for both men and women. Using SEM to test gender invariance, there was no statistically significant difference in the meaning of SS between men and women. However, unique invariances in responses occurred, including a stronger relationship between tangible support and self-care for women (r = 0.24; p = 0.061). CONCLUSIONS Of the four components of SS, tangible and affectionate support had the strongest influence on glycemic control. While affectionate support will improve glycemic control in both men and women, tangible support will improve self-care management, particularly in women.
Collapse
Affiliation(s)
- Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| |
Collapse
|
26
|
Chan R, Walker RJ, Samaranayaka A, Schollum J. Long-term impact of early non-infectious complications at the initiation of peritoneal dialysis. ARCH ESP UROL 2023; 43:53-63. [PMID: 36325812 DOI: 10.1177/08968608221132647] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Early non-infectious complications at initiation of peritoneal dialysis (PD) are a major burden with unknown long-term impacts on individuals. METHODS Prospective multicentre cohort study using univariable and multivariable Cox regression to identity mortality risk and PD discontinuation risk in those with and without non-infectious complications. All individuals commencing PD between 1 January 2014 and 31 December 2018, registered in the New Zealand Peritoneal Dialysis Registry (NZPDR) were followed up to 31 December 2020. Early non-infectious complications defined as functional, catheter-related, exit-site dialysate leak or anatomical leak complications occurring within 30 days of initiation of PD. Primary outcomes were patient survival and time on PD therapy. Secondary outcomes were peritonitis free survival, first PD catheter survival and catheter tunnel infection free survival. RESULTS Of 1596 individuals included in the study, 102 experienced an early non-infectious complication. Multivariable analysis demonstrated these complications were associated with higher risk of overall mortality (hazard ratio (HR) 1.71; 95% confidence interval (CI) 1.21-2.44), PD discontinuation (HR 1.84; 95% CI 1.41-2.41) and first catheter failure (HR 2.89; 95% CI 2.28-3.66). No difference was found for risk of development of first peritonitis episode or catheter tunnel infection. Mortality risk was associated with functional and exit-site dialysate leak complications and continued beyond 180 days. Risk of PD discontinuation and first catheter loss were associated with catheter and functional complications in the first 180 days. CONCLUSION Early non-infectious complications are associated with long-term mortality risk. Further research in risk factors and causes of early non-infectious complications are required.
Collapse
Affiliation(s)
- R Chan
- Department of Nephrology, Southern District Health Board, Dunedin, New Zealand
| | - R J Walker
- Department of Nephrology, Southern District Health Board, Dunedin, New Zealand.,Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - A Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Jbw Schollum
- Department of Nephrology, Southern District Health Board, Dunedin, New Zealand.,Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| |
Collapse
|
27
|
Dawson AZ, Walker RJ, Gregory C, Egede LE. Contributions of social determinants of health to systolic blood pressure in United States adult immigrants: Use of path analysis to validate a conceptual framework. Chronic Illn 2022; 18:757-769. [PMID: 33726528 PMCID: PMC8443685 DOI: 10.1177/17423953211000412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Validate a conceptual framework and identify pathways between antecedent (life-course socioeconomic status (L-SES)), predisposing (age, sex, married, homeless as a child), enabling (health literacy, acculturation), and need (disability) social determinants of health (SDoH) and systolic blood pressure (SBP) in US immigrants. METHODS 181 immigrants were enrolled in the study. Path analysis was used to identify paths by which SDoH influence SBP and to determine if antecedents, predisposing, enabling, and need factors have direct and indirect relationships with SBP. RESULTS The final model(chi2(5)=14.88, p = 0.011, RMSEA = 0.070, pclose = 0.17, CFI = 0.96) showed L-SES was directly associated with age (0.12, p = 0.019) and disability(0.17, p = 0.001); and indirectly associated with disability (0.29, p < 0.001) and SBP (0.31, p < 0.001). Age (0.31, p < 0.001) and sex(0.25, p < 0.001) were directly associated with SBP, and age was directly associated with disability (0.29, p < 0.001) and indirectly associated with SBP(0.14, p = 0.018). Other predisposing factors such as being married (-0.32, p < 0.001) and being homeless as a child alone (0.16, p < 0.001) were directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Enabling factor of health literacy (0.16, p = 0.001) was directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Need factor of disability (0.14, p = 0.018) was directly associated with SBP. CONCLUSIONS This study provides the first validation of a conceptual model for the relationship between SDoH and SBP among immigrants and identifies potential targets for focused interventions.
Collapse
Affiliation(s)
- Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chris Gregory
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
28
|
Williams JS, Walker RJ, Burgess KM, Shay LA, Schmidt S, Tsevat J, Campbell JA, Dawson AZ, Ozieh MN, Phillips SA, Egede LE. Mentoring strategies to support diversity in research-focused junior faculty: A scoping review. J Clin Transl Sci 2022; 7:e21. [PMID: 36755542 PMCID: PMC9879913 DOI: 10.1017/cts.2022.474] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The purpose of this scoping review is two-fold: to assess the literature that quantitatively measures outcomes of mentorship programs designed to support research-focused junior faculty and to identify mentoring strategies that promote diversity within academic medicine mentoring programs. Methods Studies were identified by searching Medline using MESH terms for mentoring and academic medicine. Eligibility criteria included studies focused on junior faculty in research-focused positions, receiving mentorship, in an academic medical center in the USA, with outcomes collected to measure career success (career trajectory, career satisfaction, quality of life, research productivity, leadership positions). Data were abstracted using a standardized data collection form, and best practices were summarized. Results Search terms resulted in 1,842 articles for title and abstract review, with 27 manuscripts meeting inclusion criteria. Two studies focused specifically on women, and four studies focused on junior faculty from racial/ethnic backgrounds underrepresented in medicine. From the initial search, few studies were designed to specifically increase diversity or capture outcomes relevant to promotion within academic medicine. Of those which did, most studies captured the impact on research productivity and career satisfaction. Traditional one-on-one mentorship, structured peer mentorship facilitated by a senior mentor, and peer mentorship in combination with one-on-one mentorship were found to be effective strategies to facilitate research productivity. Conclusion Efforts are needed at the mentee, mentor, and institutional level to provide mentorship to diverse junior faculty on research competencies and career trajectory, create a sense of belonging, and connect junior faculty with institutional resources to support career success.
