Browsing by Subject "Health Disparities"
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Item 5-OR: Health Disparities in People with and without Diabetes during the COVID-19 Pandemic(American Diabetes Association, 2021-06-01) Myers, Barbara A.; Klingensmith, Rachel; de Groot, Mary; Medicine, School of MedicinePurpose: To characterize the psychosocial experiences of adults with (PWD) and without diabetes (ND) during the COVID-19 pandemic. US adults (2176) completed a web-based survey in May-June, 2020 and November-December, 2020, including demographics, COVID-19 exposure, diabetes-related distress (DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). At baseline, mean age was 49.6 years (S.D. = 16.9), 80% female, 88.3% White, with an annual household income of ≥ $60,000 (57.6%), type 2 diabetes (T2D; 301,13.9%), 145 prediabetes (145, 6.6%) and type 1 (T1D, 100, 4.6%). One-third (29.7%) reported decreased income due to the pandemic. T2Ds had more medical comorbidities and COVID risk factors than T1Ds and NDs (all p < 0.01). Mean PHQ-8 scores were 7.1 (S.D. = 5.8; mild), with the T2Ds (M = 7.7; S.D. = 5.9) exceeding NDs (M = 6.9; S.D. = 5.7; p<.001). Mean DDS-17 and GAD-7 scores were comparable for T1Ds and T2Ds (moderate level; p=NS). At 6 months (6MFU), 1,345 (62.6%) completed follow up surveys. Completers were more likely to be older, male, White, married, with higher education levels, and homeowners, with a greater proportion of medical comorbidities and lower A1cs at baseline than non-completers (all p<.05). 6MFU completers had lower baseline depressive symptoms and diabetes distress, lower household COVID-19 rates and less difficulty paying bills than non-completers (all p<.05). At 6MFU for all groups, depressive symptoms decreased (p<.0001) and financial strain improved (p<.001), while COVID exposure increased (personal and household, p<.001). Diabetes distress remained at a moderate level for T1Ds and T2Ds. T1Ds and T2Ds showed comparable levels of depressive symptoms to NDs but were more likely to report financial hardship (p<.05) and difficulty paying bills than NDs (p<.001). Health outcomes were worse for PWDs compared to NDs during the COVID-19 pandemic despite high SES protective factors. Persistent financial strain and diabetes distress increase the risk for future poor health outcomes.Item “Clinical Characteristics, Outcomes and Prognosticators in Adult Patients Hospitalized with COVID-19”(Elsevier, 2020-07-08) Gavin, Warren; Campbell, Elliott; Zaidi, Adeel; Gavin, Neha; Dbeibo, Lana; Beeler, Cole; Kuebler, Kari; Abdel-Rahman, Ahmed; Luetkemeyer, Mark; Kara, Areeba; Medicine, School of MedicineBackground: COVID-19 is a novel disease caused by SARS-CoV-2. Methods: We conducted a retrospective evaluation of patients admitted with COVID-19 to one site in March 2020. Patients were stratified into three groups: survivors who did not receive mechanical ventilation (MV), survivors who received MV and those who received MV and died during hospitalization. Results: There were 140 hospitalizations; 22 deaths (mortality rate 15.7%), 83 (59%) survived and did not receive MV, 35 (25%) received MV and survived; 18 (12.9%) received MV and died. Thee mean age of each group was 57.8 , 55.8 and 72.7 years respectively (p=.0001). Of those who received MV and died, 61% were male (p=.01). More than half the patients ( n=90, 64%) were African American. First measured d-dimer >575.5 ng/mL, procalcitonin > 0.24 ng/mL, LDH > 445.6 units/L and BNP > 104.75 pg/mL had odds ratios of 10.5, 5 , 4.5 and 2.9 respectively forMV (p < .05 for all). Peak BNP > 167.5 pg/mL had an odds ratio of 6.7 for inpatient mortalitywhen mechanically ventilated (p= .02).Conclusions: Age and gender may impact outcomes in COVID-19. D-dimer, procalcitonin, LDH and BNP may serve as early indicators of disease trajectory.Item Clinical Features of Critical Coronavirus Disease 2019 in Children(Wolters Kluwer, 2020-07-08) Bhumbra, Samina; Malin, Stefan; Kirkpatrick, Lindsey; Khaitan, Alka; John, Chandy C.; Rowan, Courtney M.; Enane, Leslie A.; Pediatrics, School of MedicineObjectives: We sought to describe the presentation, course, and outcomes of hospitalized pediatric coronavirus disease 2019 patients, with detailed description of those requiring mechanical ventilation, and comparisons between critically ill and noncritical hospitalized pediatric patients. Design: Observational cohort study. Setting: Riley Hospital for Children at Indiana University Health in Indianapolis in the early weeks of the coronavirus disease 2019 pandemic. Patients: All hospitalized pediatric patients with confirmed coronavirus disease 2019 as of May 4, 2020, were included. Interventions: Patients received therapies including