1
|
Rogerson C, Owora A, Tu W, Mendonca E. The influence of social and environmental determinants of health on hospitalizations for pediatric asthma. J Asthma 2024; 61:453-462. [PMID: 38010826 DOI: 10.1080/02770903.2023.2288323] [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: 06/22/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Asthma is the most common chronic disease of childhood, and has several social, environmental, and demographic factors potentially influential to its disease burden. This study sought to determine the influence of these factors on hospital admissions and readmissions for pediatric asthma. METHODS This was a retrospective cohort study using data from the Indiana Network for Patient Care, a state-wide health information exchange in the United States. Study participants were children 2-18 years old admitted to the hospital with a respiratory diagnostic code between 2010 and 2021. Clinical variables were obtained from electronic health record data, and social and environmental determinants of health data were obtained from the Indiana Social Assets and Vulnerabilities Indicators using geocoding systems. Negative binomial models were used to examine community level social and environmental risk factors modifying the relationship between patient characteristics and the risk of asthma-related hospitalizations and 30-day readmissions. RESULTS The study sample included 25,063 patients with an average follow-up of 9 (SD = 5) years. Of these, there were 17,816 asthma-related admissions. There were a total of 1,037 asthma-related 30-day readmissions, with an incidence rate of readmissions relative to total visits of 0.028 per person-year. A high social vulnerability index (SVI) was associated with an increased rate of hospital admissions (Proportion attributable ratio: 1.09, 95%CI (1.03,1.15), p < 0.05). No environmental determinants of health were significantly associated with hospitalization rate. CONCLUSION High SVI was significantly associated with increased risk of total hospital admissions for pediatric asthma.
Collapse
Affiliation(s)
- Colin Rogerson
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Arthur Owora
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eneida Mendonca
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
Mihalopoulos M, Okewunmi J, Stern BZ, Huang HH, Galatz LM, Poeran J, Moucha CS. Did the Comprehensive Care for Joint Replacement Bundled Payment Program Impact Sex Disparities in Total Hip and Knee Arthroplasties? J Arthroplasty 2024; 39:1226-1234.e4. [PMID: 37972665 DOI: 10.1016/j.arth.2023.11.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sex disparities have been noted across various aspects of total hip/knee arthroplasty (THA/TKA). Given incentives to standardize care, bundled payment initiatives including the Comprehensive Care for Joint Replacement (CJR) program may reduce disparities. This study aimed to assess the CJR program's impact on sex disparities in THA/TKA care and outcomes. METHODS This retrospective cohort study included 259,673 THAs (61.7% women) and 506,311 TKAs (64.0% women) from a large national database (2013 to 2017). Sex disparities were assessed for care and outcomes related to the period (1) before surgery, (2) during hospitalization for THA/TKA, and (3) after discharge. Disparities were reported as women:men ratios. Difference-in-differences analyses estimated the impact of the CJR program on pre-existing sex disparities. RESULTS For both THA and TKA, women were less likely than men to present with a Charlson-Deyo comorbidity index >0 (women:men ratio 0.88 to 0.92), but were more likely to require blood transfusions (women:men ratio 1.48 to 1.79) and be discharged to institutional postacute care (women:men ratio 1.50 to 1.66). Difference-in-differences models demonstrated that the CJR bundled payment program reduced sex disparities in institutional postacute care discharges (THA: -2.28%; 95% confidence interval [CI] -4.20 to -0.35%, P = .02; TKA: -2.07%; 95% CI -3.93 to -0.20%; P = .03) and THA 90-day readmissions (-1.00%, 95% CI -1.88 to -0.13%, P = .02), indicating a differential impact of CJR in women versus men for some outcomes. CONCLUSIONS While sex disparities in THA/TKA persist, the CJR program demonstrates potential to impact such differences. Future research should focus on how potential mechanisms could be leveraged to reduce disparities.
Collapse
Affiliation(s)
- Meredith Mihalopoulos
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Okewunmi
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brocha Z Stern
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hsin-Hui Huang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jashvant Poeran
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
3
|
O'Carroll JE, Zucco L, Warwick E, Radcliffe G, Moonesinghe SR, El-Boghdadly K, Guo N, Carvalho B, Sultan P. Ethnicity, socio-economic deprivation and postpartum outcomes following caesarean delivery: a multicentre cohort study. Anaesthesia 2024; 79:486-497. [PMID: 38359531 DOI: 10.1111/anae.16241] [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] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
Abstract
Disparities relating to postpartum recovery outcomes in different socio-economic and racial ethnic groups are underexplored. We conducted a planned analysis of a large prospective caesarean delivery cohort to explore the relationship between ethnicity, socio-economic status and postpartum recovery. Eligible patients were enrolled and baseline demographic, obstetric and medical history data were collected 18 h and 30 h following delivery. Patients completed postpartum quality of life and recovery measures in person on day 1 (EuroQoL EQ-5D-5L, including global health visual analogue scale; Obstetric Quality of Recovery-10 item score; and pain scores) and by telephone between day 28 and day 32 postpartum (EQ-5D-5L and pain scores). Socio-economic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. Data from 1000 patients who underwent caesarean delivery were included. There were more patients of Asian, Black and mixed ethnicity in the more deprived quintiles. Patients of White ethnicities had shorter postpartum duration of hospital stay compared with patients of Asian and Black ethnicities (35 (28-56 [18-513]) h vs. 44 (31-71 [19-465]) h vs. 49 (33-75 [23-189]) h, respectively. In adjusted models at day 30, patients of Asian ethnicity had a significantly greater risk of moderate to severe pain (numerical rating scale ≥ 4) at rest and on movement (odds ratio (95%CI) 2.42 (1.24-4.74) and 2.32 (1.40-3.87)), respectively). There were no differences in readmission rates or incidence of complications between groups. Patients from White ethnic backgrounds experience shorter postpartum duration of stay compared with patients from Asian and Black ethnic groups. Ethnic background impacts pain scores and recovery at day 1 postpartum and following hospital discharge, even after adjusting for socio-economic group. Further work is required to understand the underlying factors driving differences in pain and recovery and to develop strategies to reduce disparities in obstetric patients.
Collapse
Affiliation(s)
- J E O'Carroll
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London
| | - L Zucco
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Warwick
- Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK
| | - G Radcliffe
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S R Moonesinghe
- University College London Hospitals, London, UK
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London
| | - K El-Boghdadly
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - N Guo
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P Sultan
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
4
|
Andrews A, Fraser-Irwin C, Herbison K, Han DY, Evans HM, Roberts AJ. Ethnicity and socio-economic deprivation in children with intestinal failure in New Zealand: Disparities in incidence, but not in outcomes. J Paediatr Child Health 2024. [PMID: 38655775 DOI: 10.1111/jpc.16550] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 01/10/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
AIMS The New Zealand National Intestinal Failure and Rehabilitation Service (NZ-NIFRS) was established in October 2015 to gather longitudinal data on the aetiology, clinical course and outcomes of children with intestinal failure (IF). One main objective is to achieve health equity for patients with IF in NZ. METHODS Clinical outcomes (enteral autonomy, parenteral nutrition (PN) dependence, death or intestinal transplantation) for IF patients diagnosed from October 2015 to 2018 were analysed; comparisons were made by ethnicity and socio-economic status (SES) using published 'prioritised-ethnicity' health data and the NZ index of deprivation, respectively. The Cox proportional-hazards model was used to assess time to enteral autonomy. RESULTS Of the 208 patients (55.77% male, 43.75% preterm), 170 (81.73%) achieved enteral autonomy and 14 (6.73%) remained PN dependent. Pacific and Māori children accounted for 12.98% and 27.88% of the patient cohort, respectively, compared to 9.46% and 25.65% of the NZ paediatric population. More significantly, IF patients with a high NZ socio-economic deprivation score were overrepresented, with 35.92% in the highest deprivation quintile and 10.19% in the least deprived quintile, compared to 23.53% and 20.31%, respectively, of the NZ paediatric population. There were no significant differences in primary clinical outcomes for any patients based on ethnicity or SES. CONCLUSION While disparities in ethnicity and social deprivation do exist in the incidence of IF in NZ children, clinical outcomes are similar for children regardless of ethnicity or SES. NZ-NIFRS has achieved one of its core objectives: to achieve health equity for all patients with IF nationwide.
Collapse
Affiliation(s)
- Amy Andrews
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Cate Fraser-Irwin
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
| | - Kim Herbison
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Dug Y Han
- Clinical Research Office, Te Toka Tumai - Auckland, Auckland, New Zealand
| | - Helen M Evans
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Amin J Roberts
- New Zealand National Intestinal Failure & Rehabilitation Service (NZ-NIFRS), Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Nacier CM, Vutescu ES, Bergen MA, Quinn MS, Albright JA, Cruz AI. Social deprivation index affects time to MRI after knee injury in pediatric patients and is predicted by patient demographics. PHYSICIAN SPORTSMED 2024:1-6. [PMID: 38618689 DOI: 10.1080/00913847.2024.2342235] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES This study aims to characterize the association between the timing of MRI ordering and completion for pediatric knee injuries and Social Deprivation Index (SDI), which is a comprehensive, validated, county-level, measure of socioeconomic variation in health outcomes based upon combining geography, income, education, employment, housing, household characteristics, and access to transportation. METHODS A retrospective chart review was completed of patients 21 years old and younger from our institution with a history of knee sports injury (ligamentous/soft tissue injury, structural abnormality, instability, inflammation) evaluated with MRI between 5/26/2017 and 12/28/2020. Patients were from three states and attended to by physicians associated with an urban academic institution. Patients were assigned SDI scores based on their ZIP code. Excluded from the study were patients with a non-knee related diagnosis (hip, foot, or ankle), patients from ZIP codes with unknown SDI, and non-sports medicine diagnoses (tumor, infection, fracture). RESULTS In a multivariate regression analysis of 355 patients, increased SDI was independently associated with increased time from clinic visit to MRI order (p = 0.044) and from clinic visit to MRI completion (p = 0.047). Each 10-point increase in SDI (0-100) was associated with a delay of 7.2 days on average. SDI itself was found to be associated with a patient's race (p < 0.001), ethnicity (p < 0.001), and insurance category (p < 0.001). CONCLUSION Increased SDI is independently associated with longer time from clinic visit to knee MRI order and longer time from clinic visit to knee MRI completion in our pediatric population. Recognizing potential barriers to orthopedic care can help create the change necessary to provide the best possible care for all individual patients.