Collapse
Affiliation(s)
- Joni S. Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaylin M. Burgess
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - L. Aubree Shay
- UTHealth School of Public Health in San Antonio, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joel Tsevat
- ReACH Center and Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jennifer A. Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z. Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mukoso N. Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Shane A. Phillips
- Department of Physical Therapy, College of Applied Health Sciences, Center for Clinical and Translational Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
29
|
Martinez M, Dawson AZ, Lu K, Walker RJ, Egede LE. Effect of cognitive impairment on risk of death in Hispanic/Latino adults over the age of 50 residing in the United States with and without diabetes: Data from the Health and Retirement Study 1995-2014. Alzheimers Dement 2022; 18:1616-1624. [PMID: 34873809 PMCID: PMC9170835 DOI: 10.1002/alz.12521] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To understand the relationship between mortality and cognitive function among older US Hispanic adults with and without diabetes. METHODS Data from the Health and Retirement Study (1995-2014) were analyzed. Cox proportional hazard models were used to estimate the association between mortality and cognitive function. Models were stratified by diabetes. RESULTS Four thousand thirteen older US Hispanic adults were included. Fully adjusted models for individuals with diabetes showed those with mild cognitive impairment (MCI; hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.06, 2.45; P = .025) and dementia (HR: 2.14; 95% CI: 1.25, 3.67; P = .006) had increased mortality compared to normal cognition. Fully adjusted models for individuals without diabetes showed those with MCI (HR: 1.87; 95% CI: 1.28, 2.74; P = .001) and dementia (HR: 3.25; 95% CI: 1.91, 5.55; P < .001) had increased mortality compared to normal cognition. CONCLUSIONS Cognitive impairment is associated with increased mortality in older US Hispanic adults with and without diabetes. Clinicians should regularly assess cognitive function in this group to quickly identify declines and make appropriate referrals for support to optimize health and reduce mortality.
Collapse
Affiliation(s)
- Martin Martinez
- Department of MedicineMedical College of WisconsinMedical SchoolMilwaukeeWisconsinUSA
| | - Aprill Z. Dawson
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA,Center for Advancing Population ScienceMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Kevin Lu
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Rebekah J. Walker
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA,Center for Advancing Population ScienceMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Leonard E. Egede
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA,Center for Advancing Population ScienceMedical College of WisconsinMilwaukeeWisconsinUSA
| |
Collapse
|
30
|
Hawks LC, Walker RJ, Egede LE. Association Between Lifetime Criminal Justice Involvement and Substance Use Disorders in U.S. Adults with Diabetes. Health Equity 2022; 6:684-690. [PMID: 36225660 PMCID: PMC9536329 DOI: 10.1089/heq.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura C. Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebekah J. Walker
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leonard E. Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
31
|
Corwin T, Ozieh MN, Garacci E, Walker RJ, Egede LE. Association of Social Risk Domains With Poor Cardiovascular Risk Factor Control in US Adults With Diabetes, From 2006 to 2016. JAMA Netw Open 2022; 5:e2230853. [PMID: 36083585 PMCID: PMC9463604 DOI: 10.1001/jamanetworkopen.2022.30853] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Few studies have examined the association between social risk factors and poor control of cardiovascular disease (CVD) risk factors. OBJECTIVE To examine the sequential association between social risk domains and CVD risk control over time in older adults with diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed core interviews from 4877 US adults with diabetes who were participating in the Health and Retirement Study, a national longitudinal survey of US adults. Participants were older than 50 years, completed the social risk domain questions, and had data on CVD risk factor measures from January 2006 to December 2016. Data were analyzed from June to July 2022. EXPOSURES Five social risk domains were created: (1) economic stability, (2) neighborhood or built environment, (3) education access, (4) health care access, and (5) social or community context. MAIN OUTCOMES AND MEASURES The 4 primary outcomes were (1) poor glycemic control (hemoglobin A1c [HbA1c] level ≥8.0%), (2) poor blood pressure (BP) control (systolic BP≥140 mm Hg and diastolic BP ≥90 mm Hg), (3) poor cholesterol control (total cholesterol/high-density lipoprotein ratio ≥5), and (4) a composite of poor CVD risk control (≥2 poorly controlled glucose level, BP, or cholesterol level). RESULTS Among this cohort of 4877 older adults with diabetes (mean [SD] age, 68.6 [9.8] years; 2715 women [55.7%]), 890 participants (18.3%) had an HbA1c level of 8% or higher, 774 (15.9%) had systolic BP of 140 mm Hg or higher and diastolic BP of 90 mm Hg or higher, 962 (19.7%) had total cholesterol/high-density lipoprotein ratio of 5 or higher, and 437 (9.0%) had at least 2 poorly controlled CVD risk factors. Neighborhood or built environment (ie, adverse social support) was independently associated with poor glycemic control (odds ratio [OR], 1.31; 95% CI, 1.06-1.63), whereas economic stability (ie, medication cost-related nonadherence) (OR, 1.40; 95% CI, 1.04-1.87) and health care access (ie, lack of health insurance) (OR, 1.58; 95% CI, 1.20-2.09) were independently associated with poor BP control after full adjustment. Education access (ie, lack of education) (OR, 1.24; 95% CI, 1.01-1.52) and health care access (ie, lack of health insurance) (OR, 1.31; 95% CI, 1.02-1.68) were independently associated with poor cholesterol control. Health care access (ie, lack of health insurance) was the only social risk domain that was independently associated with having at least 2 poorly controlled CVD risk factors (OR, 1.72; 95% CI, 1.26-2.37). CONCLUSIONS AND RELEVANCE Results of this study suggest that certain social risk domains are associated with control of CVD risk factors over time. Interventions targeting domains, such as neighborhood or built environment, economic stability, and education access, may be beneficial to controlling CVD risk factors in older adults with diabetes.
