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Swietek K, Jones KA, Bettger JP, French A, Maslow G, Norman KS, Lake AD, Carvalho M, Cholera R, Freed SS, Tchuisseu YP, Repka S, Whitaker RG. What Explains Inequalities in Telehealth Utilization Among North Carolina Medicaid Beneficiaries? Telemed J E Health 2024. [PMID: 38728091 DOI: 10.1089/tmj.2023.0563] [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: 05/12/2024] Open
Abstract
Background: Increased availability of telehealth can improve access to health care. However, there is evidence of persistent disparities in telehealth usage, as well as among people from minoritized racial and ethnic groups and rural residents. The objective of our work was to explore the degree to which disparities in telehealth use for behavioral health (BH) and musculoskeletal (MSK) related services during the COVID-19 pandemic are explained by observed beneficiary- and area-level characteristics. Methods: Using North Carolina Medicaid claims data of Medicaid beneficiaries with BH or MSK conditions, we apply nonlinear regression-based decomposition analysis-based models developed by Kitagawa, Oaxaca, and Blinder to determine which observed variables are associated with racial, ethnic, and rural inequalities in telehealth usage. Results: In the BH cohort, we found statistically significant differences in telehealth usage by race in the adult population, and by race, Hispanic ethnicity, and rurality in the pediatric population. In the MSK cohort, we found significant inequities by Hispanic ethnicity and rurality among adults, and by race and rurality among children. Inequalities in telehealth use between groups were small, ranging from 0.7 percentage points between urban and rural adults with MSK conditions to 3.8 percentage points between white adults and people of color among those with BH conditions. Overall, we found that racial and ethnic inequalities in telehealth use are not well explained by the observed variables in our data. Rural disparities in telehealth use are better explained by observed variables, particularly area-level broadband internet use. Conclusions: For inequalities between rural and urban residents, our analysis provides observational evidence that infrastructure such as broadband internet access is an important driver of differences in telehealth use. For racial and ethnic inequalities, the pathways may be more complex and difficult to measure, particularly when relying on administrative data sources in place of more detailed data on individual-level socioeconomic factors.
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Affiliation(s)
- Karen Swietek
- Health Care Evaluation Department, NORC at the University of Chicago, Cambridge, Massachusetts, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Janet Prvu Bettger
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gary Maslow
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine S Norman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashley D Lake
- Duke Physical Therapy Sports Medicine at the Center for Living, Duke Health, Durham, North Carolina, USA
| | - Marissa Carvalho
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA
| | - Rushina Cholera
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Salama S Freed
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | | | - Samantha Repka
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
| | - Rebecca G Whitaker
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
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Huber K, Nohria R, Nandagiri V, Whitaker R, Tchuisseu YP, Pylypiw N, Dennison M, Van Stekelenburg B, Van Vleet A, Perez MR, Morreale MC, Thoumi A, Lyn M, Saunders RS, Bleser WK. Addressing Housing-Related Social Needs Through Medicaid: Lessons From North Carolina's Healthy Opportunities Pilots Program. Health Aff (Millwood) 2024; 43:190-199. [PMID: 38315916 DOI: 10.1377/hlthaff.2023.01044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
North Carolina Medicaid's Healthy Opportunities Pilots program is the country's first comprehensive program to evaluate the impact of paying community-based organizations to provide eligible Medicaid enrollees with an array of evidence-based services to address four domains of health-related social needs, one of which is housing. Using a mixed-methods approach, we mapped the distribution of severe housing problems and then examined the design and implementation of Healthy Opportunities Pilots housing services in the three program regions. Four cross-cutting implementation and policy themes emerged: accounting for variation in housing resources and needs to address housing insecurity, defining and pricing housing services in Medicaid, engaging diverse stakeholders across sectors to facilitate successful implementation, and developing sustainable financial models for delivery. The lessons learned and actionable insights can help inform the efforts of stakeholders elsewhere, particularly other state Medicaid programs, to design and implement cross-sectoral programs that address housing-related social needs by leveraging multiple policy-based resources. These lessons can also be useful for federal policy makers developing guidance on addressing housing-related needs in Medicaid.