Collapse
Affiliation(s)
| | - Emil Stefan Vutescu
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael A Bergen
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew S Quinn
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Alex Albright
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
6
|
Kim M, Kim Y, Sharrief AZ, Nguyen TP. Re-evaluating the gender gap: a cross-sectional analysis of accepted American Academy of Neurology annual meeting abstracts in 2020 and 2021. Front Res Metr Anal 2024; 9:1360367. [PMID: 38665144 PMCID: PMC11043524 DOI: 10.3389/frma.2024.1360367] [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: 01/03/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Background and objective Prior studies reveal that invited speaker panels, editorial boards, authors of practice guidelines, and senior authors of published articles are disproportionately male in the neurology field. We aimed to analyze a gender gap in authorship of accepted abstracts to the American Academy of Neurology annual meetings in 2020 and 2021. Design/methods This is a cross-sectional study evaluating the proportions of female first and senior abstract authors in 2020 and 2021. Abstracts were reviewed manually (n = 3,211 in 2020; n = 2,178 in 2021). Data were collected regarding the gender of first and senior authors, subspecialties, and origin of research (USA, international, or corporate-affiliated). Then, we compared the percentages of female first and senior authors in the 2 years to assess for any short-term effects of the COVID-19 pandemic. Results Accepted abstracts with female first and senior authors comprised 46%, 34% in 2020, and the same in 2021, without change. Female senior authors had a significantly higher proportion of female first authors than their male senior author counterparts. The analysis of subspecialties with more than 100 abstracts showed the lowest percentages of female senior authors was oncology (24.7%), sleep (25.5%), headache (28.7%), and cerebrovascular disease (29%) in 2020. Cerebrovascular disease (29%) and behavioral neurology (24.7%) had the lowest percentage of female senior authors in 2021. In the analysis of the origin of research, corporate-affiliated authors had the lowest percentages of female first (34 and 36%) and senior authors (22.6 and 27.6%). Conclusion The gender gap in neurology was reaffirmed in regards to female senior authorship overall and in subgroups of abstracts including cerebrovascular disease, headache, behavioral neurology, sleep, oncology, and corporate-affiliated research.
Collapse
Affiliation(s)
- Minseon Kim
- Department of Neurology, University of Texas Houston Medical School, Houston, TX, United States
| | - Youngran Kim
- Center for Healthcare Data, University of Texas Houston School of Public Health, Houston, TX, United States
| | - Anjail Z. Sharrief
- Department of Neurology, University of Texas Houston Medical School, Houston, TX, United States
| | - Thy P. Nguyen
- Department of Neurology, University of Texas Houston Medical School, Houston, TX, United States
| |
Collapse
|
7
|
Esteban JM, Martín-Serra A, Pérez-Ramos A, Rybczynski N, Jones K, Figueirido B. The influence of the land-to-sea macroevolutionary transition on vertebral column disparification in Pinnipedia. Proc Biol Sci 2024; 291:20232752. [PMID: 38593849 PMCID: PMC11003777 DOI: 10.1098/rspb.2023.2752] [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: 12/06/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
The repeated returns of vertebrates to the marine ecosystems since the Triassic serve as an evolutionary model to understand macroevolutionary change. Here we investigate the effects of the land-to-sea transition on disparity and constraint of the vertebral column in aquatic carnivorans (Carnivora; Pinnipedia) to assess how their functional diversity and evolutionary innovations influenced major radiations of crown pinnipeds. We use three-dimensional geometric morphometrics and multivariate analysis for high-dimensional data under a phylogenetic framework to quantify vertebral size and shape in living and extinct pinnipeds. Our analysis demonstrates an important shift in vertebral column evolution by 10-12 million years ago, from an unconstrained to a constrained evolutionary scenario, a point of time that coincides with the major radiation of crown pinnipeds. Moreover, we also demonstrate that the axial skeleton of phocids and otariids followed a different path of morphological evolution that was probably driven by their specialized locomotor strategies. Despite this, we found a significant effect of habitat preference (coastal versus pelagic) on vertebral morphology of crown taxa regardless of the family they belong. In summary, our analysis provides insights into how the land-to-sea transition influenced the complex evolutionary history of pinniped vertebral morphology.
Collapse
Affiliation(s)
- Juan Miguel Esteban
- Departamento de Ecología y Geología, Facultad de Ciencias, Universidad de Málaga, Campus Universitario de Teatinos s/n, 29071, Málaga, Spain
| | - Alberto Martín-Serra
- Departamento de Ecología y Geología, Facultad de Ciencias, Universidad de Málaga, Campus Universitario de Teatinos s/n, 29071, Málaga, Spain
| | - Alejandro Pérez-Ramos
- Departamento de Ecología y Geología, Facultad de Ciencias, Universidad de Málaga, Campus Universitario de Teatinos s/n, 29071, Málaga, Spain
| | - Natalia Rybczynski
- Department of Palaeobiology, Canadian Museum of Nature, Ottawa, ON, Canada K1P 6P4
- Department of Earth Sciences & Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, Canada K1S 5B6
| | - Katrina Jones
- Department of Earth and Environmental Sciences, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK
| | - Borja Figueirido
- Departamento de Ecología y Geología, Facultad de Ciencias, Universidad de Málaga, Campus Universitario de Teatinos s/n, 29071, Málaga, Spain
| |
Collapse
|
8
|
Garcia Valencia OA, Thongprayoon C, Miao J, Suppadungsuk S, Krisanapan P, Craici IM, Jadlowiec CC, Mao SA, Mao MA, Leeaphorn N, Budhiraja P, Cheungpasitporn W. Empowering inclusivity: improving readability of living kidney donation information with ChatGPT. Front Digit Health 2024; 6:1366967. [PMID: 38659656 PMCID: PMC11039889 DOI: 10.3389/fdgth.2024.1366967] [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: 01/08/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Background Addressing disparities in living kidney donation requires making information accessible across literacy levels, especially important given that the average American adult reads at an 8th-grade level. This study evaluated the effectiveness of ChatGPT, an advanced AI language model, in simplifying living kidney donation information to an 8th-grade reading level or below. Methods We used ChatGPT versions 3.5 and 4.0 to modify 27 questions and answers from Donate Life America, a key resource on living kidney donation. We measured the readability of both original and modified texts using the Flesch-Kincaid formula. A paired t-test was conducted to assess changes in readability levels, and a statistical comparison between the two ChatGPT versions was performed. Results Originally, the FAQs had an average reading level of 9.6 ± 1.9. Post-modification, ChatGPT 3.5 achieved an average readability level of 7.72 ± 1.85, while ChatGPT 4.0 reached 4.30 ± 1.71, both with a p-value <0.001 indicating significant reduction. ChatGPT 3.5 made 59.26% of answers readable below 8th-grade level, whereas ChatGPT 4.0 did so for 96.30% of the texts. The grade level range for modified answers was 3.4-11.3 for ChatGPT 3.5 and 1-8.1 for ChatGPT 4.0. Conclusion Both ChatGPT 3.5 and 4.0 effectively lowered the readability grade levels of complex medical information, with ChatGPT 4.0 being more effective. This suggests ChatGPT's potential role in promoting diversity and equity in living kidney donation, indicating scope for further refinement in making medical information more accessible.
Collapse
Affiliation(s)
- Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Division of Nephrology, Department of Internal Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Iasmina M. Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States
| | - Shennen A. Mao
- Division of Transplant Surgery, Department of Transplant, Mayo Clinic, Jacksonville, FL, United States
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Napat Leeaphorn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Pooja Budhiraja
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Phoenix, AZ, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
9
|
Yadav A, Munir F, Chan KH, Quraishi MZ, Harris TS, Brown DL, Menon N, Nguyen TT, Srivaths L. Oxygen saturation thresholds in managing sickle cell disease at US children's hospitals. Pediatr Blood Cancer 2024; 71:e30879. [PMID: 38279845 DOI: 10.1002/pbc.30879] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Adequate oxygen saturation (SpO2 ) is crucial for managing sickle cell disease (SCD). Children with SCD are at increased risk for occult hypoxemia; therefore, understanding SpO2 threshold practices would help identify barriers to oxygen optimization in a population sensitive to oxyhemoglobin imbalances. We investigated SpO2 cutoff levels used in clinical algorithms for management of acute SCD events at children's hospitals across the United States, and determined their consistency with recommended national guidelines (SpO2 > 95%). METHODS Clinical pathways and algorithms used for the management of vaso-occlusive crisis (VOC) and acute chest syndrome (ACS) in SCD were obtained and reviewed from large children's hospitals in the United States. RESULTS Responses were obtained from 94% (140/149) of eligible children's hospitals. Of these, 63 (45%) had available clinical algorithms to manage VOC and ACS. SpO2 cutoff was provided in 71.4% (45/63) of clinical algorithms. Substantial variation in SpO2 cutoff levels was noted, ranging from ≥90% to more than 95%. Only seven hospitals (5% of total hospitals and 15.6% of hospitals with clinical algorithms available) specified oxygen cutoffs that were consistent with national guidelines. Hospitals geographically located in the South (46.8%; n = 29/62) and Midwest (54.8%; n = 17/31) were more likely to have VOC and ACS clinical algorithms, compared to the Northeast (26.5%; n = 9/34) and West (36.4%; n = 8/22). CONCLUSION There is inconsistency in the use of clinical algorithms and oxygen thresholds for VOC and ACS across US children's hospitals. Children with SCD could be at risk for insufficient oxygen therapy during adverse acute events.
Collapse
Affiliation(s)
- Aravind Yadav
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Faryal Munir
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kok Hoe Chan
- Division of Hematology/Oncology, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA
| | - Mariam Z Quraishi
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Tomika S Harris
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Deborah L Brown
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Neethu Menon
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Trinh T Nguyen
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lakshmi Srivaths
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| |
Collapse
|
10
|
Meah S, Kidd C, Rothman B, Marino VL. Exploring paediatric dietetic resources available for critically ill children in the UK and Ireland: A multicentre survey. J Hum Nutr Diet 2024; 37:459-463. [PMID: 38009404 DOI: 10.1111/jhn.13267] [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: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND A dedicated intensive care dietitian, as part of the intensive care unit (ICU) multidisciplinary team, contributes to improved delivery of nutrition support. The Paediatric Critical Care Society recommends a minimum dietetic staffing to critical-care bed ratio of 1:10, led by an Agenda for Change (AfC) Band 7. METHODS A cross-sectional study was conducted using an electronic survey that was available for 12 weeks. The Paediatric Intensive Care Audit Network database was used to identify all hospitals with paediatric intensive care unit (PICU) beds (n = 28). RESULTS Only 14% (n = 4/28) of trusts met the recommended 1:10 dietitian to bed ratio. PICU dietetic whole time equivalent was 0.7 ± 0.4, with a staff to bed ratio of 1:23.7 ± 10.7, compared to adult staff to bed ratio of 1:24.7. Some 92.8% (n = 26/28) had a AfC Band 7 Lead and only 7% (n = 2/28) had an AfC Band 8a Lead compared to adult services where 12.5% (n = 15/122) had an AfC Band 8a (p < 0.05). CONCLUSIONS There is a significant disparity between adult versus paediatric services with regard to seniority of dietitians. Dietitians in well-resourced centres were more likely to review patients without the need for a referral, which may improve nutrition outcomes.
Collapse
Affiliation(s)
| | - Catherine Kidd
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Brittany Rothman
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - V Luise Marino
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
11
|
Demmel Ferreira MM, Degrange FJ, Tirao GA. Brain surface morphology and ecological and macroevolutionary inferences of avian New World suboscines (Aves, Passeriformes, Tyrannides). J Comp Neurol 2024; 532:e25617. [PMID: 38629472 DOI: 10.1002/cne.25617] [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: 07/25/2023] [Revised: 03/11/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
The New World suboscines (Passeriformes and Tyrannides) are one of the biggest endemic vertebrate radiations in South America, including the families Furnariidae and Tyrannidae. Avian brain morphology is a reliable proxy to study their evolution. The aim of this work is to elucidate whether the brains of these families reflect the ecological differences (e.g., feeding behavior) and to clarify macroevolutionary aspects of their neuroanatomy. Our hypotheses are as follows: Brain size is similar between both families and with other Passeriformes; brain morphology in Tyrannides is the result of the pressure of ecological factors; and brain disparity is low since they share ecological traits. Skulls of Furnariidae and Tyrannidae were micro-computed tomography-scanned, and three-dimensional models of the endocast were generated. Regression analyses were performed between brain volume and body mass. Linear and surface measurements were used to build phylomorphospaces and to calculate the amount of phylogenetic signal. Tyrannidae showed a larger brain disparity than Furnariidae, although it is not shaped by phylogeny in the Tyrannides. Furnariidae present enlarged Wulsts (eminentiae sagittales) but smaller optic lobes, while in Tyrannidae, it is the opposite. This could indicate that in Tyrannides there is a trade-off between the size of these two visual-related brain structures.