hydroxychloroquine, remdesivir, tocilizumab, and convalescent serum and were managed according to an institutional algorithm based on evidence available at the time of presentation. Measurements and Main Results: Of 407 children tested for severe acute respiratory syndrome-coronavirus 2 at our hospital, 24 were positive, and 19 required hospitalization. Seven (36.8%) were critically ill in ICU, and four (21%) required mechanical ventilation. Hospitalized children were predominantly male (14, 74%) and African-American or Hispanic (14, 74%), with a bimodal distribution of ages among young children less than or equal to 2 years old (8, 42%) and older adolescents ages 15–18 (6, 32%). Five of seven (71.4%) of critically ill patients were African-American (n = 3) or Hispanic (n = 2). Critical illness was associated with older age (p = 0.017), longer duration of symptoms (p = 0.036), and lower oxygen saturation on presentation (p = 0.016); with more thrombocytopenia (p = 0.015); higher C-reactive protein (p = 0.031); and lower WBC count (p = 0.039). Duration of mechanical ventilation averaged 14.1 days. One patient died. Conclusions: Severe, protracted coronavirus disease 2019 is seen in pediatric patients, including those without significant comorbidities. We observed a greater proportion of hospitalized children requiring mechanical ventilation than has been reported to date. Older children, African-American or Hispanic children, and males may be at risk for severe coronavirus disease 2019 requiring hospitalization. Hypoxia, thrombocytopenia, and elevated C-reactive protein may be useful markers of critical illness. Data regarding optimal management and therapies for pediatric coronavirus disease 2019 are urgently needed.Item Covid-19: Control Measures Must be Equitable and Inclusive(BMJ Publishing Group, 2020-03-20) Berger, Zackary D.; Evans, Nicholas G.; Phelan, Alexandra L.; Silverman, Ross D.; Health Policy and Management, School of Public HealthItem Educational QUality-improvement in APRN Learning: Reducing Health Inequities for ALL Program (EQUAL-ALL Program)(2020-03-03) Oruche, Ukamaka M.We proposed a quality improvement project focused on MSN students to ensure they are well prepared to contribute with all diverse patient populations from both the United States and beyond. Specific aims are to assess MSN students’ learning needs and develop and implement a training program to increase MSN students’ knowledge and skills for working with different others.Item Exploring Racial and Age Disproportionalities in COVID-19 Positive Pediatric Cohort(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2020-12-15) Freeman, Emily; Song, Yiqiang; Allen, Katie; Hui, Siu; Mendonca, Eneida; Department of Pediatrics, IU School of MedicineBackground: Social and health inequities place marginalized populations at increased risk of contracting the novel coronavirus 2019 (COVID-19). While COVID-19 literature continues to accumulate, there remains a lack of comprehensive epidemiological data on COVID-19 in children. The study aims to identify demographic trends in disease severity amongst COVID-19 positive pediatric patients. Methods: We analyzed the medical records of 2217 laboratory-confirmed COVID-19 pediatric patients, ages 0-18, across Indiana. Working with Regenstrief Institute Center of Biomedical Informatics, data was extracted from the databases of Indiana Network for Patient Care, Indiana University Health, and Eskenazi Health from February 28th, 2020 to July 13th, 2020. Factors of interest were age, race, and ethnicity. The study assessed the clinical outcome of disease severity which was defined by one of the following clinical designations: outpatient management exclusively, emergency care without hospital admission, non-pediatric intensive care unit (PICU) hospitalization, PICU hospitalization, and death. Results: The laboratory confirmed COVID-19 pediatric cohort was composed of 12.2% (N= 270) Black or African American, 49.3% (N=1094) white, and 3.2% (N= 71) American Indian/Alaska Native, Asian/Pacific Islander, and Multiracial combined group. 34.4% of Black or African American patients required emergency (12.2%) or inpatient care (22.2%) while 24.4% white patients required emergency (7.0%) or inpatient care (17.3%). 