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Affiliation(s)
- Katie Huber
- Katie Huber, Duke University, Durham, North Carolina
| | - Raman Nohria
- Raman Nohria, Duke University, Durham, North Carolina
| | | | | | | | | | - Meaghan Dennison
- Meaghan Dennison, Cape Fear Collective, Wilmington, North Carolina
| | | | - Amanda Van Vleet
- Amanda Van Vleet, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | - Madlyn C Morreale
- Madlyn C. Morreale, Legal Aid of North Carolina, Inc., Raleigh, North Carolina
| | | | - Michelle Lyn
- Michelle Lyn, Duke University, Durham, North Carolina
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Norman K, French A, Lake A, Tchuisseu YP, Repka S, Vasudeva K, Dong C, Whitaker R, Bettger JP. Describing Perspectives of Telehealth and the Impact on Equity in Access to Health Care from Community and Provider Perspectives: A Multimethod Analysis. Telemed J E Health 2024; 30:242-259. [PMID: 37410525 DOI: 10.1089/tmj.2023.0036] [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: 07/07/2023] Open
Abstract
Introduction: The rapid adoption of telehealth as a result of the COVID-19 pandemic provided the opportunity to examine perceptions of health care access and use of telehealth for delivery of effective and equitable care in low-income and historically marginalized communities. Methods: Focusing on communities with high social vulnerability, a multimethod analysis of combined perspectives, collected February through August 2022 from 112 health care providers, obtained from surveys and interviews, and 23 community members via 3 focus groups on access to care and telehealth. Qualitative data were analyzed using the Health Equity and Implementation Framework to identify barriers, facilitators, and recommendations for the implementation of telehealth using a health equity lens. Results: Participants perceived that telehealth helped maintain access to health care during the pandemic by addressing barriers including provider shortages, transportation concerns, and scheduling conflicts. Additional benefits suggested were improved care quality and coordination attributed to convenient avenues for care delivery and communication among providers and patients. However, many barriers to telehealth were reported and considered to limit equitable access to care. These included restrictive or changing policies regarding allowable services provided via telehealth, and availability of technology and broadband services to enable telehealth visits. Recommendations provided insight into care delivery innovation opportunities and potential policy changes to address equitable access to care. Conclusion: Integration of telehealth into models of care delivery could improve access to health care services and promote communication among providers and patients to improve care quality. Our findings have implications that are critical for future policy reforms and telehealth research.
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Affiliation(s)
- Katherine Norman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Ashley Lake
- Department of Rehabilitation Services, Duke Physical Therapy Sports Medicine at Center for Living, Duke University, Durham, North Carolina, USA
| | | | - Samantha Repka
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Karina Vasudeva
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia Dong
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Rebecca Whitaker
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
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Freed SS, Jones KA, Whitaker RG, Norman K, Carvalho M, Giri A, Lake A, Tchuisseu YP, Repka S, Vasudeva K, Bey N, Bettger JP. Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions: Insights From the COVID-19 Pandemic. Med Care 2023; 61:750-759. [PMID: 37733405 DOI: 10.1097/mlr.0000000000001915] [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: 09/22/2023]
Abstract
BACKGROUND The shift from in-person to virtual visits, known as telehealth (TH), during the COVID-19 pandemic was a significant change for North Carolina (NC) Medicaid beneficiaries seeking treatment for musculoskeletal (MSK) conditions, as remote care for these conditions was previously unavailable. We used this policy change to investigate factors associated with TH uptake and whether TH availability mitigated disparities in access to care or affected emergency department (ED) visits among these beneficiaries. RESEARCH DESIGN Using 2019-2021 NC Medicaid claims, we identified beneficiaries receiving treatment for MSK conditions before COVID-19 (March 2019-February 2020) and analyzed uptake of newly available TH during COVID-19 (April 2020-March 2021). We used descriptive analysis and Poisson generalized estimating equations to quantify TH uptake, factors associated with TH uptake, and the association with ED visits during COVID-19. RESULTS Black and Hispanic beneficiaries were less likely to use TH compared with White and non-Hispanic counterparts (10%, P <0.001 and 20%, P =0.03, respectively). Adults eligible for Tailored Plans, specialized NC Medicaid plans for those with significant behavioral health needs or intellectual/developmental disabilities, were less likely to use TH [adjusted risk ratio (ARR):0.83, 95% CI (0.78, 0.87)]; youth eligible for Tailored Plans were more likely to use TH [ARR:1.28, 95% CI (1.16, 1.42)]. Lower county-level internet access was associated with lower TH use [ARR: 0.85, 95% CI (0.82, 0.99)]. No statistical difference in ED utilization was observed between TH users and non-users. CONCLUSIONS TH has the potential to deliver convenient care to beneficiaries with MSK conditions who can access it. Further research and policy changes should explore and address underlying factors driving disparities and improve equitable access to care for this population.
