Browsing by Subject "Social determinants of health"
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Item Analyzing Chlamydia and Gonorrhea Health Disparities from Health Information Systems: A Closer Examination Using Spatial Statistics and Geographical Information Systems(2022-05) Lai, Patrick T. S.; Jones, Josette; Dixon, Brian E.; Wilson, Jeffrey; Wu, Huanmei; Shih, PatrickThe emergence and development of electronic health records have contributed to an abundance of patient data that can greatly be used and analyzed to promote health outcomes and even eliminate health disparities. However, challenges exist in the data received with factors such as data inconsistencies, accuracy issues, and unstructured formatting being evident. Furthermore, the current electronic health records and clinical information systems that are present do not contain the social determinants of health that may enhance our understanding of the characteristics and mechanisms of disease risk and transmission as well as health disparities research. Linkage to external population health databases to incorporate these social determinants of health is often necessary. This study provides an opportunity to identify and analyze health disparities using geographical information systems on two important sexually transmitted diseases in chlamydia and gonorrhea using Marion County, Indiana as the geographical location of interest. Population health data from the Social Assets and Vulnerabilities Indicators community information system and electronic health record data from the Indiana Network for Patient Care will be merged to measure the distribution and variability of greatest chlamydia and gonorrhea risk and to determine where the greatest areas of health disparities exist. A series of both statistical and spatial statistical methods such as a longitudinal measurement of health disparity through the Gini index, a hot-spot and cluster analysis, and a geographically weighted regression will be conducted in this study. The outcome and broader impact of this research will contribute to enhanced surveillance and increased effective strategies in identifying the level of health disparities for sexually transmitted diseases in vulnerable localities and high-risk communities. Additionally, the findings from this study will lead to improved standardization and accuracy in data collection to facilitate subsequent studies involving multiple disparate data sources. Finally, this study will likely introduce ideas for potential social determinants of health to be incorporated into electronic health records and clinical information systems.Item Assessing psychosocial risk factors in children with Sickle Cell Disease(Springer Nature, 2025-01-18) Frey, Nicole; LaMotte, Julia E.; Bouck, Jillian R.; Fancher, Lauren; Parker, Genese T.; Carter, Allie; Jacob, Seethal A.; Pediatrics, School of MedicineBackground: Individuals with Sickle Cell Disease (SCD) are a minoritized and marginalized community that have disparate health outcomes as a result of systemic racism and disease-related stigma. The purpose of this study was to determine the psychosocial risk factors for families caring for children with SCD at a pediatric SCD center through use of the Psychosocial Assessment Tool (PAT), a validated caregiver-report screener. Methods: The PAT was administered annually during routine clinical visits and scored by the SCD Social Worker to provide tailored resources to families. The PAT stratifies scores into 3 categories of psychosocial concern: Universal, Targeted, Clinical. PATs administered between September 2021-December 2022 were analyzed. Results: Two hundred twenty-five PATs were included for analysis. Most caregivers identified as Black, single Women over 21 years old with a high school degree or more. The average patient age was 8.2 years (0-22 years). Sixty-seven percent of PATs fell into the Universal category. Dyads that scored in the Targeted or Clinical categories were more likely to report financial hardship, caregiver mental health concerns, and family stressors (p < 0.001). Nearly 50% of all families reported some form of financial difficulty, including almost 40% in the Universal category. Conclusions: Universal implementation of a psychosocial risk screener identified financial challenges for many families, as well as caregiver burden and mental health concerns, allowing for timely resource support. However, overall risk for many of these families was categorized as Universal or low risk, indicating that distribution of resources and support cannot be based on PAT category alone.Item Association Between Parental Education Level & Outcomes for Children with Long-Term Ventilator Dependence: Communication Behaviors as Moderating Variables(Elsevier, 2024) Hornberger, Sydney R.; Zhang, Yin; Zhang, Nanhua; Giambra, Barbara K.; Medicine, School of MedicinePurpose: The purpose of this study was to examine the correlation between parental education level and outcomes for children with long-term ventilator dependence (LTVD) and their families and whether parent communication behaviors with hospital nurses moderated the relationship. Advances in medical technology and policy