Collapse
Affiliation(s)
- Timothy Corwin
- Medical College of Wisconsin School of Medicine, Milwaukee
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Mukoso N. Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
32
|
Egede LE, Walker RJ, Dawson AZ, Zosel A, Bhandari S, Nagavally S, Martin I, Frank M. Short-term impact of COVID-19 on quality of life, perceived stress, and serious psychological distress in an adult population in the midwest United States. Qual Life Res 2022; 31:2387-2396. [PMID: 35020111 PMCID: PMC8753941 DOI: 10.1007/s11136-022-03081-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE This study aimed to investigate changes over time in quality of life, perceived stress, and serious psychological distress for individuals diagnosed with COVID-19 in an urban academic health system. METHODS Phone-based surveys were completed with adult patients tested for COVID-19 during emergency department visits, hospitalizations, or outpatient visits at the Froedtert and Medical College of Wisconsin Health Network. Data were then matched to medical record data. Unadjusted and adjusted mixed effects linear models using random intercept were run for each outcome (physical health-related quality of life, mental health-related quality of life, perceived stress, and serious psychological distress) with time (baseline vs 3-month follow-up) as the primary independent variable. Individuals were treated as a random effect, with all covariates (age, sex, race/ethnicity, payor, comorbidity count, hospitalization, and intensive care unit (ICU) stay) treated as fixed effects. RESULTS 264 adults tested positive for COVID-19 and completed baseline and 3-month follow-up assessments. Of that number, 31.8% were hospitalized due to COVID-19, and 10.2% were admitted for any reason to the ICU. After adjustment, patients reported higher physical health-related quality of life at 3 months compared to baseline (0.63, 95% CI 0.15, 1.11) and decreased stress at 3 months compared to baseline (- 0.85, 95% CI - 1.33, - 0.37). There were no associations between survey time and mental health-related quality of life or serious psychological distress. CONCLUSIONS Results suggest the influence of COVID-19 on physical health-related quality of life and stress may resolve over time, however, the influence of mental health on daily activities, work, and social activities may not.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Amy Zosel
- Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Sanjay Bhandari
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Sneha Nagavally
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Ian Martin
- Department of Emergency Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Michael Frank
- Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| |
Collapse
|
33
|
Bhandari S, Dawson AZ, Kobylarz Z, Walker RJ, Egede LE. Interventions to Reduce Hospital Readmissions in Older African Americans: A Systematic Review of Studies Including African American Patients. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01378-4. [PMID: 35913544 PMCID: PMC9889568 DOI: 10.1007/s40615-022-01378-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This systematic review aims to summarize interventions that effectively reduced hospital readmission rates for African Americans (AAs) aged 65 and older. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were identified by searching PubMed for clinical trials on reducing hospital readmission among older patients published between 1 January 1990 and 31 January 2020. Eligibility criteria for the included studies were mean or median age ≥ 65 years, AAs included in the study, randomized clinical trial or quasi-experimental design, presence of an intervention, and hospital readmission as an outcome. RESULTS There were 5270 articles identified and 11 were included in the final review based on eligibility criteria. The majority of studies were conducted in academic centers, were multi-center trials, and included over 200 patients, and 6-90% of participants were older AAs. The length of intervention ranged from 1 week to over a year, with readmission assessed between 30 days and 1 year. Four studies which reported interventions that significantly reduced readmissions included both inpatient (e.g., discharge planning prior to discharge) and outpatient care components (e.g., follow-ups after discharge), and the majority used a multifaceted approach. CONCLUSION Findings from the review suggest successful interventions to reduce readmissions among AAs aged 65 and older should include inpatient and outpatient care components at a minimum. This systematic review showed limited evidence of interventions successfully decreasing readmission in older AAs, suggesting a need for research in the area to reduce readmission disparities and improve overall health.
Collapse
Affiliation(s)
- Sanjay Bhandari
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Aprill Z. Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Zacory Kobylarz
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Rebekah J. Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| |
Collapse
|
34
|
Linde S, Walker RJ, Campbell JA, Egede LE. Historic Residential Redlining and Present-day Diabetes Mortality and Years of Life Lost: The Persistence of Structural Racism. Diabetes Care 2022; 45:1772-1778. [PMID: 35639415 PMCID: PMC9346977 DOI: 10.2337/dc21-2563] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The association between structural racism, as captured by historic residential redlining practices under the Home Owners' Loan Corporation (HOLC), and present-day diabetes mortality, and years of life lost (YLL), remains unknown. RESEARCH DESIGN AND METHODS Age-standardized mortality and YLL data were combined with historic HOLC redlining data for the city of Seattle, WA (a sample of 109 census tract-level observations) for each of the years 1990 through 2014 (25 years). Spatial autoregressive regression analyses were used for assessment of the association between an area's historic HOLC redlining score and diabetes (and all-cause) mortality and YLL. RESULTS Spatial autoregressive model estimates indicate that an area's HOLC redlining score explains 45%-56% of the variation in the census tract-level diabetes mortality rate and 51%-60% of the variation in the census tract diabetes YLL rate between the years of 1990 and 2014. For 2014, estimates indicate that areas with a unit-higher HOLC grade are associated with 53.7% (95% CI 43.3-64.9; P < 0.01) higher diabetes mortality rates and 66.5% (53.7-80.4; P < 0.01) higher diabetes YLL rate. Magnitudes of marginal effects were consistently larger for diabetes than for all-cause outcomes. CONCLUSIONS Results indicate sizable, and statistically significant, associations between historic redlining practices and present-day diabetes mortality and YLL rates. In addition, the persistence of these associations across the 1990-2014 period highlight a need for targeted action to undo the impact of historical redlining on current health.