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Affiliation(s)
- Salama S Freed
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine
| | | | - Katherine Norman
- Department of Population Health Sciences, Duke University School of Medicine
| | - Marissa Carvalho
- Department of Physical Therapy and Occupational Therapy, Duke Health, Durham NC
| | - Abhigya Giri
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Ashley Lake
- Duke Physical Therapy Sports Medicine at Center for Living, Duke University, Durham
| | | | | | - Karina Vasudeva
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nadia Bey
- Duke Margolis Center for Health Policy, Duke University
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA
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French A, Jones KA, Bettger JP, Maslow GR, Cholera R, Giri A, Swietek K, Tchuisseu YP, Repka S, Freed S, Whitaker R. Telehealth Utilization Among Adult Medicaid Beneficiaries in North Carolina with Behavioral Health Conditions During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01730-2. [PMID: 37584807 PMCID: PMC11006092 DOI: 10.1007/s40615-023-01730-2] [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: 05/04/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions. DATA SOURCES AND STUDY SETTING NC Medicaid 2019-2021 beneficiary and claims data. STUDY DESIGN This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics. DATA COLLECTION/EXTRACTION METHODS We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19. PRINCIPAL FINDINGS Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively). CONCLUSIONS During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.
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Affiliation(s)
- Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, 1700 N. Broad Street, Suite 300, Philadelphia, PA, 19121, USA
| | - Gary R Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
| | - Rushina Cholera
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Abhigya Giri
- The George Washington University Biostatistics Center, 6110 Executive Blvd, Rockville, MD, 20852, USA
| | - Karen Swietek
- NORC at the University of Chicago, 1 Broadway, 14Th Floor, Cambridge, MA, 02142, USA
| | - Yolande Pokam Tchuisseu
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Samantha Repka
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Salama Freed
- Health Policy and Management, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, 6th Floor, Washington, DC, 20052, USA
| | - Rebecca Whitaker
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
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Mitchell EM, Hall KM, Doede A, Rong A, McLean Estrada M, Granera OB, Maldonado F, Al Kallas H, Bravo-Rodriguez C, Forero M, Pokam Tchuisseu Y, Dillingham RA. Feasibility and acceptability of self-collection of Human Papillomavirus samples for primary cervical cancer screening on the Caribbean Coast of Nicaragua: A mixed-methods study. Front Oncol 2023; 12:1020205. [PMID: 36741739 PMCID: PMC9895854 DOI: 10.3389/fonc.2022.1020205] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/29/2022] [Indexed: 01/22/2023] Open
Abstract
Background Cervical cancer is the primary cause of cancer death for women in Nicaragua, despite being highly preventable through vaccination against high-risk genotypes of the Human Papillomavirus (hrHPV), screening for hrHPV, and early detection of lesions. Despite technological advances designed to increase access to screening in low resource settings, barriers to increasing population-level screening coverage persist. On the Caribbean Coast of Nicaragua, only 59% of women have received one lifetime screen, compared to 78.6% of eligible women living on the Pacific and in the Interior. In concordance with the WHO's call for best practices to eliminate cervical cancer, we explored the feasibility and acceptability of self-collection of samples for hrHPV testing on the Caribbean Coast of Nicaragua through a multi-year, bi-national, community-based mixed methods study. Methods Between 2016 and 2019, focus groups (n=25), key informant interviews (n=12) [phase I] and an environmental scan [phase II] were conducted on the Caribbean Coast of Nicaragua in partnership and collaboration with long-term research partners at the University of Virginia and community-based organizations. In spring 2020, underscreened women on the Caribbean Coast of Nicaragua were recruited and screened for hrHPV, with the choice of clinician collection or self-collection of samples. Results Over the course of the study, providers and potential patients expressed significant acceptability of self-collection of samples as a strategy to reduce barriers currently contributing to the low rates of screening (phases I and II). Ultimately 99.16% (n=1,767) of women chose to self-collect samples, demonstrating a high level of acceptability of self-collection in this pilot sample (phase III). Similarly, focus groups, key informant interviews, and the environmental scan (phases I and II) of resources indicated critical considerations for feasibility of implementation of both HPV primary screening and subsequently, self-collection of samples. Through phase III, we piloted hrHPV screening (n=1,782), with a 19.25% hrHPV positivity rate. Conclusion Self-collection of samples for hrHPV testing demonstrated high acceptability and feasibility. Through concerted effort at the local, regional, and national levels, this project supported capacity building in reporting, monitoring, and surveilling cervical cancer screening across the continuum of cervical cancer control.