Collapse
Affiliation(s)
- María Manuela Demmel Ferreira
- Centro de Investigaciones en Ciencias de la Tierra (CICTERRA), Facultad de Ciencias Exactas, Físicas y Naturales (FCEFyN), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Federico Javier Degrange
- Centro de Investigaciones en Ciencias de la Tierra (CICTERRA), Facultad de Ciencias Exactas, Físicas y Naturales (FCEFyN), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Germán Alfredo Tirao
- Instituto de Física Enrique Gaviola (IFEG), Facultad de Matemática, Astronomía y Física (FaMAF), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| |
Collapse
|
12
|
Shelton SK, Rice JD, Knoepke CE, Matlock DD, Havranek EP, Daugherty SL, Perman SM. Examining the Impact of Layperson Rescuer Gender on the Receipt of Bystander CPR for Women in Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2024; 17:e010249. [PMID: 38533649 DOI: 10.1161/circoutcomes.123.010249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/29/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Women who suffer a witnessed out-of-hospital cardiac arrest receive bystander cardiopulmonary resuscitation (CPR) less often than men. To understand this phenomenon, we queried whether there are differences in deterrents to providing CPR based on the rescuer's gender. METHODS Participants were surveyed using a national crowdsourcing platform. Participants ranked the following 5 previously identified themes as reasons: rescuers are afraid to injure or hurt women; rescuers might have a misconception that women do not suffer cardiac arrest; rescuers are afraid to be accused of sexual assault or sexual harassment; rescuers have a fear of touching women or that their touch might be inappropriate; and rescuers think that women are faking it or being overdramatic. Participants were adult US residents able to correctly define CPR. Participants ranked the themes if the rescuer was gender unidentified, a man, and a woman, in variable order. RESULTS In November 2018, 520 surveys were completed. The respondents identified as 42.3% women, 74.2% White, 10.4% Black, and 6.7% Hispanic. Approximately half (48.1%) of the cohort knew how to perform CPR, but only 7.9% had ever performed CPR. When the rescuer was identified as a man, survey participants ranked fear of sexual assault or sexual harassment and fear of touching women or that the touch might be inappropriate as the top reasons (36.2% and 34.0% of responses, respectively). Conversely, when the rescuer was identified as a woman, survey respondents reported fear of hurting or injuring as the top reason (41.2%). CONCLUSIONS Public perceptions as to why women receive less bystander CPR than men were different based on the gender of the rescuer. Participants reported that men rescuers would potentially be hindered by fears of accusations of sexual assault/harassment or inappropriate touch, while women rescuers would be deterred due to fears of causing physical injury.
Collapse
Affiliation(s)
- Shelby K Shelton
- Department of Emergency Medicine, Children's Hospital of Orange County, CA (S.K.S.)
| | - John D Rice
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora (J.D.R.)
- Ludeman Center for Women's Health Research (J.D.R., C.E.K., S.M.P.), University of Colorado School of Medicine, Aurora
| | - Christopher E Knoepke
- Ludeman Center for Women's Health Research (J.D.R., C.E.K., S.M.P.), University of Colorado School of Medicine, Aurora
- Division of Cardiology, Department of Medicine (C.E.K.), University of Colorado School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver (C.E.K., D.D.M.)
| | - Daniel D Matlock
- Division of Geriatrics, Department of Medicine (D.D.M.), University of Colorado School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver (C.E.K., D.D.M.)
| | - Edward P Havranek
- Department of Internal Medicine, Denver Health Hospital Authority, CO (E.P.H.)
| | - Stacie L Daugherty
- Department of Emergency Medicine, Children's Hospital of Orange County, CA (S.K.S.)
| | - Sarah M Perman
- Ludeman Center for Women's Health Research (J.D.R., C.E.K., S.M.P.), University of Colorado School of Medicine, Aurora
- Department of Emergency Medicine (S.M.P.), University of Colorado School of Medicine, Aurora
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (S.M.P.)
| |
Collapse
|
13
|
Everingham H, Vance-Chalcraft HD, Moss ME. Trends in dental visits among US adults from 1997 through 2019: Implications for policy reform. J Am Dent Assoc 2024; 155:312-318.e2. [PMID: 38363251 DOI: 10.1016/j.adaj.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Examination of serial cross-sectional national surveys from a representative sample of the population can identify patterns and help support policy development. METHODS The authors used data from the National Health Interview Survey on US adults reporting a dental visit in the past 12 months to examine trends from 1997 through 2019. Groups analyzed were based on sociodemographic factors including residence in a metropolitan statistical area, race and ethnicity, family income level, and geographic region. RESULTS Over the 23-year period, the authors found differences for family income level, living in a rural (nonmetropolitan vs metropolitan) area, race and ethnicity, and geographic region (P < .0001). When stratified by family income, racial disparities have diminished. Gaps in dental service use are long-standing for rural nonmetropolitan communities. CONCLUSIONS Relative to urban locales, rural communities experienced persistent disparities in the use of the oral health care delivery system throughout the 23 years measured. Strategies to create innovative models of care are needed to address oral health needs in underserved rural communities. PRACTICAL IMPLICATIONS Policy is needed to foster a shift toward population health that will incentivize a health care system that reduces financial barriers and enhances health outcomes for adult oral health, especially for rural areas.
Collapse
|
14
|
Hobgood CD, Jarman AF. Resilience Building Practices for Women Physicians. J Womens Health (Larchmt) 2024; 33:532-541. [PMID: 37843899 DOI: 10.1089/jwh.2022.0502] [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] [Indexed: 10/17/2023] Open
Abstract
Women now make up more than half of the physician workforce, but they are disproportionately plagued by burnout. Medicine is a fast-paced stressful field, the practice of which is associated with significant chronic stress due to systems issues, crowding, electronic medical records, and patient case mix. Hospitals and health care systems are responsible for mitigating system-based burnout-prone conditions, but often their best efforts fail. Physicians, particularly women, must confront their stressors and the daily burden of significant system strain when this occurs. Those who routinely exceed their cumulative stress threshold may experience burnout, career dissatisfaction, and second victim syndrome and, ultimately, may prematurely leave medicine. These conditions affect women in medicine more often than men and may also produce a higher incidence of health issues, including depression, substance use disorder, and suicide. The individual self-care required to maintain health and raise stress thresholds is not widely ingrained in provider practice patterns or behavior. However, the successful long-term practice of high-stress occupations, such as medicine, requires that physicians, especially women physicians, attend to their wellness. In this article, we address one aspect of health, resilience, and review six practices that can create additional stores of personal resilience when proactively integrated into a daily routine.
Collapse
Affiliation(s)
- Cherri D Hobgood
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Angela F Jarman
- Department of Emergency Medicine, University of California, Davis School of Medicine, California, USA
| |
Collapse
|
15
|
Okoro UE, Harland KK, Assimacopoulos E, Findlay S. Trends in Health Care Coverage and Out-Of-Pocket Cost Barriers: A Gender Comparison. J Womens Health (Larchmt) 2024; 33:473-479. [PMID: 38215276 DOI: 10.1089/jwh.2023.0121] [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: 01/14/2024] Open
Abstract
Objective: The presence of disparities in access to health care and insurance coverage can have a tremendous impact on health care outcomes. Programs like the Affordable Care Act were implemented to improve health care access and to address the existing inequities. The objective of this study was to identify any disparities that exist between males and females regarding health care coverage and out-of-pocket cost to health care. Methods: This analysis was a cross-sectional study using the Behavioral Risk Factor Surveillance System survey data collected between 2013 and 2018. The primary predictor was sex assigned at birth (with the binary option of male vs. female). The primary outcome was adequate health coverage. Survey participants who indicated that they had health insurance with no out-of-pocket cost barriers to receiving medical care were considered to have adequate health coverage, while participants who did not meet these criteria were considered to have inadequate health coverage. Covariates measured were age, race/ethnicity, educational level, employment status, and annual household income. SAS survey procedures and weighting methods were used to measure the association between the sex and adequate health coverage, after controlling for covariates. Results: The data spanning 6 years included 2,249,749 adults, of whom 1,898,097 (84.4%) had adequate health coverage. Females made up 55.8% (N = 1,256,243) of the total sample. About 32.6% (N = 733,216) survey participants were aged ≥65 years. Most respondents, 77.6%, were White (Non-Hispanic). Across the 6-year period, females were more likely to have health insurance but with out-of-pocket costs that served as a barrier to their medical care (adjusted odds ratios with 95% CI from 2013 to 2018 were 1.36 [1.29-1.43], 1.38 [1.32-1.46], 1.31 [1.24-1.38], 1.33 [1.26-1.40], and 1.32 [1.25-1.40], respectively). Conclusions: Females were more likely than males to indicate an out-of-pocket cost barrier to medical care despite having health insurance.
Collapse
Affiliation(s)
- Uche E Okoro
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Shannon Findlay
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
16
|
Mettler SK, Charoenngam N, Jaroenlapnopparat A, Tern C, Xanthavanij N, Economidou S, Strand MJ, Hobbs BD, Moll M, Cho MH. Clinical factors associated with racial differences in the prevalence of occult hypoxemia: a retrospective case-control study. medRxiv 2024:2024.03.28.24305036. [PMID: 38585762 PMCID: PMC10996744 DOI: 10.1101/2024.03.28.24305036] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Recent studies showed that Black patients more often have falsely normal oxygen saturation on pulse oximetry compared to White patients. However, whether the racial differences in occult hypoxemia are mediated by other clinical differences is unknown. Methods We conducted a retrospective case-control study utilizing two large ICU databases (eICU and MIMIC-IV). We defined occult hypoxemia as oxygen saturation on pulse oximetry within 92-98% despite oxygen saturation on arterial blood gas below 90%. We assessed associations of commonly measured clinical factors with occult hypoxemia using multivariable logistic regression and conducted mediation analysis of the racial effect. Results Among 24,641 patients, there were 1,855 occult hypoxemia cases and 23,786 controls. In both datasets, Black patients were more likely to have occult hypoxemia (unadjusted odds ratio 1.66 [95%-CI: 1.41-1.95] in eICU and 2.00 [95%-CI: 1.22-3.14] in MIMIC-IV). In multivariable models, higher respiratory rate, PaCO2 and creatinine as well as lower hemoglobin were associated with increased odds of occult hypoxemia. Differences in the commonly measured clinical markers accounted for 9.2% and 44.4% of the racial effect on occult hypoxemia in eICU and MIMIC-IV, respectively. Conclusion Clinical differences, in addition to skin tone, might mediate some of the racial differences in occult hypoxemia.