17.6% of the cohort was 0-5 years old, 24.8% was 6-12 years old, and 57.6% was 13-18 years old. 30.9% of the 0-5 age group required emergency or inpatient care while the percentages of the 6-12 age group and 13-18 age group requiring emergency or inpatient care were 20.6% and 18.9%, respectively. Conclusion: While our data is preliminary and requires additional validation, our exploration of racial and age disproportionalities in pediatric coronavirus severity serves to expand on the current COVID-19 literature and understanding of this virus.Item Health Disparities Among Black Persons in the US and Addressing Racism in the Health Care System(American Medical Association, 2020-06-01) Carroll, Aaron E.; Pediatrics, School of MedicineItem Indiana's Black Death Rates from COVID-19, Institutional Sources of Disparity(Center for Research on Inclusion & Social Policy (CRISP), IU Public Policy Institute, 2020-04) Merritt, Breanca; School of Public and Environmental AffairsCOVID-19 has resulted in a disproportionate number of deaths among black, Hispanic/Latinx, and indigenous Americans across the nation. Where data is available for various states and cities, these groups consistently experience worse outcomes. This trend holds true for Indiana’s black residents. On April 13, 2020, the Indiana State Department of Health began including racial/ethnic demographics of diagnosed cases and deaths in its online dashboard. On that date, black Hoosiers comprised about 10 percent of Indiana’s population, but 20 percent of COVID-19 deaths. This brief looks beyond differences in racial health disparities to understand the structural and social sources for these trends.Item Patient and Physician Race and the Allocation of Time and Patient Engagement Efforts to Mental Health Discussions in Primary Care: An Observational Study of Audiorecorded Periodic Health Examinations(Wolters Kluwer, 2017-07) Foo, Patricia K.; Frankel, Richard M.; McGuire, Thomas G.; Zaslavsky, Alan M.; Lafata, Jennifer Elston; Tai-Seale, Ming; Medicine, School of MedicineThis study investigated racial differences in patient-physician communication around mental health versus biomedical issues. Data were collected from audiorecorded periodic health examinations of adults with mental health needs in the Detroit area (2007-2009). Patients and their primary care physicians conversed for twice as long, and physicians demonstrated greater empathy during mental health topics than during biomedical topics. This increase varied by patient and physician race. Patient race predicted physician empathy, but physician race predicted talk time. Interventions to improve mental health communication could be matched to specific populations based on the separate contributions of patient and physician race.Item Reducing Physical Activity Disparities Among Vulnerable Minorities: Methods and Preliminary Outcomes(2023) Alamilla, Rafael A.; Georgiadis, Yanoula M.; Kaushal, Navin; Keith, NiCole R.INTRODUCTION: Vulnerable minorities experience high rates of chronic disease. Physical Activity (PA) is an effective preventive behavior to mitigate multiple diseases. Vulnerable minorities have low PA participation. Finding ways to engage vulnerable minorities in PA is imperative. PURPOSE: To describe preliminary data from a community-based wait-list pilot PA trial for vulnerable minorities. METHODS: Forty-five participants from a Midwest urban community were randomized to an experimental (EXP: N = 23; 15 F) or control (CON: N = 22; 15 F) group. Baseline measures are height = 168.5 ± 9.1cm (EXP), and 167.9 ± 7.0cm (CON); weight = 95.8 ± 26.4kg (EXP) and 85.0 ± 19.3kg (CON), age = 39.9 ± 9.7y (EXP) and 48.8 ± 13.2y (CON). EXP participants were counseled to engage in regular PA (>4d/wk for >30 mins). EXP participants received a fitness center membership, trainer, and on-site monthly education to help them develop exercise identity and habit formation. The CON group could engage in PA if desired but did not have the same research resources. Both groups completed monthly surveys assessing exercise identity, social support, and habit formation. Baseline data included one week of moderate-to-vigorous PA (MVPA) and health-related fitness (measured by accelerometry and fitness tests, respectively). RESULTS: Paired-samples T-test were used to make baseline comparisons. Study participants were 73.2% White, 67.4% employed full-time, 56.1% obtained a bachelor’s degree or higher, and 32.0% earned >300% of the federal poverty level. MVPA was 127.9 ± 69.8 min/wk (EXP) and 174.7 ± 103.1 min/wk (CON). Other non-significant outcomes included body fat % (EXP: 37.1 ± 10.9%; CON: 32.9 ± 12.0%), 8ft-up-and-go time (EXP: 5.01 ± 0.8s; CON: 5.05 ± 1.10s), and 30s chair stand (EXP: 15.3 ± 6.5; CON: 17.5 ± 5.2), 30s seated arm curl (EXP: R =18.9 ± 5.1, L = 19.2 ± 5.1; CON: R = 21.2 ± 5.7, L = 20.1 ± 5.4). Chair sit-and-reach scores for right (EXP: -0.1 ± 8.3cm; CON: 1.0 ± 12.2cm, p = 0.003 ) and left (EXP: -0.3 ± 8.2cm; CON: 0.1 ± 11.4cm, p = 0.01) legs were different. CONCLUSION: Data show baseline measures did not vary between groups and difficulty recruiting vulnerable minorities. Next steps include reporting final outcomes and developing refined recruitment methods.