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Affiliation(s)
- Emma McKim Mitchell
- Department of Family, Community & Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA, United States,*Correspondence: Emma McKim Mitchell,
| | - Katherine M. Hall
- Department of Family, Community & Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Aubrey Doede
- Department of Family Medicine, University of California San Diego, La Jolla, CA, United States
| | - Anneda Rong
- School of Data Science, University of Virginia, Charlottesville, VA, United States
| | - Michelet McLean Estrada
- Department of Family, Community & Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA, United States
| | | | | | - Hala Al Kallas
- St. George’s University School of Medicine, Great River, NY, United States
| | - Cassandra Bravo-Rodriguez
- Department of Family, Community & Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Mariana Forero
- School of Arts and Sciences, University of Virginia, Charlottesville, VA, United States
| | | | - Rebecca A. Dillingham
- Department of Infectious Disease, School of Medicine, University of Virginia, Charlottesville, VA, United States
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Campos MAG, Moraes Filho AS, Rêgo GRFM, Silva ROL, Sousa RAB, Tchuisseu YP, Silva GEB, Gama MEA. Is splenectomy an option for multiple relapses in a child with visceral leishmaniasis? A case report. Rev Soc Bras Med Trop 2021; 54:e0748-2020. [PMID: 33759927 PMCID: PMC8008903 DOI: 10.1590/0037-8682-0748-2020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania spp. The recurrence of the disease occurs, in general, in patients with decreased or loss of T-cell function, whether due to the use of corticosteroids, immunosuppressive disease, or another cause. In some cases, splenectomy may be a therapeutic option. However, the effectiveness of splenectomy is not well defined. This report describes the evolution of a pediatric patient with seven recurrences of VL, who relapsed post-surgery after drug therapy and splenectomy.
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de Carvalho Dutra A, Silva LL, Pedroso RB, Tchuisseu YP, da Silva MT, Bergamini M, Scheidt JFHC, Iora PH, do Lago Franco R, Staton CA, Vissoci JRN, Nihei OK, de Andrade L. The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis. Glob Heart 2021; 16:5. [PMID: 33598385 PMCID: PMC7824986 DOI: 10.5334/gh.770] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 12/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers. Objectives To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil. Methods An ecological study using secondary data from Brazilian Health Informatics Department between 2013-2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R2 and lowest Akaike Information Criterion. Results A total of 22,920 individuals died from IHD between 2013-2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran's I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R2: 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05). Conclusion Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil. Highlights The increase in ischemic heart disease mortality rates is related to geographical disparities.The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health.Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state.Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling.