Collapse
Affiliation(s)
- Sebastian Linde
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
35
|
Egede LE, Walker RJ, Linde S, Campbell JA, Dawson AZ, Williams JS, Ozieh MN. Nonmedical Interventions For Type 2 Diabetes: Evidence, Actionable Strategies, And Policy Opportunities. Health Aff (Millwood) 2022; 41:963-970. [PMID: 35759702 PMCID: PMC9563395 DOI: 10.1377/hlthaff.2022.00236] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This systematic review identified studies of nonmedical interventions designed to reduce risk for and improve clinical outcomes for type 2 diabetes. Specifically, this review sought to identify interventions that target structural racism and social determinants of health. To be included, studies were published in English; published between database initiation and January 2022; conducted in the United States; measured an intervention effect using a clinical trial, quasi-experimental, or pre-post design; included a population of adults at risk for or with type 2 diabetes; and targeted hemoglobin A1c levels, blood pressure, lipids, self-care, or quality of life as outcomes. The findings of our review indicate that interventions with targeted, multicomponent designs that combine both medical and nonmedical approaches can reduce risk for and improve clinical outcomes for type 2 diabetes. HbA1c levels improved significantly with the use of food supplementation with referral and diabetes support; the use of financial incentives with education and skills training; the use of housing relocation with counseling support; and the integration of nonmedical interventions into medical care using the electronic medical record. Our findings demonstrate that the literature on nonmedical interventions designed to address relevant social factors and target structural racism is limited. The article offers actionable strategies and identifies policy opportunities for targeting structural inequalities and decreasing social risk among adults with type 2 diabetes.
Collapse
|
36
|
Renta V, Walker RJ, Nagavally S, Dawson AZ, Campbell JA, Egede LE. Differences in the relationship between social capital and hypertension in emerging vs. established economies in Sub-Saharan Africa. BMC Public Health 2022; 22:1038. [PMID: 35610591 PMCID: PMC9128267 DOI: 10.1186/s12889-022-13471-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background The global burden of hypertension is growing, particularly in low- and middle-income countries. This study aimed to investigate differences in the relationship between social capital and hypertension between regions in Sub-Saharan Africa (West vs. South Africa) and within regions (rural vs. urban residence within each country). Methods Data for 9,800 adults were analyzed from the Study on Global Ageing and Adult Health (SAGE) 2007-2010 for Ghana (West African emerging economy) and South Africa (South African established economy). Outcomes were self-reported and measured hypertension. The primary independent variable was social capital, dichotomized into low vs. medium/high. Interaction terms were tested between social capital and rural/urban residence status for each outcome by country. Linear and logistic regression models were run separately for both countries and each outcome. Results Those with low social capital in the emerging economy of Ghana were more likely to have hypertension based on measurement (OR=1.35, 95% CI=1.18,1.55), but the relationship with self-reported hypertension lost significance after adjustment. There was no significant relationship in the relationship between social capital and hypertension in the established economy of South Africa after adjustment. No significant interactions existed by rural/urban residence status in either country. Conclusion Low social capital was associated with worse hypertension outcomes, however, the relationship differed between South Africa and Ghana. Further investigation is needed to understand differences between and within countries to guide development of programs targeted at leveraging and promoting social capital as a positive component of overall health.
Collapse
Affiliation(s)
- Vincent Renta
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, USA.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sneha Nagavally
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, USA.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, USA.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, USA.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, USA. .,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
37
|
Hawks LC, Walker RJ, Egede LE. Individual and Combined Effect of Diabetes and Lifetime Criminal Justice Involvement on Healthcare Utilization in US Adults, 2015-2019. J Gen Intern Med 2022; 37:1688-1696. [PMID: 35137299 PMCID: PMC9130376 DOI: 10.1007/s11606-021-07218-1] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diabetes and criminal justice involvement (CJI) are both associated with poor health outcomes and increased healthcare utilization. However, little is known about the additive effects of these risk factors when combined. This study examined the individual and combined effects of diabetes and CJI on healthcare utilization. METHODS Data from the National Survey of Drug Use and Health (2015-2019) was used to create a cross-sectional, nationally representative sample of US adults with diabetes, CJI, combination of both, or neither. Negative binomial regression was used to test the association between those with CJI and diabetes (compared to diabetes alone) and three utilization types (outpatient, ED, and inpatient) controlling for relevant sociodemographic and clinical covariates. RESULTS Of 212,079 respondents, representing 268,893,642 US adults, 8.8% report having diabetes alone, 15.2% report having CJI alone, and 1.8 % report both diabetes and lifetime CJI. After adjustment, those with diabetes and CJI had increased acute care utilization compared to those with diabetes alone (ED visits: IRR 1.13; 95% CI 1.00-1.28; nights hospitalized: IRR 1.34; 95% CI 1.08-1.67). There was no difference in outpatient utilization between those with both diabetes and CJI compared to those with diabetes alone (IRR 1.04, 95% CI 0.99-1.10). CONCLUSION Individuals with complex social and health risks such as diabetes and lifetime CJI experience increased acute healthcare utilization but no difference in outpatient utilization. Tailored interventions that target both diabetes and CJI are needed to reduce unnecessary utilization in this population.