Collapse
Affiliation(s)
- Sofia K. Mettler
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Mount Auburn Hospital, Cambridge, MA, United States
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nipith Charoenngam
- Mount Auburn Hospital, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
- Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | | | - Courtney Tern
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Nutchapon Xanthavanij
- Mount Auburn Hospital, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Sofia Economidou
- Mount Auburn Hospital, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Matthew J. Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, United States
| | - Brian D. Hobbs
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Matthew Moll
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, West Roxbury, MA, United States
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| |
Collapse
|
17
|
Tan JY, Yeo YH, Ng WL, Fong ZV, Brady JT. How have US colorectal cancer mortality trends changed in the past 20 years? Int J Cancer 2024. [PMID: 38525799 DOI: 10.1002/ijc.34926] [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: 10/28/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
In the last two decades, colorectal cancer (CRC) mortality has been decreasing in the United States. However, the mortality trends for the different subtypes of CRC, including different sides of colon, rectosigmoid, and rectal cancer remain unclear. We analyzed the mortality trends of different subtypes of CRC based on Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research data from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and examined the trends over time by estimating the average annual percent change (AAPC) using the Joinpoint Regression Program. Our study shows that the overall CRC rates decreased significantly from 26.42 to 15.98 per 100,000 individuals, with an AAPC of -2.41. However, the AAMR of rectosigmoid cancer increased significantly from 0.82 to 1.08 per 100,000 individuals, with the AAPC of +1.10. Men and Black individuals had the highest AAMRs respectively (23.90 vs. 26.93 per 100,000 individuals). The overall AAMR of CRC decreased for those aged ≥50 years but increased significantly from 1.02 to 1.58 per 100,000 individuals for those aged 15-49 years, with an AAPC of +0.75. Rural populations had a higher AAMR than the urban populations (22.40 vs. 19.60 per 100,000 individuals). Although overall CRC mortality declined, rising trends in young-onset CRC and rectosigmoid cancer warrant attention. Disparities persist in terms of sex, race, and geographic region, and urbanization level, emphasizing the need for targeted public health measures.
Collapse
Affiliation(s)
- Jia Yi Tan
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Yong-Hao Yeo
- Department of Internal Medicine/Pediatrics, Beaumont Health, Royal Oak, Michigan, USA
| | - Wern Lynn Ng
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Harrisburg, Harrisburg, Pennsylvania, USA
| | - Zhi Ven Fong
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Justin T Brady
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
18
|
Shankar M, Satheesh G, A. K, C. G. S, Reddy GG. Gender disparity in maintenance hemodialysis units in South India: a cross-sectional observational study. Front Nephrol 2024; 4:1322003. [PMID: 38590819 PMCID: PMC10999745 DOI: 10.3389/fneph.2024.1322003] [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] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/19/2024] [Indexed: 04/10/2024]
Abstract
Background Diseases manifest differently according to gender in many medical specialties. However, sex differences in kidney diseases have not been well explored worldwide, especially in India. These differences could also be attributed to sociocultural factors. Although CKD is more prevalent in women worldwide, most men are initiated on kidney replacement therapy (KRT). This study aimed to examine sex disparities in patients on maintenance hemodialysis. Materials and methods A cross-sectional observational study was conducted in two maintenance hemodialysis units at the Institute of Nephrourology, a tertiary care referral government center in Bengaluru, India. Demographic characteristics and laboratory parameters were also recorded. Results In total, 374 adult patients (aged >18 years) were included in the study. Most patients (72.7%) were men. Mean age in men was 46.95 ± 12.65 years, and women was 46.63 ± 13.66 years. There was no significant difference in marital status and the availability of caretakers between the groups. Spouses were the predominant caretakers for both sexes (64% men and 51% women, P = 0.14). Sons cared more for patients with mother than fathers (19.6% vs 8.8%, P = 0.074). Diabetic nephropathy was the most common cause of ESKD in both groups (33.1% vs 31.3%, P = 0.92). Men had a significantly longer duration of HTN and received more HD sessions per week than women. Mean hemoglobin (9.9 ± 1.79 vs 9.46 ± 1.47 g%) and mean serum creatinine (7.76 ± 2.65 vs 6.41 ± 2.27 mg/dl) were higher in men compared to women (P <0.002). Intradialytic complications, such as hypotension and cramps, were significantly more common in women than in men (P = 0.004). Most men (47.1%) were planning a kidney transplant (and were waitlisted) compared with fewer women (43%). There was no significant difference in the average number of hospitalizations per month or HD vintage. Conclusion Women tend to initiate dialysis later, and a lesser number are waitlisted for kidney transplantation, which might be partly related to varying access to or delivery of health care services. Factors such as lack of education, insufficient identification of and strategies to address cultural obstacles to healthcare, and a shortage of financial means to afford medical care are potentially correctable elements that might explain this discrepancy.
Collapse
Affiliation(s)
- Mythri Shankar
- Department of Nephrology, Institute of NephroUrology, Bengaluru, India
| | | | | | | | | |
Collapse
|
19
|
Linggonegoro D, Williams K, Hlobik M, Huang J. Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey. JMIR Dermatol 2024; 7:e51511. [PMID: 38517468 PMCID: PMC10998172 DOI: 10.2196/51511] [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: 08/03/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024] Open
Abstract
Certain sociodemographic factors are associated with low technology access and digital healthy literacy.
Collapse
Affiliation(s)
- Danny Linggonegoro
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kathryn Williams
- Biostatistics and Research Design Center, ICCTR, Boston Children's Hospital, Boston, MA, United States
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
20
|
Oh HY, Jacob L, Smith L, Leaune E, Zhou S, Shin JI, Koyanagi A. Sexual Minority Status and Psychotic Experiences Among Young Adult College Students in the United States. J Homosex 2024; 71:916-933. [PMID: 36318731 DOI: 10.1080/00918369.2022.2132582] [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] [Indexed: 06/16/2023]
Abstract
2020-2021 Healthy Minds Study, and used multivariable logistic regression to examine the associations between sexual minority status and psychotic experiences, adjusting for age, gender, and race/ethnicity. We then tested whether psychosocial factors accounted for the association. Sexual minority status was associated with 1.87 times greater odds of having psychotic experiences over the past 12 months (aOR: 1.87; 95% CI: 1.77-1.99; N = 110,551). Several factors mediated the association between sexual orientation and psychotic experiences such as loneliness (26.93%), anxiety (30.90%), depression (33.18%), and marijuana use (13.95%); all factors together accounted for 59.01% of the association between sexual minority status and psychotic experiences. Food insecurity, recent abuse, and discrimination did not significantly mediate the association. Findings should raise clinical awareness that psychotic experiences are more common among sexual minorities than among heterosexuals, which is largely explained by mental health factors, calling for targeted outreach and intervention.
Collapse
Affiliation(s)
- Hans Y Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM ISCIII), Barcelona, Spain
- Center for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Edouard Leaune
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Sasha Zhou
- Department of Public Health, Wayne State University, Detroit, Michigan, USA
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM ISCIII), Barcelona, Spain
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain
| |
Collapse
|
21
|
Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Authors' Response to Peer Reviews of "Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers". JMIRx Med 2024; 5:e56439. [PMID: 38509604 PMCID: PMC11004510 DOI: 10.2196/56439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| |
Collapse
|
22
|
Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers. JMIRx Med 2024; 5:e42211. [PMID: 38488740 PMCID: PMC11004515 DOI: 10.2196/42211] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/11/2023] [Accepted: 01/13/2024] [Indexed: 03/19/2024]
Abstract
Background Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. Objective We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. Methods This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Results Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Conclusions Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.
Collapse
Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| |
Collapse
|
23
|
Shi Y, Heien HC, Orvidas LJ, Sangaralingham LR, Halbauer M, Warner DO, Phelan S. Racial and Ethnic Disparities in Otolaryngology Office Visit and Tympanostomy Tube Placement in Children with Otitis Media. Laryngoscope 2024. [PMID: 38450789 DOI: 10.1002/lary.31380] [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: 11/13/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Racial disparities are pervasive in access to pediatric surgery. The goal of this study was to test the hypotheses that, compared with White children, non-White and Hispanic children: (1) were less likely to attend evaluations by otolaryngologists after a diagnosis of otitis media (OM) eligible for surgical referral, and (2) these children were less likely to receive tympanostomy tube (TT) after surgical consultation. METHODS The OptumLabs Data Warehouse is a de-identified claims database of privately insured enrollees. Guidelines on the management of OMs suggest that children should be evaluated for surgery if they have recurrent acute OM or chronic OM with effusion. A cohort of children who were diagnosed with OM were constructed. For Hypothesis 1, the primary outcome was otolaryngology office visit within 6 months of a diagnosis of recurrent or chronic OM. For Hypothesis 2, the outcome was TT placement within 6 months following the otolaryngology office visit. Cox regression models were used to determine the relationship between race/ethnicity and the primary outcomes. RESULTS Among 187,776 children with OMs, 72,774 (38.8%) had otolaryngology visits. In a multivariate Cox model, the hazard ratios of attending otolaryngology visit for Black, Hispanic, and Asian children were 0.93 (95% CI,0.90, 0.96), 0.86 (0.83, 0.88), and 0.74 (0.71, 0.77), compared with White children. Among the children evaluated by otolaryngologists, 46,554 (63.97%) received TT. Black, Hispanic, and Asian children with recurrent acute OM had lower likelihood of receiving TT. CONCLUSIONS Racial disparities in attending otolaryngology office visit contributed to the disparities in receiving TT. QUALITY OF EVIDENCE Level 3 Laryngoscope, 2024.
Collapse
Affiliation(s)
- Yu Shi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Herbert C Heien
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Laura J Orvidas
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Lindsey R Sangaralingham
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
- OptumLabs, Cambridge, Massachusetts, U.S.A
| | - Moira Halbauer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sean Phelan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| |
Collapse
|
24
|
Abraham O, Agoke A, Sanuth K, Fapohunda A, Ogunsanya M, Piper M, Trentham-Dietz A. Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States. JMIR Cancer 2024; 10:e53956. [PMID: 38447129 PMCID: PMC10955401 DOI: 10.2196/53956] [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: 10/25/2023] [Revised: 01/23/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Cancer prevalence data for Black Americans is monolithic and fails to consider the diverse cultures and backgrounds within that community. For instance, African immigrants constitute a meaningful proportion of the foreign-born Black immigrants in the United States (42%), but the prevalence of cancer in the African immigrant community itself is unknown. Therefore, without accurate cancer prevalence data, it is impossible to identify trends and other key factors that are needed to support the health of African immigrants and their children. Moreover, it is impossible to understand how the culture and language of subgroups influence their cancer-related health behavior. While research in this area is limited, the existing literature articulates the need for culturally responsive and culturally tailored cancer education for African immigrants and their adolescent children, which is what we advocate for in this viewpoint paper. Existing projects demonstrate the feasibility of culturally responsive programming for adults; however, few projects include or focus on adolescents or children born to African immigrants. To best meet the needs of this understudied community, researchers must use culturally competent interventions alongside familiar, usable media. For adolescents, technology is ubiquitous thus, the creation of a culturally tailored digital intervention has immense potential to improve cancer awareness and prevention for youth and their community. More research is needed to address many of the existing research gaps and develop a rich understanding of the unique experience of cancer among African immigrant families that can be used to inform intervention development. Through this viewpoint, we review the current state of cancer-related research among African immigrant families in the United States. In this paper, we acknowledge the current knowledge gaps and issues surrounding measurement and then discuss the factors relevant to designing an educational intervention targeted at African immigrants and the role of African immigrant youth.