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Affiliation(s)
- Amanda de Carvalho Dutra
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Lincoln Luís Silva
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Raíssa Bocchi Pedroso
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
| | - Yolande Pokam Tchuisseu
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, US
| | - Mariana Teixeira da Silva
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Marcela Bergamini
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - João Felipe Hermann Costa Scheidt
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Medicine, State University of Maringá, Maringá, Paraná, BR
| | - Pedro Henrique Iora
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Medicine, State University of Maringá, Maringá, Paraná, BR
| | - Rogério do Lago Franco
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Catherine Ann Staton
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, US
- Duke Global Health Institute, Duke University, Durham, North Carolina, US
| | - João Ricardo Nickenig Vissoci
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Duke Global Health Institute, Duke University, Durham, North Carolina, US
| | - Oscar Kenji Nihei
- Education, Letters and Health Center, State University of the West of Paraná, Foz do Iguaçu, Paraná, BR
| | - Luciano de Andrade
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Medicine, State University of Maringá, Maringá, Paraná, BR
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Bergamini M, Iora PH, Rocha TAH, Tchuisseu YP, Dutra ADC, Scheidt JFHC, Nihei OK, de Barros Carvalho MD, Staton CA, Vissoci JRN, de Andrade L. Mapping risk of ischemic heart disease using machine learning in a Brazilian state. PLoS One 2020; 15:e0243558. [PMID: 33301451 PMCID: PMC7728276 DOI: 10.1371/journal.pone.0243558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular diseases are the leading cause of deaths globally. Machine learning studies predicting mortality rates for ischemic heart disease (IHD) at the municipal level are very limited. The goal of this paper was to create and validate a Heart Health Care Index (HHCI) to predict risk of IHD based on location and risk factors. Secondary data, geographical information system (GIS) and machine learning were used to validate the HHCI and stratify the IHD municipality risk in the state of Paraná. A positive spatial autocorrelation was found (Moran's I = 0.6472, p-value = 0.001), showing clusters of high IHD mortality. The Support Vector Machine, which had an RMSE of 0.789 and error proportion close to one (0.867), was the best for prediction among eight machine learning algorithms after validation. In the north and northwest regions of the state, HHCI was low and mortality clusters patterns were high. By creating an HHCI through ML, we can predict IHD mortality rate at municipal level, identifying predictive characteristics that impact health conditions of these localities' guided health management decisions for improvements for IHD within the emergency care network in the state of Paraná.
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Affiliation(s)
- Marcela Bergamini
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Brazil
| | | | | | - Yolande Pokam Tchuisseu
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | - Oscar Kenji Nihei
- Education, Letters and Health Center, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil
| | | | - Catherine Ann Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Brazil
- Department of Medicine, State University of Maringa, Maringa, Brazil
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El-Gabri D, Toomey N, Gil NM, de Oliveira AC, Calvo PRS, Tchuisseu YP, Williams S, Andrade L, Vissoci JRN, Staton C. Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil. Front Public Health 2020; 8:66. [PMID: 32269983 PMCID: PMC7109310 DOI: 10.3389/fpubh.2020.00066] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Previous research has corroborated a high burden of alcohol-related injury in Brazil and the presence of socioeconomic disparities among the injured. Yet, individual-level data is scarce. To fill this gap, we examined the association between demographic and socioeconomic characteristics with non-fatal alcohol-related injury in Maringá, Brazil. Methods: We used household survey data collected during a 2015 cross-sectional study. We conducted univariate and multivariate analyses to evaluate associations of demographic (age, gender, race) and socioeconomic characteristics (employment, education, income) with non-fatal alcohol-related injury. Results: Of the 995 participants who reported injuries, 62 (6.26%) were alcohol-related. Fifty-three (85%) alcohol-related injuries were reported by males. Multivariate analysis indicated being male (OR = 5.98 95% CI = 3.02, 13.28), 15–29 years of age (OR = 3.62 95% CI = 1.72, 7.71), and identifying as Black (OR = 2.38 95% CI = 1.09, 4.95) were all significantly associated with increased likelihood of reporting an alcohol-related injury, whereas unemployment was significantly associated with decreased likelihood of reporting an alcohol-related injury (OR = 0.41 95% CI = 0.18, 0.88). Conclusion: Our findings suggest that in Maringá, being male, between the ages of 15 and 29, employed, or identifying as Black were characteristics associated with a higher risk for non-fatal alcohol-related injury. Individual level data, such as ours, should be considered in combination with area-level and country-level data when developing evidence-based public-health policies.
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Affiliation(s)
- Deena El-Gabri
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Nelly Moraes Gil
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | | | | | | | - Sarah Williams
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Luciano Andrade
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
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