Collapse
Affiliation(s)
- Laura C Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA. .,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
38
|
Anguzu R, Cassidy LD, Beyer KMM, Babikako HM, Walker RJ, Dickson-Gomez J. Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda. BMC Health Serv Res 2022; 22:283. [PMID: 35232438 PMCID: PMC8889632 DOI: 10.1186/s12913-022-07669-0] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background Uganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda. Methods We conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis. Results Participants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse. Conclusions Our findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07669-0.
Collapse
Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA.
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| | - Harriet M Babikako
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Makerere University College of Health Sciences, New Mulago Gate Road, Mulago, Kampala, Uganda.,Department of Child Health and Development Center, School of Medicine, Makerere University, College of Health Sciences, Mulago Hill, Hospital Complex, P.O. Box 7072, Kampala, Kampala, Uganda
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, USA
| |
Collapse
|
39
|
Hawks LC, Walker RJ, Egede LE. Association Between Social Adaptability Index Score and Lifetime Criminal Legal Involvement in U.S. Adults. Health Equity 2022; 6:240-247. [PMID: 35402774 PMCID: PMC8985533 DOI: 10.1089/heq.2021.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Exposure to the criminal legal system is associated with negative health outcomes and profound socioeconomic health disparities. The social adaptability index (SAI) is a validated composite scale based on five indicators of socioeconomic status; a higher score predicts better health outcomes. However, little is known about the relationship between cumulative social risk factors as measured by the SAI and lifetime criminal legal involvement (CLI). Methods Using a cross-sectional, nationally representative sample of U.S. adults, we calculated SAI score by lifetime CLI status, and used logistic regression with predictive margins to calculate risk of lifetime CLI by SAI quartile adjusting for demographic and clinical covariates. Results A total of 213,678 participants were included, among whom 16.8% reported lifetime CLI. Mean SAI score was lower among those with lifetime CLI compared with those without (7.77, 95% confidence interval [CI]: 7.72–7.83 vs. 8.52, 95% CI: 8.50–8.55). There was a linear association between SAI quartile and predicted probability of lifetime CLI: first quartile: 23.9% (95% CI: 23.0–24.7); second quartile: 19.2% (95% CI: 18.6–19.8); third quartile: 17.5% (95% CI: 16.9–18.1); and fourth quartile: 12.5% (95% CI: 12.1–13.0). Conclusion The SAI score is associated in a reverse linear manner with lifetime risk of CLI, suggesting that to successfully improve health outcomes among those with CLI, interventions may need to target multiple SAI components simultaneously. Interventions that successfully position individuals to achieve higher social adaptability by targeting multiple factors may reduce the health-harming effects of exposure to the criminal legal system.
Collapse
Affiliation(s)
- Laura C. Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebekah J. Walker
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leonard E. Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
40
|
Egede JK, Campbell JA, Walker RJ, Egede LE. Perceived Stress as a Pathway for the Relationship Between Neighborhood Factors and Glycemic Control in Adults With Diabetes. Am J Health Promot 2022; 36:269-278. [PMID: 34860603 PMCID: PMC8823403 DOI: 10.1177/08901171211050369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Neighborhood factors such as crime, discrimination, and violence are increasingly recognized as correlates of poor glycemic control. However, pathways for these relationships are unclear. This study examined stress and self-efficacy as potential pathways for the relationship between neighborhood factors and glycemic control in adults with type 2 diabetes. DESIGN Cross-sectional study. SETTING Two primary care clinics in southeastern US. PARTICIPANTS 615 adults aged 18 years and older. MEASURES Validated measures were used to capture neighborhood factors, stress, and self-efficacy, while hemoglobin A1c (HbA1c) was abstracted from the electronic health record. ANALYSIS Path analysis was used to investigate direct and indirect relationships between neighborhood factors, stress, self-efficacy, and glycemic control. RESULTS In the final model, violence (r = .17, P = .024), discrimination (r = .46, P < .001), and crime (r = .36, P = .046) were directly associated with higher perceived stress. Stress (r = -.5, P < .001) was directly associated with lower self-efficacy. Self-efficacy was directly associated with better general diet (r = .12, P < .001), better specific diet (r = .04, P < .001), more exercise (r = .08, P < .001), and lower HbA1c (r = -.11, P < .001). Stress (r = .05, P < .001), crime (r = .20, P < .001), and discrimination (r = .08, P < .001) were indirectly associated with higher HbA1c. CONCLUSION Stress and self-efficacy are potential pathways for the relationship between neighborhood factors like violence, discrimination, and crime and glycemic control. Interventions aimed at mitigating stress and improving self-efficacy may improve self-care behaviors and glycemic control.
Collapse
Affiliation(s)
- Joshua K. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A. Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
41
|
Diaz R, Walker RJ, Lu K, Weston BW, Young N, Fumo N, Hilgeman B. The relationship between adverse childhood experiences, the frequency and acuity of emergency department utilization and primary care engagement. Child Abuse Negl 2022; 124:105479. [PMID: 35026607 DOI: 10.1016/j.chiabu.2021.105479] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION A history of adverse child experiences (ACEs) is associated with increased high-risk adult behaviors, morbidity, mortality, and use of the emergency department. This study was designed to understand the relationship between ACEs and the characteristics of emergency department use and primary care engagement. METHODS An in-person survey was conducted at an academic emergency department (ED) assessing ACE score, emergency department utilization and acuity, and primary care engagement. RESULTS The prevalence of ACEs was 71.1% with 1+ ACE and 32.5% with 4+ ACE. ACE scores of four or more were associated with three or more ED visits in the past year compared those with an ACE score of zero (OR 3.22; p < 0.05) and when adjusted for sociodemographic factors (OR 3.22; p < 0.10). Higher ACE scores were associated with lower acuity presentations as indicated by the Emergency Severity Index before (ACE score 1 OR 3.91 p < 0.05; ACE score 2-3 OR 2.35 p < 0.05; ACE score 4+ OR 3.95 p < 0.05) and after adjustment (ACE score 1 OR 3.80 p < 0.10; ACE 2-3 OR 3.50 p < 0.10; ACE 4+ OR 4.36 p < 0.05). There was no association between ACE score and having a primary care provider (PCP), frequency of PCP visits, or PCP rating. CONCLUSION Higher ACE scores were associated with higher emergency department utilization and lower acuity presentations but not associated with levels of primary care engagement. Additional investigations are needed to adequately characterize the discrete causal mechanisms behind these current findings.