Collapse
Affiliation(s)
- Olufunmilola Abraham
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | - Adeola Agoke
- African Cultural Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Kazeem Sanuth
- National African Language Resource Center, Indiana University Bloomington, Bloomington, IN, United States
| | - Abimbola Fapohunda
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Motolani Ogunsanya
- College of Pharmacy, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Megan Piper
- Department of Medicine and Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Amy Trentham-Dietz
- Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
25
|
Roster K, Kann RB, Farabi B, Gronbeck C, Brownstone N, Lipner SR. Readability and Health Literacy Scores for ChatGPT-Generated Dermatology Public Education Materials: Cross-Sectional Analysis of Sunscreen and Melanoma Questions. JMIR Dermatol 2024; 7:e50163. [PMID: 38446502 PMCID: PMC10955394 DOI: 10.2196/50163] [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: 06/21/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Katie Roster
- New York Medical College, New York, NY, United States
| | | | - Banu Farabi
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, NY, United States
| | - Christian Gronbeck
- Department of Dermatology, University of Connecticut HealthCenter, Framington, CT, United States
| | - Nicholas Brownstone
- Department of Dermatology, Temple University Hospital, Philadelphia, PA, United States
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
| |
Collapse
|
26
|
Wan V, Habibi A, Abdi P, Mukovozov I, Asiniwasis RN, Maibach HI. Systematic scoping review on the barriers to access of biologics in moderate-to-severe adult atopic dermatitis. Australas J Dermatol 2024. [PMID: 38439194 DOI: 10.1111/ajd.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/10/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Vincent Wan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alireza Habibi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parsa Abdi
- Faculty of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland, Canada
| | | | - Rachel N Asiniwasis
- Division of Dermatology, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
27
|
Burdjalov M, Qattea I, Nandakumar V, Mohamed MA, Aly H. Caucasian and African American racial disparity in neonatal hospital mortality. Front Pediatr 2024; 12:1289399. [PMID: 38500591 PMCID: PMC10944948 DOI: 10.3389/fped.2024.1289399] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
Objective To examine disparity in hospital mortality among Caucasian (C) and African American (AA) neonates born at different gestational ages (GA). Methods De-identified national inpatient data were obtained from the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ) for the years 2011-2018. We compared the odds ratio for mortality among C and AA infants by sex and GA category. Analyses were repeated after controlling for multiple maternal and neonatal confounding variables in a logistic regression model. Results The study included 18,758,233 infants; 78.3% of them were C and 21.7% were AA. Compared to C population, AA population has a significantly higher mortality in term infants born at GA ≥ 36 weeks. The racial/ethnic disparity in preterm infants was inconsistent without any difference at 35-36 weeks in male and female infants. The overall aOR for mortality in AA in all male preterm infants ≤36 weeks was 1.44 (1.39-1.49), <0.01; and the overall aOR for mortality in AA in all preterm female infants ≤36 weeks was 1.38 (1.33-1.44). Conclusion Racial/Ethnic disparity in hospital mortality exists with higher AA mortality in infants born with GA > 36 weeks and less AA mortality in infants born with GA 24-26 weeks.
Collapse
Affiliation(s)
- Maria Burdjalov
- College of Arts and Sciences, The Ohio State University, Columbus, OH, United States
| | - Ibrahim Qattea
- Neonatology, Cleveland Clinic Children’s Hospital, Cleveland, OH, United States
| | | | - Mohamed A. Mohamed
- Neonatology, Cleveland Clinic Children’s Hospital, Cleveland, OH, United States
| | - Hany Aly
- Neonatology, Cleveland Clinic Children’s Hospital, Cleveland, OH, United States
| |
Collapse
|
28
|
Aoki M, Katsura M, Matsumoto S, Matsushima K. Persistent disparities between trauma center types in the management of children with high-grade blunt splenic injuries. World J Surg 2024; 48:568-573. [PMID: 38501566 DOI: 10.1002/wjs.12072] [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: 10/09/2023] [Accepted: 12/27/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND In the early 2000s, substantial variations were reported in the management of pediatric patients with blunt splenic injury (BSI). The purpose of this study was to assess the recent trends and disparities between different types of trauma centers. We hypothesized that there would be persistent disparities despite decreased trends in the rate of splenectomy. METHODS This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database. We included patients (age ≤18 years) with high-grade BSI (Abbreviated Injury Scale 3-5) between 2014 and 2021. The patients were divided into three groups based on trauma center types (adult trauma centers [ATCs], mixed trauma centers [MTCs], and pediatric trauma centers [PTCs]). The primary outcome was the splenectomy rate. Logistic regression was performed to evaluate the association between trauma center types and clinical outcomes. Additionally, the trends in the rate of splenectomy at ATCs, MTCs, and PTCs were evaluated. RESULTS A total of 6601 patients with high-grade BSI were included in the analysis. Overall splenectomy rates were 524 (17.5%), 448 (16.3%), and 32 (3.7%) in the ATC, MTC, and PTC groups, respectively. ATCs and MTCs had significantly higher splenectomy rates compared to PTCs (ATCs: OR = 5.72, 95%CI = 3.78-8.67, and p < 0.001 and MTCs: OR = 4.50, 95%CI = 2.97-6.81, and p < 0.001), while decreased trends in the splenectomy rates were observed in ATCs and MTCs (ATCs: OR = 0.92, 95%CI = 0.87-0.97, and p = 0.003 and MTCs: OR = 0.92, 95%CI = 0.87-0.98, and p = 0.013). CONCLUSIONS This study suggested persistent disparities between different trauma center types in the management of children with high-grade BSI.
Collapse
Affiliation(s)
- Makoto Aoki
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
- Division of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Morihiro Katsura
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Shokei Matsumoto
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
29
|
Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [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: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
Collapse
Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|
30
|
Lee K, Zhao S. Do Household Headship and Gender Affect Diet Quality under the Supplemental Nutrition Assistance Program (SNAP)? Am J Health Promot 2024; 38:349-354. [PMID: 37891714 DOI: 10.1177/08901171231211158] [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: 10/29/2023]
Abstract
PURPOSE Examine whether the association between Supplemental Nutrition Assistance Program (SNAP) participation and diet quality is different by gender and household headship. DESIGN Quantitative, cross-sectional. SETTING The 2007-2018 waves of the National Health and Nutrition Examination Survey (NHANES). SUBJECTS 6180 individuals aged 20 to 65 with household annual income below 130% of the poverty level. MEASURES The outcome of diet quality was measured using the 2015 Healthy Eating Index (HEI) based on dietary intake from 24-hour diet recall. The exposures were self-reported participation in SNAP and socio-demographic variables. ANALYSIS Ordinary Least Square (OLS) regression models. RESULTS The study found that female household heads had higher average total HEI scores relative to their male and non-head counterparts (β = 1.81, 95% CI: -.27, 3.88). However, for SNAP participants, female household heads had lower average total HEI scores (β = -3.67, 95% CI: -7.36, .11). CONCLUSION Female household heads are more likely to experience difficulty in maintaining diet quality relative to their counterparts. The study suggests that intra-household effort allocation may play an important role in differentiating and maintaining diet quality.
Collapse
Affiliation(s)
- Keehyun Lee
- Department of Agricultural Economics, University of Kentucky, Lexington, KY, USA
| | - Shuoli Zhao
- Department of Agricultural Economics, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
31
|
Rodriguez M, McKenzie M, McKee H, Ledingham EM, John K, Koziol J, Hallowell BD. Differences in Substance Use and Harm Reduction Practices by Race and Ethnicity: Rhode Island Harm Reduction Surveillance System, 2021-2022. J Public Health Manag Pract 2024; 30:E84-E93. [PMID: 38153310 PMCID: PMC10872563 DOI: 10.1097/phh.0000000000001863] [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] [Indexed: 12/29/2023]
Abstract
CONTEXT In the United States, minority populations are disproportionately affected by the overdose epidemic, have higher mortality rates, and unequal access to harm reduction and treatment services. OBJECTIVE This analysis aims to better understand harm reduction utilization and substance use patterns among minority populations to improve overdose outreach and prevention initiatives in Rhode Island. DESIGN The present analysis used data from the Harm Reduction Surveillance System from January 2021 to December 2022 (N = 393). Chi-square tests and multivariable regression models were used to investigate differences in substance use behaviors by race and ethnicity. SETTING Rhode Island. PARTICIPANTS Participants include individuals who self-reported the use of illicit drugs, currently reside in Rhode Island, and were older than 18 years. MAIN OUTCOME MEASURES Methods of drug use and uptake of harm reduction practices. RESULTS Among survey participants, 41% were non-Hispanic White, 57% were aged 25 to 44 years, 62% identified as male, and 95% had health insurance coverage. Most participants reported smoking as their method of drug use (90%) and harm reduction practices were underutilized by all race and ethnicity groups. Fewer non-Hispanic Black participants reported carrying naloxone compared to the other race and ethnicity groups. Non-Hispanic Black and Hispanic participants were significantly less likely to inject drugs compared with non-Hispanic White participants (adjusted odds ratio [AOR] = 0.14; 95% confidence interval [CI], 0.04-0.45) (AOR = 0.40; 95% CI, 0.18-0.90). CONCLUSIONS Smoking was the most common self-reported method of substance administration for all participants, whereas injection was more prevalent among non-Hispanic White participants. There is a continued need for minority-led and culturally informed harm reduction and treatment services for minority populations.
Collapse
Affiliation(s)
- McClaren Rodriguez
- Substance Use Epidemiology Program, Center for Health Data Analysis, Rhode Island Department of Health, Providence, Rhode Island (Mss Rodriguez, Ledingham, and St. John and Dr Hallowell); Preventing Overdose and Naloxone Intervention (PONI), The Miriam Hospital, Providence, Rhode Island (Mss McKenzie and McKee); and Drug Overdose Prevention Program, Center for Health Data Analysis, Rhode Island Department of Health, Providence, Rhode Island (Ms Koziol)
| | | | | | | | | | | | | |
Collapse
|
32
|
Vastola ME, Mumma BE, Fine JR, Tancredi DJ, Elder JW, Jarman AF. Analgesia Administration by Sex Among Pediatric Emergency Department Patients with Abdominal Pain. JEM Rep 2024; 3:100062. [PMID: 38435028 PMCID: PMC10906997 DOI: 10.1016/j.jemrpt.2023.100062] [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] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background There is conflicting data about sex-based differences in the treatment of acute pain in the ED. Little is known about sex-based disparities in analgesia in pediatric ED patients. Objectives Our objective was to determine whether analgesic administration rates differ between female and male pediatric patients presenting to the ED with abdominal pain. Methods We conducted a retrospective cohort study of ED patients 5-21 years old with abdominal pain between 6/1/19 and 6/30/21. The primary outcome was receipt of any analgesia, and secondary outcomes were receipt of opioid analgesia and time to receipt of analgesia. Multivariable regression models were fitted for each outcome. Results We studied 1,087 patients; 681 (63%) were female with a median age of 17 years (IQR 13, 19) and 406 (37%) were male with a median age of 14 years (IQR 9, 18). 371 female patients (55%) and 180 male patients (44%) received any analgesia. 132 female patients (19%) and 83 male patients (20%) received opioid analgesia. In multivariate analyses, female patients were equally likely to receive any analgesia (OR 1.30, 95% CI 0.97 - 1.74, p = 0.07), but time to analgesia was 14% longer (GMR 1.14, 95% CI 1.00 - 1.29, p = 0.04). Non-White patients were 32% less likely to receive opioids (OR 0.68, 95% CI 0.47 - 0.97, p = 0.04). Conclusions Female pediatric ED patients were equally likely to receive any analgesia as male patients, but their time to analgesia was longer. Non-White patients were less likely to receive opioid analgesia than White patients.
