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Browsing by Subject "Health status disparities"
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Item Association of missing paternal demographics on infant birth certificates with perinatal risk factors for childhood obesity(Springer (Biomed Central Ltd.), 2016-07-14) Cheng, Erika R.; Hawkins, Summer Sherburne; Rifas-Shiman, Sheryl L.; Gillman, Matthew W.; Taveras, Elsie M.; Department of Pediatrics, IU School of MedicineBACKGROUND: The role of fathers in the development of obesity in their offspring remains poorly understood. We evaluated associations of missing paternal demographic information on birth certificates with perinatal risk factors for childhood obesity. METHODS: Data were from the Linked CENTURY Study, a database linking birth certificate and well-child visit data for 200,258 Massachusetts children from 1980-2008. We categorized participants based on the availability of paternal age, education, or race/ethnicity and maternal marital status on the birth certificate: (1) pregnancies missing paternal data; (2) pregnancies involving unmarried women with paternal data; and (3) pregnancies involving married women with paternal data. Using linear and logistic regression, we compared differences in smoking during pregnancy, gestational diabetes, birthweight, breastfeeding initiation, and ever recording a weight for length (WFL) ≥ the 95th percentile or crossing upwards ≥2 WFL percentiles between 0-24 months among the study groups. RESULTS: 11,989 (6.0 %) birth certificates were missing paternal data; 31,323 (15.6 %) mothers were unmarried. In adjusted analyses, missing paternal data was associated with lower birthweight (β -0.07 kg; 95 % CI: -0.08, -0.05), smoking during pregnancy (AOR 4.40; 95 % CI: 3.97, 4.87), non-initiation of breastfeeding (AOR 0.39; 95 % CI: 0.36, 0.42), and with ever having a WFL ≥ 95th percentile (AOR 1.10; 95 % CI: 1.01, 1.20). Similar associations were noted for pregnancies involving unmarried women with paternal data, but differences were less pronounced. CONCLUSIONS: Missing paternal data on the birth certificate is associated with perinatal risk factors for childhood obesity. Efforts to understand and reduce obesity risk factors in early life may need to consider paternal factors.Item Developing a brief assessment of social risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients(Wiley, 2023) Hausmann, Leslie R. M.; Cohen, Alicia J.; Eliacin, Johanne; Gurewich, Deborah A.; Lee, Richard E.; McCoy, Jennifer L.; Meterko, Mark; Michaels, Zachary; Moy, Ernest M.; Procario, Gregory T.; Russell, Lauren E.; Schaefer, James H., Jr.; Medicine, School of MedicineObjective: To determine whether a 6- or 12-month look-back period affected rates of reported social risks in a social risk survey for use in the Veterans Health Administration and to assess associations of social risks with overall health and mental health. Study design: Cross-sectional survey of respondents randomized to 6- or 12-month look-back period. Data sources and study setting: Online survey with a convenience sample of Veterans in June and July 2021. Data collection/extraction methods: Veteran volunteers were recruited by email to complete a survey assessing social risks, including financial strain, adult caregiving, childcare, food insecurity, housing, transportation, internet access, loneliness/isolation, stress, discrimination, and legal issues. Outcomes included self-reported overall health and mental health. Chi-squared tests compared the prevalence of reported social risks between 6- and 12-month look-back periods. Spearman correlations assessed associations among social risks. Bivariate and multivariable logistic regression models estimated associations between social risks and fair/poor overall and mental health. Principal findings: Of 3418 Veterans contacted, 1063 (31.10%) responded (87.11% male; 85.61% non-Hispanic White; median age = 70, interquartile range [IQR] = 61-74). Prevalence of most reported social risks did not significantly differ by look-back period. Most social risks were weakly intercorrelated (median |r| = 0.24, IQR = 0.16-0.31). Except for legal issues, all social risks were associated with higher odds of fair/poor overall health and mental health in bivariate models. In models containing all significant social risks from bivariate models, adult caregiving and stress remained significant predictors of overall health; food insecurity, housing, loneliness/isolation, and stress remained significant for mental health. Conclusions: Six- and 12-month look-back periods yielded similar rates of reported social risks. Although most individual social risks are associated with fair/poor overall and mental health, when examined together, only adult caregiving, stress, loneliness/isolation, food, and housing remain significant.Item Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage(American Academy of Neurology, 2017-01-17) Tormoehlen, Laura M.; Blatsioris, Ashley D.; Moser, Elizabeth A.S.; Carter, Ravan J.L.; Stevenson, Alec; Ofner, Susan; Hulin, Abigail L.; O’Neill, Darren P.; Cohen-Gadol, Aaron A.; Leipzig, Thomas J.; Williams, Linda S.; Mackey, Jason; Neurology, School of MedicineOBJECTIVE: To characterize the pattern of urine drug screening in a cohort of intracerebral hemorrhage (ICH) patients at our academic centers. METHODS: We identified cases of primary ICH occurring from 2009 to 2011 in our academic centers. Demographic data, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed logistic regression to identify predictors for screening and evaluated preguideline and postguideline reiteration screening patterns. RESULTS: We identified 610 patients with primary ICH in 2009-2011; 379 (62.1%) were initially evaluated at an outside hospital. Overall, 142/610 (23.3%) patients were screened, with 21 positive for cocaine and 3 for amphetamine. Of patients <55 years of age, only 65/140 (46.4%) were screened. Black patients <55 years of age were screened more than nonblack patients <55 years of age (38/61 [62.3%] vs 27/79 [34.2%]; p = 0.0009). In the best multivariable model, age group (p = 0.0001), black race (p = 0.4529), first Glasgow Coma Scale score (p = 0.0492), current smoking (p < 0.0001), and age group × black race (p = 0.0097) were associated with screening. Guideline reiteration in 2010 did not improve the proportion <55 years of age who were screened: 42/74 (56.8%) were screened before and 23/66 (34.9%) after (p = 0.01). CONCLUSIONS: We found disparities in drugs of abuse (DOA) screening and suboptimal guideline adherence. Systematic efforts to improve screening for DOA are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and influence decision-making and prognosis counseling.Item Health disparities in chronic liver disease(Wolters Kluwer, 2023) Kardashian, Ani; Serper, Marina; Terrault, Norah; Nephew, Lauren D.; Medicine, School of MedicineThe syndemic of hazardous alcohol consumption, opioid use, and obesity has led to important changes in liver disease epidemiology that have exacerbated health disparities. Health disparities occur when plausibly avoidable health differences are experienced by socially disadvantaged populations. Highlighting health disparities, their sources, and consequences in chronic liver disease is fundamental to improving liver health outcomes. There have been large increases in alcohol use disorder in women, racial and ethnic minorities, and those experiencing poverty in the context of poor access to alcohol treatment, leading to increasing rates of alcohol-associated liver diseases. Rising rates of NAFLD and associated fibrosis have been observed in Hispanic persons, women aged > 50, and individuals experiencing food insecurity. Access to viral hepatitis screening and linkage to treatment are suboptimal for racial and ethnic minorities and individuals who are uninsured or underinsured, resulting in greater liver-related mortality and later-stage diagnoses of HCC. Data from more diverse cohorts on autoimmune and cholestatic liver diseases are lacking, supporting the need to study the contemporary epidemiology of these disorders in greater detail. Herein, we review the existing literature on racial and ethnic, gender, and socioeconomic disparities in chronic liver diseases using a social determinants of health framework to better understand how social and structural factors cause health disparities and affect chronic liver disease outcomes. We also propose potential solutions to eliminate disparities, outlining health-policy, health-system, community, and individual solutions to promote equity and improve health outcomes.Item Moving Beyond Gender Disparities: A Call to Action for Gender Parity and Equity(Elsevier, 2022) Jarman, Angela F.; Hobgood, Cherri D.; Madsen, Tracy E.; Emergency Medicine, School of MedicineItem Race/Ethnicity Moderates Associations between Depressive Symptoms and Diet Composition among U.S. Adults(American Psychological Association, 2021) Vrany, Elizabeth A.; Polanka, Brittanny M.; Hsueh, Loretta; Hill-Briggs, Felicia; Stewart, Jesse C.; Psychology, School of ScienceObjective: Although depression is associated with poorer overall diet quality, few studies have examined its association with levels of particular macronutrients, and none have examined moderation by race/ethnicity. The present study examined (a) associations between depressive symptom severity and nine indices of diet composition and (b) whether race/ethnicity moderates these associations. Method: Participants were 28,940 adults (mean age = 49 years, 52% female, 52% nonwhite) from NHANES 2005-2018. Depressive symptom severity was measured using the Patient Health Questionnaire-9 (PHQ-9). Nine diet composition indices were derived from the average of two 24-hr dietary recalls (e.g., total energy, total fat, saturated fat, total carbohydrate, sugar, fiber, and protein). Results: Separate linear regression analyses revealed that PHQ-9 total was positively associated with saturated fat and sugar and negatively associated with protein and fiber. Moderation by race/ethnicity was observed (interaction ps < .05). Among non-Hispanic Whites, PHQ-9 total was positively associated with sugar and negatively associated with protein and fiber. Among non-Hispanic Blacks, PHQ-9 total was positively associated with total energy, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, total carbohydrate, and sugar. Among Mexican Americans, PHQ-9 was positively associated with saturated fat. Among other Hispanics, PHQ-9 total was negatively associated with fiber, protein, and total, monounsaturated, and polyunsaturated fat. Conclusions: Findings from this large, nationally representative sample demonstrate that associations between depressive symptom severity and diet composition vary by race/ethnicity. Critically, an unhealthy diet composition pattern may be one mechanism explaining the excess risk of obesity and cardiometabolic diseases in individuals with depression, especially in non-Hispanic Blacks.