Collapse
Affiliation(s)
- Robert Diaz
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Kaiwei Lu
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Benjamin W Weston
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nicholas Young
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nicole Fumo
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Brian Hilgeman
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America.
| |
Collapse
|
42
|
Hawks LC, Walker RJ, Egede LE. Association between mental health outcomes and lifetime criminal justice involvement in U.S. adults with diabetes. J Affect Disord 2022; 298:451-456. [PMID: 34767857 PMCID: PMC8647859 DOI: 10.1016/j.jad.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/26/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetes is a leading cause of death in the United States, and comorbid mental illness is associated with worse diabetes outcomes. Those with criminal justice involvement (CJI) have high rates of mental illness and diabetes prevalence. However, little is known about the relationship between CJI and mental illness among those with diabetes. METHODS Using a nationally representative sample of U.S. adults with diabetes from the National Survey of Drug Use and Health (2015-2018), we investigated the relationship between CJI and mental health outcomes (depression, serious psychologic distress, serious mental illness, moderate mental illness, any mental illness, functional status). Multiple linear and logistic regression models were used to assess the relationship between CJI and each mental health outcome adjusting for multiple socio-demographic and comorbidity variables. RESULTS Of 11,594 respondents, representing 25,834,422 adults with diabetes, 17.1% reported prior CJI. In fully adjusted models, CJI was independently associated with all mental health outcomes: depression (aOR 1.80, 95% CI: 1.41, 2.30), serious psychologic distress (aOR 1.53, 95% CI: 1.23, 1.90), serious mental illness (aOR 2.00, 95% CI: 1.58, 2.52), moderate mental illness (aOR 1.72, 95% CI 1.30, 2.26), any mental illness (aOR 1.92, 95% CI: 1.56, 2.35) and functional status (regression coefficient 3.6, 95% CI: 3.53, 3.79). CONCLUSION Those with diabetes and criminal justice involvement experience concentrated risk for poor mental health outcomes. Our findings suggest that mental health interventions may be imperative to achieving control of diabetes in the justice-involved population.
Collapse
Affiliation(s)
- Laura C. Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
43
|
Mosley-Johnson E, Walker RJ, Thakkar M, Campbell JA, Hawks L, Pyzyk S, Egede LE. Relationship between housing insecurity, diabetes processes of care, and self-care behaviors. BMC Health Serv Res 2022; 22:61. [PMID: 35022049 PMCID: PMC8756650 DOI: 10.1186/s12913-022-07468-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this analysis was to examine the influence of housing insecurity on diabetes processes of care and self-care behaviors and determine if that relationship varied by employment status or race/ethnicity. Methods Using nationally representative data from the Behavioral Risk Factor Surveillance System (2014-2015), 16,091 individuals were analyzed for the cross-sectional study. Housing insecurity was defined as how often respondents reported being worried or stressed about having enough money to pay rent/mortgage. Following unadjusted logistic models testing interactions between housing insecurity and either employment or race/ethnicity on diabetes processes of care and self-care behaviors, stratified models were adjusted for demographics, socioeconomic status, health insurance status, and comorbidity count. Results 38.1% of adults with diabetes reported housing insecurity. Those reporting housing insecurity who were employed were less likely to have a physicians visit (0.58, 95%CI 0.37,0.92), A1c check (0.45, 95%CI 0.26,0.78), and eye exam (0.61, 95%CI 0.44,0.83), while unemployed individuals were less likely to have a flu vaccine (0.84, 95%CI 0.70,0.99). Housing insecure White adults were less likely to receive an eye exam (0.67, 95%CI 0.54,0.83), flu vaccine (0.84, 95%CI 0.71,0.99) or engage in physical activity (0.82, 95%CI 0.69,0.96), while housing insecure Non-Hispanic Black adults were less likely to have a physicians visit (0.56, 95%CI 0.32,0.99). Conclusions Housing insecurity had an influence on diabetes processes of care and self-care behaviors, and this relationship varied by employment status and race/ethnicity. Diabetes interventions should incorporate discussion surrounding housing insecurity and consider differences in the impact by demographic factors on diabetes care.
Collapse
|
44
|
O'Toole SM, Walker RJ, Garacci E, Dawson AZ, Campbell JA, Egede LE. Explanatory role of sociodemographic, clinical, behavioral, and social factors on cognitive decline in older adults with diabetes. BMC Geriatr 2022; 22:39. [PMID: 35012474 PMCID: PMC8751249 DOI: 10.1186/s12877-021-02740-7] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/22/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes. METHODS Adults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors. RESULTS Unadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95%CI 2.35-3.81; Hispanic OR: 3.55, 95%CI 2.77-4.56), and normal cognition to MCI (NHB OR = 2.45, 95%CI 2.14-2.82; Hispanic OR = 2.49, 95%CI 2.13-2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95%CI 1.11-1.84). After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95%CI 2.52-5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95%CI 2.37-3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95%CI 1.17-2.52) than NHW to reach dementia from MCI. CONCLUSION Clinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.