Collapse
Affiliation(s)
- Marie E Vastola
- School of Medicine, University of California Davis, 4610 X Street, Sacramento, CA 95817 USA
| | - Bryn E Mumma
- Department of Emergency Medicine, School of Medicine, University of California Davis, 4150 V Street, PSSB #2100, Sacramento, CA 95817, USA
| | - Jeffrey R Fine
- Department of Public Health Sciences, School of Medicine, University of California Davis, Medical Sciences 1-C, One Shield's Ave, Davis, CA 95616 USA
| | - Daniel J Tancredi
- Department of Pediatrics, School of Medicine, University of California Davis, 2516 Stockton Blvd, Sacramento, CA 95817, USA
| | - Joshua W Elder
- Department of Emergency Medicine, School of Medicine, University of California Davis, 4150 V Street, PSSB #2100, Sacramento, CA 95817, USA
| | - Angela F Jarman
- Department of Emergency Medicine, School of Medicine, University of California Davis, 4150 V Street, PSSB #2100, Sacramento, CA 95817, USA
| |
Collapse
|
33
|
Sim Y, Hausberger CF, Wang J. Effects of comprehensive medication review on opioid overuse among medicare beneficiaries. J Pharm Health Serv Res 2024; 15:rmae002. [PMID: 38425883 PMCID: PMC10901462 DOI: 10.1093/jphsr/rmae002] [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: 08/30/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Objectives This study examined the effects of the comprehensive medication review of Medicare medication therapy management programs on opioid overuse among Medicare beneficiaries. Methods This retrospective study analyzed Medicare data from 2016 to 2017. The intervention group included Medicare beneficiaries who newly received comprehensive medication review in 2017; the control group referred to patients who met the general eligible criteria for the medication therapy management program but did not enroll in 2016 or 2017. Propensity score matching was performed to increase characteristic compatibility between the intervention and control groups. Three measures of opioid overuse were analyzed: use of opioids at a high dosage, use of opioids from multiple providers, and concurrent use of opioids and benzodiazepines. The effects of comprehensive medication review on opioid overuse were analyzed with a multivariate logistic regression with an interaction term between the receipt of comprehensive medication review and the year 2017. Key Findings The proportion of concurrent use of opioids and benzodiazepines declined at a greater rate among the recipients (2.21%) than non-recipients (1.55%) of the comprehensive medication review. In the adjusted analysis, the odds ratio of no concurrent use of opioids and benzodiazepines was 5% higher (1.05; 95% confidence interval = 1.02-1.09) among recipients than non-recipients. These significant findings were not found for the other two measures of opioid overuse. Conclusions Comprehensive medication review is associated with reduced concurrent use of opioids and benzodiazepines among Medicare beneficiaries. Such service should be incorporated into the current approaches for addressing the opioid epidemic.
Collapse
Affiliation(s)
- Yongbo Sim
- Department of Economics, City University of New York, New York, NY, United States
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
| | - Clayton F Hausberger
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
| | - Junling Wang
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
| |
Collapse
|
34
|
Pelton M, Ssentongo P, Sun A, Groff D, Dalessio S, Clarke K. Race and Ethnic Representation in Crohn's Disease Trials of Biologic and Small Molecule Medications: A Systematic Review and Meta-analysis. J Crohns Colitis 2024; 18:204-211. [PMID: 37586091 DOI: 10.1093/ecco-jcc/jjad138] [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: 02/08/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND AIMS Randomised controlled trials historically under-represent marginalised racial and ethnic populations. As incidence and prevalence of Crohn's disease in these groups rise, it is important to characterise their inclusion in randomised controlled trials on first-line and pipe-line medications. METHODS PubMed was searched systematically for randomised controlled trials of biologic and small molecule inhibitor [SMI] medications, with a primary outcome related to efficacy following PRISMA guidelines. We used descriptive statistics to summarise demographic variables and meta-regression analyses to estimate temporal trends in racial inclusion. RESULTS More than a half of trials did not report any racial/ethnic demographics [53.7%] and several reported racial demographics for only one race [20.9%]. When racial data were reported, Whites made up 90.2% of participants. Percentages of Black, Asian, Native American/Pacific Islander, and participants considered 'Other' averaged 2.9%, 11.6%, 0.5%, and 1.6% out of the total sample sizes of 3901, 3742, 828 and 4027, respectively. Proportional representation of White participants decreased over time [p <0.01] and proportional representation of Asian participants increased over time [p = 0.047]. In ordinal logistic regression, mean year of trial enrolment significantly increased the number of racial groups reported [p <0.001]. CONCLUSIONS Half of published randomised controlled trials in Crohn's disease contain no racial or ethnic demographics, and the remaining often only have limited inclusion of Black, Native American/Pacific Islander, and Hispanic patients. Further work should characterise representation in observational and prospective trials. Researchers should work to: 1] increase reporting of racial and ethnic demographics; and 2] improve recruitment and retention of marginalised populations.
Collapse
Affiliation(s)
- Matt Pelton
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Paddy Ssentongo
- Department of Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ashley Sun
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Destin Groff
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Shannon Dalessio
- Department of Gastroenterology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kofi Clarke
- Department of Gastroenterology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
35
|
Tay ET, Fernbach M, Chen H, Ng C, Tapia J, O'Callaghan S. A community-based volunteer service to reduce COVID-19 vaccination inequities in New York City. J Public Health (Oxf) 2024; 46:168-174. [PMID: 38070144 DOI: 10.1093/pubmed/fdad208] [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: 10/14/2022] [Revised: 10/07/2023] [Accepted: 10/15/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES We describe our experiences and challenges as community volunteers in assisting individuals in scheduling initial COVID-19 vaccine appointments and highlight disparities and barriers in vaccine access in New York City (NYC). METHODS Priority for assistance was given to individuals who were eligible for vaccination in NYC and New York State with the following barriers: technological, language, medical, physical and undocumented immigrants. Volunteers in NYC performed outreach and created program to assist in scheduling appointments. RESULTS In sum, 2101 requests were received to schedule COVID-19 vaccine appointments from 28 February to 30 April 2021. Vaccinations were successfully scheduled for 1935 (92%) individuals. Challenges in this project included limited community outreach, language barriers, transportation difficulties and safety concerns travelling to vaccination sites. Spanish (40.5%) and Chinese (35.6%) were the primary languages spoken by appointment requesters. Most requests came from residents of Queens (40%) and Brooklyn (27.2%). CONCLUSIONS The older population, public-facing workers, non-English speakers, undocumented immigrants and the medically complicated population experienced challenges in vaccine appointment access. In-person services and early website access in languages in addition to English may have reduced barriers in appointment navigation. While volunteers faced numerous obstacles when assisting individuals in scheduling vaccine appointments, most found the work fulfilling and rewarding.
Collapse
Affiliation(s)
- Ee Tein Tay
- Department of Emergency Medicine and Pediatrics, NYU Grossman School of Medicine, New York, NY 10016, USA
| | | | - Haidee Chen
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Charis Ng
- Office of Institutional Research, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Jade Tapia
- Department of Emergency Medicine and Pediatrics, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Stasha O'Callaghan
- Office of Quality and Safety, NYC Health+Hospitals, New York, NY 10004 USA
| |
Collapse
|
36
|
Nieh C, Mabila SL. Incidence and health care burden of uterine fibroids among female service members in the active component of the U.S. Armed Forces, 2011-2022. MSMR 2024; 31:9-15. [PMID: 38466970 PMCID: PMC10959453] [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] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Uterine fibroids are the most common benign tumors of the uterus among women of reproductive age, disproportionally affecting non-Hispanic Black women compared to other races and ethnicities. This report is an update of a 2011 MSMR report that examined uterine fibroids among female active component service members in the U.S. Armed Forces from 2001 to 2010. Incident uterine fibroids were identified for this report from inpatient and outpatient medical encounter data from 2011 to 2022. Health care burden was estimated utilizing uterine fibroid-related inpatient and outpatient diagnostic and procedure codes. Crude incidence rates and incidence rate ratios were calculated to compare rate differences between subpopulations. A total of 16,046 new uterine fibroid cases were identified, with an incidence rate of 63.5 cases per 10,000 person-years (95% confidence interval: 62.5-64.5). The highest incidence rates were observed among service women 40 years and older, non-Hispanic Black women, and those who served in the Army. Health care burden analysis showed that, even with increases in medical encounters and individuals affected, the numbers of hospital bed days declined over time. The decline in uterine fibroid-related hospital bed days could be attributed to early diagnoses and minimally-invasive treatments. Continued promotion of uterine fibroid awareness can potentially help further reduce uterine fibroid-related impacts on military readiness.
Collapse
Affiliation(s)
- Chiping Nieh
- Epidemiology and Analysis Section, Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, MD
| | - Sithembile L Mabila
- Epidemiology and Analysis Section, Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, MD
| |
Collapse
|
37
|
Saito T, Imahashi K, Yamaki C. Use of General Health Examination and Cancer Screening among People with Disability Who Need Support from Others: Analysis of the 2016 Comprehensive Survey of Living Conditions in Japan. Int J Environ Res Public Health 2024; 21:219. [PMID: 38397708 PMCID: PMC10888656 DOI: 10.3390/ijerph21020219] [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] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Research on preventive healthcare services among people with disability in Japan is scarce. This study aimed to (1) examine the relationship between disability and the use of general health examination (GHE) and cancer screening (lung, gastric, colorectal, breast and cervical cancer) and (2) explore the reasons for not using GHE. This cross-sectional study used secondary data from individuals aged 20-74 years (n = 15,294) from the Comprehensive Survey of Living Conditions of 2016. Binomial logistic regression analysis was conducted to examine the relationship between disability and non-participation in preventive services. In addition, a descriptive analysis was conducted to explore the reasons for non-participation in GHE. Consequently, disability was identified as an independently associated factor for non-participation in GHE (odds ratios (OR): 1.73; 95% confidence interval (95%CI): 1.14-2.62) and screening for colorectal (OR: 1.78; 95%CI: 1.08-2.94), gastric (OR: 2.27; 95%CI: 1.27-4.05), cervical (OR: 2.12; 95%CI: 1.04-4.32) and breast cancer (OR: 2.22; 95%CI: 1.04-4.72), controlling for confounding factors. The most dominant reason for non-participation was "I can go to see the doctor anytime, if I am worried (25/54, 46.3%)." Our findings imply the existence of disability-based disparity in preventive healthcare service use in Japan.