Collapse
Affiliation(s)
- Sean M O'Toole
- College of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emma Garacci
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
45
|
Dawson AZ, Walker RJ, Campbell JA, Williams JS, Egede LE. Prevalence and sociodemographic correlates of diabetes among adults in Namibia and South Africa. J Natl Med Assoc 2022; 113:636-644. [PMID: 34176662 PMCID: PMC8702571 DOI: 10.1016/j.jnma.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aims of this study were to understand the prevalence and sociodemographic characteristics associated with diabetes among adults in Namibia and South Africa. METHODS Data from the Demographic and Health Survey for Namibia (2013) and South Africa (2016) were analyzed. The dependent variable, diabetes, was defined using lab values for blood glucose≥ 126 for Namibia, and hemoglobin A1c (HbA1c) ≥ 6.5% for South Africa. Logistic regression was used to identify independent correlates of diabetes for each country. Demographic (age, sex, geographic location, number of children), economic (wealth index, education level), and cultural (religion - Namibia, ethnicity - South Africa) factors were added in blocks to the models. RESULTS In Namibia, 4.6% had diabetes based on blood glucose, and 14.6% had diabetes based on HbA1c in South Africa. In Namibia, after adjustment, higher wealth was independently associated with diabetes (OR:1.67; 95% CI: 1.11, 2.50). In South Africa, after adjustment, those who were older (OR: 1.06; 95% CI: 1.04, 1.07), female (OR: 1.25; 95% CI: 1.03, 1.52), lived in a rural area (OR: 1.54; 95% CI: 1.20, 1.96), and Black (OR: 2.27; 95% CI: 1.17, 4.42) or Other (OR: 5.74; 95% CI: 2.50, 13.20) compared to White, had increased odds of diabetes. CONCLUSIONS Prevalence of diabetes is high in South Africa and relatively low in Namibia using reliable laboratory diagnostic indices. Strategies to address the rising burden of non-communicable diseases like diabetes are needed in sub-Saharan Africa.
Collapse
Affiliation(s)
- Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| |
Collapse
|
46
|
Yang E, Zhou Z, Walker RJ, Segon Y, Segon A. The Impact of Hospitalist Switch Day on Length of Stay. Qual Manag Health Care 2022; 31:7-13. [PMID: 34326291 DOI: 10.1097/qmh.0000000000000316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Hospitalist practices around the country switch service on different days of the week. It is unclear whether switching clinical service later in the week is associated with an increase in length of stay (LOS). The aim of this study was to examine the association between service switch day for hospitalists at an academic medical center and LOS. METHODS A single-center, cross-sectional study examined 4284 discharges from hospitalist staffed general internal medicine ward teams over a 1-year period between July 2018 and June 2019. Hospitalist service switch day changed from Tuesday to Thursday on January 1, 2019. The period between July 1, 2018, and December 31, 2018, was defined as the pre-switch time, while January 1, 2019, to June 30, 2019, was defined as the post-switch period. We calculated the LOS in days for patients discharged from hospitalist general internal medicine teams in the 2 periods. Generalized linear models were used to examine the association between attending switch day and LOS while adjusting for demographic factors, payer status, markers of severity of illness, and hospital or discharge-level confounders. RESULTS There was no difference in mean LOS for patients discharged in the pre-switch time (6 days) period versus patients discharged in the post-switch time (6.03 days) (difference of means 0.03 days, 95% confidence interval -0.04 to 0.09, P value .37). CONCLUSIONS Change in attending switch day from earlier in the week to later in the week is not associated with an increase in LOS. Other factors such as group preference and institutional needs should drive service switch day selection for hospitalist groups.
Collapse
Affiliation(s)
- Evan Yang
- Medical College of Wisconsin, Milwaukee (Mr Yang and Drs Y. Segon and A. Segon); Columbia University Medical Center, Fort Lee, New Jersey (Mr Zhou); and Center for Advancement of Population Science, Medical College of Wisconsin, Milwaukee (Dr Walker)
| | | | | | | | | |
Collapse
|
47
|
Egede LE, Ozieh MN, Campbell JA, Williams JS, Walker RJ. Cross-Sector Collaborations Between Health Care Systems and Community Partners That Target Health Equity/Disparities in Diabetes Care. Diabetes Spectr 2022; 35:313-319. [PMID: 36082007 PMCID: PMC9396714 DOI: 10.2337/dsi22-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Evidence shows that social determinants of health (SDOH) are key drivers of diabetes outcomes and disparities in diabetes care. Targeting SDOH at the individual, organizational, and policy levels is an essential step in improving health equity for individuals living with diabetes. In addition, there is increasing recognition of the need to build collaboration across the health care system and the communities experiencing inequities to improve health equity. As a result, partnerships between health and nonhealth sectors have emerged as a crucial component for increasing health equity in diabetes care and achieving health equity. The purpose of this article is to discuss cross-sector collaborations between health care systems and nonhealth partners that target health equity in diabetes care.
Collapse
Affiliation(s)
- Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Corresponding author: Leonard E. Egede,
| | - Mukoso N. Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI
| | - Jennifer A. Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Joni S. Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
48
|
Abstract
OBJECTIVE The aim of this study was to investigate prenatal factors associated with insulin prescription as a first-line pharmacotherapy for gestational diabetes mellitus (GDM; compared with oral antidiabetic medication) after failed medical nutrition therapy. STUDY DESIGN This is a retrospective cohort study of 437 women with a singleton pregnancy and diagnosis of A2GDM (GDM requiring pharmacotherapy), delivering in a university hospital between 2015 and 2019. Maternal sociodemographic and clinical characteristics, as well as GDM-related factors, including provider type that manages GDM, were compared between women who received insulin versus oral antidiabetic medication (metformin or glyburide) as the first-line pharmacotherapy using univariable and multivariable analyses. RESULTS In univariable analysis, maternal age, race and ethnicity, insurance, chronic hypertension, gestational age at GDM diagnosis, glucose level after 50-g glucose loading test, and provider type were associated with insulin prescription. In multivariable analysis, after adjusting for sociodemographic and clinical maternal factors, GDM characteristics and provider type, Hispanic ethnicity (0.26, 95% confidence interval [CI]: 0.09-0.73), and lack of insurance (0.34, 95% CI: 0.13-0.89) remained associated with lower odds of insulin prescription, whereas endocrinology management of GDM (compared with obstetrics and gynecology [OBGYN]) (8.07, 95% CI: 3.27-19.90) remained associated with higher odds of insulin prescription. CONCLUSION Women of Hispanic ethnicity and women with no insurance were less likely to receive insulin and more likely to receive oral antidiabetic medication for GDM pharmacotherapy, while management by endocrinology was associated with higher odds of insulin prescription.This finding deserves more investigation to understand if differences are due to patient choice or a health disparity in the choice of pharmacologic agent for A2GDM. KEY POINTS · Insulin is recommended as a first-line pharmacotherapy for gestational diabetes.. · Women of Hispanic ethnicity were less likely to receive insulin as first line.. · Lack of insurance was also associated with lower odds of insulin prescription..
Collapse
Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel K. Harrison
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Madhuli Y. Thakkar
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
49
|
Egede LE, Davidson TM, Knapp RG, Walker RJ, Williams JS, Dismuke CE, Dawson AZ. HOME DM-BAT: home-based diabetes-modified behavioral activation treatment for low-income seniors with type 2 diabetes-study protocol for a randomized controlled trial. Trials 2021; 22:787. [PMID: 34749788 PMCID: PMC8574935 DOI: 10.1186/s13063-021-05744-1] [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: 06/10/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND About 13% of African Americans and 13% of Hispanics have diabetes, compared to 8% of non-Hispanic Whites (NHWs). This is more pronounced in the elderly where about 25-30% of those aged 65 and older have diabetes. Studies have found associations between social determinants of health (SDoH) and increased incidence, prevalence, and burden of diabetes; however, few interventions have accounted for the context in which the elderly live by addressing SDoH. Specifically, psychosocial factors (such as cognitive dysfunction, functional impairment, and social isolation) impacting this population may be under-addressed due to numerous medical concerns addressed during the clinical visit. The long-term goal of the project is to identify strategies to improve glycemic control and reduce diabetes complications and mortality in African Americans and Hispanics/Latinos with type 2 diabetes. METHODS This is a 5-year prospective, randomized clinical trial, which will test the effectiveness of a home-based diabetes-modified behavioral activation treatment for low-income, minority seniors with type 2 diabetes mellitus (T2DM) (HOME DM-BAT). Two hundred, aged 65 and older and with an HbA1c ≥8%, will be randomized into one of two groups: (1) an intervention using in-home, nurse telephone-delivered diabetes education, and behavioral activation or (2) a usual care group using in-home, nurse telephone-delivered, health education/supportive therapy. Participants will be followed for 12 months to ascertain the effect of the intervention on glycemic control, blood pressure, and low-density lipoprotein (LDL) cholesterol. The primary hypothesis is low-income, minority seniors with poorly controlled type 2 diabetes randomized to HOME DM-BAT will have significantly greater improvements in clinical outcomes at 12 months of follow-up compared to usual care. DISCUSSION Results from this study will provide important insight into the effectiveness of a home-based diabetes-modified behavioral activation treatment for low-income, minority seniors with uncontrolled type 2 diabetes mellitus and inform strategies to improve glycemic control and reduce diabetes complications in minority elderly with T2DM. TRIAL REGISTRATION ClinicalTrials.gov NCT04203147 ). Registered on December 18, 2019, with the National Institutes of Health Clinical Trials Registry.
Collapse
Affiliation(s)
- Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, USA
| | - Rebecca G Knapp
- Department of Public Health Services, College of Medicine, Medical University of South Carolina, 135 Cannon St., Charleston, SC, 29425, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Joni S Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Clara E Dismuke
- Health Economics Resource Center, VA Palo Alto Healthcare System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| |
Collapse
|
50
|
Walker RJ, Walker RE, Mosley-Johnson E, Egede LE. Exploring the Lived Experience of Food Insecure African Americans with Type 2 Diabetes Living in the Inner City. Ethn Dis 2021; 31:527-536. [PMID: 34720556 PMCID: PMC8545483 DOI: 10.18865/ed.31.4.527] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Despite evidence that food insecure African Americans with type 2 diabetes are at particularly high risk for poor health outcomes, there is currently a lack of information on their lived experience. This qualitative study aimed to identify challenges, facilitators, and barriers to effective diabetes care for food insecure African Americans with type 2 diabetes residing in an inner city. Methods In fall 2018, we conducted two focus groups attended by a total of 16 food insecure adults with type 2 diabetes residing in the inner city of Milwaukee, Wisconsin. A standardized moderator guide included questions to explore the role of food insecurity in managing diabetes, and facilitators that improve diabetes management within the context of food insecurity. Focus groups were audio recorded and recordings were transcribed by a professional transcription service. A grounded theory approach was used for analysis. Results Six major challenges existed at the individual level (diet/nutrition, exercise, diabetes knowledge and skills, complications from diabetes, a family history of diabetes, and a preoccupation with food). Five major barriers and facilitators existed both internally and externally to the individuals (access to food, medications, stress, cost of health-related needs and religion/spirituality). Conclusions This study identified multiple challenges, barriers, and facilitators to effective care for food insecure African American adults with type 2 diabetes. It is imperative to incorporate this understanding in future work by using an ecological approach to investigate strategies to address food insecurity beyond a singular focus on access to food.
Collapse
Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Renee E Walker
- Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI
| | - Elise Mosley-Johnson
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|