Collapse
Affiliation(s)
- Takashi Saito
- Department of Social Rehabilitation, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa 359-8555, Japan;
| | - Kumiko Imahashi
- Department of Social Rehabilitation, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa 359-8555, Japan;
| | - Chikako Yamaki
- Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuou 104-0045, Japan;
| |
Collapse
|
38
|
Sharma Y, Saha A, Goldsack JC. Defining the Dimensions of Diversity to Promote Inclusion in the Digital Era of Health Care: A Lexicon. JMIR Public Health Surveill 2024; 10:e51980. [PMID: 38335013 PMCID: PMC10891484 DOI: 10.2196/51980] [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: 08/18/2023] [Revised: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024] Open
Abstract
The pandemic provided a stark reminder of the inequities faced by populations historically marginalized by the health care system and accelerated the adoption of digital health technologies to drive innovation. Digital health technologies' purported promises to reduce inefficiencies and costs, improve access and health outcomes, and empower patients add a new level of urgency to health equity. As conventional medicine shifts toward digital medicine, we have the opportunity to intentionally develop and deploy digital health technologies with an inclusion focus. The first step is ensuring that the multiple dimensions of diversity are captured. We propose a lexicon that encompasses elements critical for implementing an inclusive approach to advancing health care quality and health services research in the digital era.
Collapse
Affiliation(s)
| | - Anindita Saha
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | | |
Collapse
|
39
|
Allred CM, Nakamura R, Mull H, Wang X, Jio J, Messner J, Parikh SR, Sie K, Bonilla-Velez J. Effect of an Outbound Scheduling Team on the Timeliness of Scheduling Referrals to Pediatric Otolaryngology. Otolaryngol Head Neck Surg 2024. [PMID: 38327234 DOI: 10.1002/ohn.660] [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: 03/25/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Families preferring to receive care in a language-other-than-English have disparities in access to care. We studied the effect of implementing an ambulatory outbound scheduling team on the timeliness of scheduling referrals to pediatric otolaryngology. We hypothesized this intervention could increase access to care. STUDY DESIGN Retrospective cohort analysis. SETTING Tertiary care academic center. METHODS Data were abstracted from the hospital's enterprise database for patients referred to Otolaryngology over 3 years (October 2019-August 2022; 7675 referrals). An outbound scheduling team was created April 2021 and tasked with calling out to schedule referrals within one business day of receipt. Referral lag was compared across patient cohorts before and after the scheduling intervention. Log-transformed linear regression models were used to assess the impact of the scheduling intervention on referral lag for language cohorts. RESULTS The median preintervention referral lag was 6 days (interquartile range [IQR] 2-18), which was reduced to 1 day postintervention (IQR 0-5; P < .001). Preintervention language-other-than-English families had a median referral lag of 8 days (IQR 2-23), which was 1.27 times higher than for patients speaking English (P < .001). With implementation of the scheduling intervention, language-other-than-English families were scheduled in a median of 1 day (IQR 0-6), and the disparity in timeliness of scheduling was eliminated (P = .131). Postintervention, referral lag was reduced by 58% in the English and 64% in the language other than English cohorts. CONCLUSION Implementation of an outbound ambulatory scheduling process reduces referral lag for all patients and eliminated a disparity in referral lag for language-other-than-English families.
Collapse
Affiliation(s)
- Caleb M Allred
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Rina Nakamura
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Helen Mull
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Xing Wang
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jason Jio
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jack Messner
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay R Parikh
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathleen Sie
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juliana Bonilla-Velez
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
40
|
Song S, Guo C, Wu R, Zhao H, Li Q, Dou JH, Guo FS, Wei J. Impact of the COVID-19 pandemic on cardiovascular mortality and contrast analysis within subgroups. Front Cardiovasc Med 2024; 11:1279890. [PMID: 38385134 PMCID: PMC10879411 DOI: 10.3389/fcvm.2024.1279890] [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: 08/18/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
Background An increase in deaths has been perceived during the pandemic, which cannot be explained only by COVID-19. The actual number of deaths far exceeds the recorded data on deaths directly related to SARS-CoV-2 infection. Data from early and short-lived pandemic studies show a dramatic shift in cardiovascular mortality. Grounded in the post-pandemic era, macroscopic big data on cardiovascular mortality during the pandemic need to be further reviewed and studied, which is crucial for cardiovascular disease prevention and control. Methods We retrieved and collected data associated with cardiovascular disease mortality from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform based on the ICD-10 codes. We applied regression analysis to characterize overall cardiovascular disease mortality trends from 2010 to 2023 and built a time series model to predict mortality for 2020-2023 based on mortality data from 2010 to 2019 in order to affirm the existence of the excess deaths by evaluating observed vs. predicted mortality. We also conducted subgroup analyses by sex, age and race/ethnicity for the purpose of obtaining more specific sociodemographic information. Results All-cause age-standardised mortality rates (ASMRs) for CVD dramatically increased between 2019 and 2021[annual percentage change (APC) 11.27%, p < 0.01], and then decreased in the following 2021-2023(APC: -7.0%, p < 0.01). Subgroup analyses found that the ASMR change was most pronounced in Alaska Indians/Native American people (APC: 16.5% in 2019-2021, -12.5% in 2021-2023, both p < 0.01), Hispanics (APC: 12.1% in 2019-2021, -12.2% in 2021-2023, both p < 0.05) and non-Hispanic Black people (APC:11.8% in 2019-2021, -10.3% in 2021-2023, both p < 0.01)whether during the increasing or declining phase. Similarly, the ASMR change was particularly dramatic for the 25-44 age group (APC:19.8% in 2019-2021, -15.4% in 2021-2023, both p < 0.01) and males (APC: 11.5% in 2019-2021, -7.6% in 2021-2023, both p < 0.01). By the end of 2023, the proportion of COVID-related excess death remained high among the elderly (22.4%), males (42.8%) and Alaska Indians/Native American people(39.7%). In addition, we did not find the presence of excess deaths in the young (25-44) and middle-aged cohort (45-64) in 2023, while excess deaths remained persistent in the elderly. Conclusions All-cause ASMRs for CVD increased notably during the initial two years of the COVID-19 pandemic and then witnessed a decline in 2021-2023. The cohorts (the young, males and minorities) with the steepest rise in mortality decreased at the fastest rate instead. Previous initiatives to promote cardiovascular health were effective, but further research on cardiovascular healthcare for the elderly and racial disparities should be attached to priority considering the presence of sociodemographic differences in CVD death.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Jin Wei
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, China
| |
Collapse
|
41
|
Rodriguez R, Osman KM, Anderson L, Pascual M, Dellavalle RP. Themes and Topics on Diversity, Equity, and Inclusion in JMIR Dermatology Publications. JMIR Dermatol 2024; 7:e48762. [PMID: 38306177 PMCID: PMC10873792 DOI: 10.2196/48762] [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: 05/06/2023] [Revised: 09/21/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
Publications dealing with topics considered to be pertinent to diversity, equity, and inclusion are increasing. Due to the increasing trend, dermatology journals have started to implement ways to evaluate and understand these publications. Here, we discuss a keyword approach to identify and then categorize these publications. Keywords identified 43 manuscripts. Two reviewers screened the articles' titles and abstracts, and recommended a full manuscript review for 24 publications. Through the scope of definitions from the National Institutes of Health, an editorial board member performed a full-text review and assigned a primary theme to the publications. Themes included equity (n=20) and diversity/inclusion (n=4). Topics were racial/ethnic differences in care delivery or society (n=17), incomplete understanding of gender and sex (n=3), gender identity (n=2), socioeconomic class and its impact on health (n=1), care for rural underserved communities (n=1), and religion (n=1). The results of this review demonstrate a predominance of equity-related publications, particularly emphasizing racial/ethnic differences in health care delivery, in the publications identified in JMIR Dermatology. Future research can focus on creating a review aid to assist editorial board members when providing feedback to manuscripts, refining the keywords, and using thematic analysis methodology to evaluate large sets of publications.
Collapse
Affiliation(s)
- Ramiro Rodriguez
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Karima M Osman
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lachlan Anderson
- Texas Christian University School of Medicine, Fort Worth, TX, United States
| | - Micah Pascual
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Dermatology Service, US Department of Veterans Affairs Rocky Mountain Regional Medical Center, Aurora, CO, United States
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
42
|
Popp K, Popp R, Bansal S, Sharan S, Hoorulain S, Sukiam KB, Raikot S, Jimenez PB, Manaise HK, Kowkabany G, Gabriel EM. Disparities in Time-to-treatment for Patients With Melanoma. Anticancer Res 2024; 44:631-637. [PMID: 38307585 DOI: 10.21873/anticanres.16852] [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: 10/16/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM This study aimed to investigate the demographic and socioeconomic factors associated with disparities in the time-to-treatment for melanoma. PATIENTS AND METHODS We conducted an analysis of patients with melanoma from 2004 to 2019 using the National Cancer Database. Time intervals from diagnosis to surgery, radiation, and chemotherapy were compared based on age, sex, race, and socioeconomic status. RESULTS A total of 647,273 patients with melanoma were included. Overall, Hispanic patients had the longest times to surgery, radiation, and chemotherapy compared to non-Hispanic patients (surgery 38.52 vs. 31.90 days, radiation 130.12 vs. 99.67 days, chemotherapy 93.66 vs. 83.72 days, all p<0.01). Similarly, black patients and those who were uninsured had the longest times-to-treatment. CONCLUSION We identified significant disparities in time-to-treatment, related to both race and socioeconomic factors. It is increasingly imperative to conduct further investigations into the root causes of these disparities to effectively address and rectify the inequities present in breast cancer care.
Collapse
Affiliation(s)
- Kyle Popp
- Florida State University College of Medicine, Tallahassee, FL, U.S.A.;
| | - Reed Popp
- College of Medicine, University of Florida, Gainesville, FL, U.S.A
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Chen Q, Malas J, Emerson D, Megna D, Catarino P, Esmailian F, Chikwe J, Czer LS, Kobashigawa JA, Bowdish ME. Heart transplantation in patients from socioeconomically distressed communities. J Heart Lung Transplant 2024; 43:324-333. [PMID: 37591456 PMCID: PMC10843295 DOI: 10.1016/j.healun.2023.08.004] [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: 01/23/2023] [Revised: 06/20/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Studies examining heart transplantation disparities have focused on individual factors such as race or insurance status. We characterized the impact of a composite community socioeconomic disadvantage index on heart transplantation outcomes. METHODS From the Scientific Registry of Transplant Recipients (SRTR), we identified 49,340 primary, isolated adult heart transplant candidates and 32,494 recipients (2005-2020). Zip code-level socioeconomic disadvantage was characterized using the Distressed Community Index (DCI: 0-most prosperous, 100-most distressed) based on education, poverty, unemployment, housing vacancies, median income, and business growth. Patients from distressed communities (DCI ≥ 80) were compared to all others. RESULTS Patients from distressed communities were more often non-white, less educated, and had public insurance (all p < 0.01). Distressed patients were more likely to require ventricular assist devices at listing (29.4 vs 27.1%) and before transplant (44.8 vs 42.0%, both p < 0.001), and they underwent transplants at lower-volume centers (23 vs 26 cases/year, p < 0.01). Distressed patients had higher 1-year waitlist mortality or deterioration (12.3% [95% confidence interval (CI) 11.6-13.0] vs 10.9% [95% CI 10.5-11.3]) and inferior 5-year survival (75.3% [95% CI 74.0-76.5] vs 79.5% [95% CI 79.0-80.0]) (both p < 0.001). After adjustment, living in a distressed community was independently associated with an increased risk of waitlist mortality or deterioration hazard ratio (HR 1.10, 95% CI 1.02-1.18) and post-transplant mortality (HR 1.13, 95% CI 1.06-1.20). CONCLUSIONS Patients from socioeconomically distressed communities have worse waitlist and post-transplant mortality. These findings should not be used to limit access to heart transplantation, but rather highlight the need for further studies to elucidate mechanisms underlying the impact of community-level socioeconomic disparity.
Collapse
Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lawrence S Czer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| |
Collapse
|
44
|
Javier SJ, Carey EP, Gunzburger E, Chen HYP, Zeliadt SB, Williams EC, Chen JA. Pain Care Disparities and the Use of Virtual Care Among Racial-Ethnic Minority Groups During COVID-19. J Gen Intern Med 2024; 39:68-78. [PMID: 38252245 PMCID: PMC10937888 DOI: 10.1007/s11606-023-08473-0] [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: 04/21/2023] [Accepted: 10/10/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE COVID-19 led to an unprecedented reliance on virtual modalities to maintain care continuity for patients living with chronic pain. We examined whether there were disparities in virtual specialty pain care for racial-ethnic minority groups during COVID-19. DESIGN AND PARTICIPANTS This was a retrospective national cohort study with two comparison groups: primary care patients with chronic pain seen immediately prior to COVID-19 (3/1/19-2/29/20) (N = 1,649,053) and a cohort of patients seen in the year prior (3/1/18-2/28-19; n = 1,536,954). MAIN MEASURES We assessed use of telehealth (telephone or video) specialty pain care, in-person care specialty pain care, and any specialty pain care for both groups at 6 months following cohort inclusion. We used quasi-Poisson regressions to test associations between patient race and ethnicity and receipt of care. KEY RESULTS Prior to COVID-19, there were Black-White (RR = 0.64, 95% CI [0.62, 0.67]) and Asian-White (RR = 0.63, 95% CI [0.54, 0.75]) disparities in telehealth use, and these lessened during COVID-19 (Black-White: RR = 0.75, 95% CI [0.73, 0.77], Asian-White: RR = 0.81, 95% CI [0.74, 0.89]) but did not disappear. Individuals identifying as American Indian/Alaska Native used telehealth less than White individuals during early COVID-19 (RR = 0.98, 95% CI [0.85, 1.13] to RR = 0.87, 95% CI [0.79, 0.96]). Hispanic/Latinx individuals were less likely than non-Hispanic/Latinx individuals to use telehealth prior to COVID-19 but more likely during early COVID-19 (RR = 0.70, 95% CI [0.66, 0.75] to RR = 1.06, 95% CI [1.02, 1.09]). Disparities in virtual pain care occurred over the backdrop of overall decreased specialty pain care during the early phase of the pandemic (raw decrease of n = 17,481 specialty care encounters overall from pre-COVID to COVID-era), including increased disparities in any VA specialty pain care for Black (RR = 0.81, 95% CI [0.80, 0.83] to RR = 0.79, 95% CI [0.77, 0.80]) and Asian (RR = 0.91, 95% CI [0.86, 0.97] to RR = 0.88, 95% CI [0.82, 0.94]) individuals. CONCLUSIONS Disparities in virtual specialty pain care were smaller during the early phases of the COVID-19 pandemic than prior to the pandemic but did not disappear entirely, despite the rapid growth in telehealth. Targeted efforts to increase access to specialty pain care need to be concentrated among racial-ethnic minority groups.
Collapse
Affiliation(s)
- Sarah J Javier
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Evan P Carey
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elise Gunzburger
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
| | - Huang-Yuan P Chen
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
| | - Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jessica A Chen
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA, USA
| |
Collapse
|
45
|
Nieri CA, Davies C, Luttrell JB, Sheyn A. Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes. Laryngoscope 2024; 134:954-962. [PMID: 38050924 DOI: 10.1002/lary.30836] [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: 01/26/2023] [Revised: 04/25/2023] [Accepted: 05/24/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To investigate the impact of neighborhood-level social vulnerability on pediatric tonsillectomy outcomes. METHODS This single-center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two-sided Pearson chi-square tests were used, whereas for continuous variables, paired t-tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post-T&A complications and readmissions. RESULTS The study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128-22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270-28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275-31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293-79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089-29.396). CONCLUSION Social vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community-based interventions. Because of the increased risk, it may have implications for preoperative decision-making, treatment plans, and clinic follow-ups. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:954-962, 2024.
Collapse
Affiliation(s)
- Chad A Nieri
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Camron Davies
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Jordan B Luttrell
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Anthony Sheyn
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
- Division of Otolaryngology, LeBonheur Children's Hospital, Memphis, Tennessee, U.S.A
| |
Collapse
|
46
|
Brock BA, Mir H, Flenaugh EL, Oprea-Ilies G, Singh R, Singh S. Social and Biological Determinants in Lung Cancer Disparity. Cancers (Basel) 2024; 16:612. [PMID: 38339362 PMCID: PMC10854636 DOI: 10.3390/cancers16030612] [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: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Lung cancer remains a leading cause of death in the United States and globally, despite progress in treatment and screening efforts. While mortality rates have decreased in recent years, long-term survival of patients with lung cancer continues to be a challenge. Notably, African American (AA) men experience significant disparities in lung cancer compared to European Americans (EA) in terms of incidence, treatment, and survival. Previous studies have explored factors such as smoking patterns and complex social determinants, including socioeconomic status, personal beliefs, and systemic racism, indicating their role in these disparities. In addition to social factors, emerging evidence points to variations in tumor biology, immunity, and comorbid conditions contributing to racial disparities in this disease. This review emphasizes differences in smoking patterns, screening, and early detection and the intricate interplay of social, biological, and environmental conditions that make African Americans more susceptible to developing lung cancer and experiencing poorer outcomes.
Collapse
Affiliation(s)
- Briana A. Brock
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Hina Mir
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Eric L. Flenaugh
- Division of Pulmonary Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Gabriela Oprea-Ilies
- Department of Pathology & Laboratory Medicine, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Rajesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Shailesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
- Cell and Molecular Biology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| |
Collapse
|
47
|
Cui W, Finkelstein J. Identifying Determinants of Survival Disparities in Multiple Myeloma Patients Using Electronic Health Record Data. Stud Health Technol Inform 2024; 310:956-960. [PMID: 38269950 DOI: 10.3233/shti231106] [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: 01/26/2024]
Abstract
Multiple myeloma (MM) is one of the most common hematological malignancies. The goal of this study was to analyze the sociodemographic, economic, and genetic characteristics of long-term and short-term survival of multiple myeloma patients using EHR data from an academic medical center in New York City. The de-identified analytical dataset comprised 2,111 patients with MM who were stratified based on the length of survival into two groups. Demographic variables, cancer stage, income level, and genetic mutations were analyzed using descriptive statistics and logistic regression. Age, race, and cancer stage were all significant factors that affected the length of survival of multiple myeloma patients. In contrast, gender and income level were not significant factors based on the multivariate adjusted analysis. Older adults, African American patients, and patients who were diagnosed with stage III of multiple myeloma were the people most likely to exhibit short-term survival after the MM diagnosis.
Collapse
Affiliation(s)
- Wanting Cui
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
48
|
Cook BL, Rastegar J, Patel N. Social Risk Factors and Racial and Ethnic Disparities in Health Care Resource Utilization Among Medicare Advantage Beneficiaries With Psychiatric Disorders. Med Care Res Rev 2024:10775587231222583. [PMID: 38235576 DOI: 10.1177/10775587231222583] [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: 01/19/2024]
Abstract
The intersection of social risk and race and ethnicity on mental health care utilization is understudied. This study examined disparities in health care treatment, adjusting for clinical need, among 25,780 Medicare Advantage beneficiaries with a diagnosis of a psychiatric disorder. We assessed contributions to disparities from racial and ethnic differences in the composition and returns of social risk variables. Black and Hispanic beneficiaries had lower rates of mental health outpatient visits than Whites. Assessing composition, Black and Hispanic beneficiaries experienced greater financial, food, and housing insecurity than White beneficiaries, factors associated with greater mental health treatment. Assessing returns, food insecurity was associated with an exacerbation of Hispanic-White disparities. Health care systems need to address the financial, food and housing insecurity of racial and ethnic minority groups with psychiatric disorder. Accounting for racial and ethnic differences in social risk adjustment-based payment reforms has significant implications for provider reimbursement and outcomes.
Collapse
Affiliation(s)
- Benjamin Lê Cook
- Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Nikesh Patel
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| |
Collapse
|
49
|
Wang X, Ghanbarzadegan A, Sohn W, Taylor E, Gao J, Christian B. Inequalities in dental caries among Indigenous and non-Indigenous children in Australia: A literature review. Aust Dent J 2024. [PMID: 38197608 DOI: 10.1111/adj.13005] [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] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
Dental caries constitutes one of the most ubiquitous diseases in Australia, with Indigenous children presenting a notably higher prevalence than their non-Indigenous peers. This literature review aims to update the knowledge base developed by Christian and Blinkhorn in 2012, with a particular focus on the contemporary disparities in dental caries between Indigenous and non-Indigenous children. Our research strategy involved a thorough exploration of the Medline, PubMed, and Scopus databases to identify pertinent studies published between 2009 and 2022. Supplementary resources included various government websites and citation searches. We prioritised studies that focused on children aged 5-6 or 12 years-reflecting the World Health Organization's index ages for oral health-and that reported dental caries prevalence and experience indicators. Our review methodology was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The updated search, spanning 2009 to 2023, retrieved studies that reported caries estimates exclusively from 2009 to 2014. Within this period, the prevalence of dental caries in Indigenous children's primary teeth ranged between 52% and 77%, while the prevalence in permanent teeth varied from 36% to 60%. This updated review indicated that Indigenous children continue to experience caries at an approximately twice higher rate than non-Indigenous children, sustaining the persisting disparity in caries estimates. The findings from this review show that no discernible improvement in dental caries rates among Australian Indigenous children has been observed in comparison to the previous review; and that Indigenous children continue to experience both higher prevalence and severity of dental caries compared to non-Indigenous children.
Collapse
Affiliation(s)
- X Wang
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A Ghanbarzadegan
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - W Sohn
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - E Taylor
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - J Gao
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - B Christian
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
50
|
Rodriguez R, Anderson L, Woolhiser E, Balmorez T, Cook B, Hauptman M, Kirk J, Keime N, Dellavalle RP. Diversity Among American Dermatological Association Members by Sex and Geographic Region. JMIR Dermatol 2024; 7:e47802. [PMID: 38198199 PMCID: PMC10809161 DOI: 10.2196/47802] [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: 04/01/2023] [Revised: 07/06/2023] [Accepted: 10/24/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Ramiro Rodriguez
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Emily Woolhiser
- College of Osteopathic Medicine, Kansas City University, Kansas, KS, United States
| | - Timothy Balmorez
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, United States
| | - Bailey Cook
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Megan Hauptman
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Jessica Kirk
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Noah Keime
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
- Dermatology Service, US Department of Veterans Affairs Rocky Mountain Regional Medical Center, Aurora, CO, United States
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|