changes allow children with LTVD to be cared for at home. The child's diagnosis and disease severity affect their health outcomes, as do their family's social determinants of health (SDoH) such as parent education. Design and methods: This secondary data analysis used chi-square tests to evaluate the correlation between parental education level and outcomes. Generalized linear mixed effect models were used to examine the moderation effect of parent communication behaviors. Results: Lower parental education level was associated with more child respiratory infections and more parental uncertainty within one month following hospital discharge. Lower parent education level was also associated with fewer unplanned contacts with providers within one week post-discharge. Additionally, parent use of Verifying Understanding communication behaviors moderated the relationship between parental education level and number of respiratory infections and amount of parental uncertainty. Finally, parent use of Negotiating Roles moderated the association between education level and number of unplanned visits. Conclusions: Contradicting previous research, lower parental education level does not consistently correspond to adverse outcomes and may be explained by parents' determination to ensure optimal outcomes for their children with LTVD. Practice implications: Overall, healthcare providers should not be concerned that children with LTVD will have different outcomes based on their parents' education level.Item Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement(Elsevier, 2024) Bolakale-Rufai, Ikeoluwapo Kendra; Shinnerl, Alexander; Knapp, Shannon M.; Johnson, Amber E.; Mohammed, Selma; Brewer, LaPrincess; Torabi, Asad; Addison, Daniel; Mazimba, Sula; Breathett, Khadijah; Medicine, School of MedicineBackground: Transcatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis. Methods and results: Using Optum's de-identified Clinformatics Data Mart Database (CDM), we identified admissions for TAVR with aortic stenosis between January 2018 and March 2022. Admission urgency was identified by CDM claims codes. SVI was cross-referenced to patient zip codes and grouped into quintiles. Generalized linear mixed effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient and hospital-level covariates. Results: Among 6680 admissions for TAVR [median age 80 years (interquartile range 75-85), 43.9 % female], 8.5 % (n = 567) were classified as urgent. After adjusting for patient and hospital-level variables, there were no significant differences in the odds of urgent admission for TAVR according to SVI quintiles [OR 5th (greatest social vulnerability) vs 1st quintile (least social vulnerability): 1.29 (95 % CI: 0.90-1.85)]. Conclusions: Among commercial or Medicare beneficiaries with aortic stenosis, SVI was not associated with admission urgency for TAVR. To clarify whether cardiovascular care delivery is improved across SVI with higher paying beneficiaries, future investigation should identify whether relationships between SVI and TAVR urgency vary for Medicaid beneficiaries compared to commercial beneficiaries.Item Associations of the Neighborhood Built Environment with Gestational Weight Gain(Thieme, 2023) Grobman, William A.; Crenshaw, Emma G.; Marsh, Derek J.; McNeil, Rebecca B.; Pemberton, Victoria L.; Haas, David M.; Debbink, Michelle; Mercer, Brian M.; Parry, Samuel; Reddy, Uma; Saade, George; Simhan, Hyagriv; Mukhtar, Farhana; Wing, Deborah A.; Kershaw, Kiarri N.; NICHD nuMoM2b NHLBI nuMoM2b Heart Health Study Networks; Obstetrics and Gynecology, School of MedicineObjective: This study aimed to determine whether specific factors of the built environment related to physical activity and diet are associated with inadequate and excessive gestational weight gain (GWG). Study design: This analysis is based on data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be, a prospective cohort of nulliparous women who were followed from the beginning of their pregnancies through delivery. At each study visit, home addresses were recorded and geocoded. Locations were linked to several built-environment characteristics such as the census tract National Walkability Score (the 2010 Walkability Index) and the number of gyms, parks, and grocery stores within a 3-km radius of residential address. The primary outcome of GWG (calculated as the difference between prepregnancy weight and weight at delivery) was categorized as inadequate, appropriate, or excessive based on weight gained per week of gestation. Multinomial regression (generalized logit) models evaluated the relationship between each factor in the built environment and excessive or inadequate GWG. Results: Of the 8,182 women in the analytic sample, 5,819 (71.1%) had excessive GWG, 1,426 (17.4%) had appropriate GWG, and 937 (11.5%) had inadequate GWG. For the majority of variables examined, built environments more conducive to physical activity and healthful food availability were associated with a lower odds of excessive or inadequate GWG category. For example, a higher number of gyms or parks within 3 km of a participant's residential address was associated with lower odds of having excessive (gyms: adjusted odds ratio [aOR] = 0.93 [0.89-0.96], parks: 0.94 [0.90-0.98]) or inadequate GWG (gyms: 0.91 [0.86-0.96]; parks: 0.91 [0.86-0.97]). Similarly, a higher number of grocery stores was associated with lower odds of having excessive GWG (0.94 [0.91-0.97]). Conclusion: Among a diverse population of nulliparous women, multiple aspects of the built environment are associated with excessive and inadequate GWG.Item Breast Cancer Patients’ Insurance Status and Residence Zip Code Correlates with Early Discontinuation of Endocrine Therapy: Analysis of ECOG-ACRIN TAILORx Trial(Wiley, 2021) Sadigh, Gelareh; Gray, Robert J.; Sparano, Joseph A.; Yanez, Betina; Garcia, Sofia F.; Timsina, Lava R.; Sledge, George W.; Cella, David; Wagner, Lynne I.; Carlos, Ruth C.; Surgery, School of MedicineBackground: Early discontinuation is a substantial barrier to the delivery of endocrine therapies (ETs) and may influence recurrence and survival. The authors investigated the association between early discontinuation of ET and social determinants of health, including insurance coverage and the neighborhood deprivation index (NDI), which was measured on the basis of patients' zip codes, in breast cancer. Methods: In this retrospective analysis of a prospective randomized clinical trial (Trial Assigning Individualized Options for Treatment), women with hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer who started ET within a year of study entry were included. Early discontinuation was calculated as stopping ET within 4 years of its start for reasons other than distant recurrence or death via Kaplan-Meier estimates. A Cox proportional hazards joint model was used to analyze the association between early discontinuation of ET and factors such as the study-entry insurance and NDI, with adjustments made for other variables. Results: Of the included 9475 women (mean age, 55.6 years; White race, 84%), 58.0% had private insurance, whereas 11.7% had Medicare, 5.8% had Medicaid, 3.8% were self-pay, and 19.1% were treated at international sites. The early discontinuation rate was 12.3%. Compared with those with private insurance, patients with Medicaid (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.23-1.92) and self-pay patients (HR, 1.65; 95% CI, 1.25-2.17) had higher early discontinuation. Participants with a first-quartile NDI (highest deprivation) had a higher probability of discontinuation than those with a fourth-quartile NDI (lowest deprivation; HR, 1.34; 95% CI, 1.11-1.62). Conclusions: Patients' insurance and zip code at study entry play roles in adherence to ET, with uninsured and underinsured patients having a high rate of treatment nonadherence. Early identification of patients at risk may improve adherence to therapy. Lay summary: In this retrospective analysis of 9475 women with breast cancer participating in a clinical trial (Trial Assigning Individualized Options for Treatment), Medicaid and self-pay patients (compared with those with private insurance) and those in the highest quartile of neighborhood deprivation scores (compared with those in the lowest quartile) had a higher probability of early discontinuation of endocrine therapy. These social determinants of health assume larger importance with the expected increase in unemployment rates and loss of insurance coverage in the aftermath of the coronavirus disease 2019 pandemic. Early identification of patients at risk and enrollment in insurance optimization programs may improve the persistence of therapy.Item Cardiometabolic health after first pregnancy: Associations with social determinants of health. A nuMoM2b-HHS study(Elsevier, 2022) Bello, N. A.; Moore, J.; Miller, E. C.; Tom, S. E.; Bairey Merz, C. N.; Haas, D. M.; Ferries-Rowe, E. A.; Grobman, W. A.; Greenland, P.; Khan, S. S.; Kim, J. K.; Chung, J. H.; Huynh, P. L. L.; Varagic, J.; McNeil, R. B.; Parker, C. B.; Wapner, R.; NICHD nuMoM2b; NHLBI nuMoM2b Heart Health Study Networks; Obstetrics and Gynecology, School of MedicineStudy objective: This study sought to evaluate the associations between social determinants of health (SDOH) at the time of first pregnancy and subsequent cardiometabolic health, defined as the development of metabolic syndrome. Design: nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study- Monitoring Mothers-to-Be-Heart Health Study) is an ongoing prospective cohort study. Setting: Eight academic medical centers enrolled and continue to follow participants. Participants: 4484 participants followed a mean of 3.2 years from the time of their first pregnancy. Interventions: N/a. Main outcome measure: Unadjusted and adjusted Poisson regression models with robust standard errors were used to obtain relative risks and 95% confidence intervals estimating the risk of metabolic syndrome for each baseline SDOH. In secondary analyses we examined the associations between SDOH and incident hypertension, obesity, and diabetes mellitus. Results: Metabolic syndrome developed in 13.6% of participants. Higher socioeconomic position at the time of pregnancy was associated with lower rates of metabolic syndrome [income > 200% poverty level aRR 0.55 (95% CI, 0.42-0.71), attainment of a bachelor's degree aRR 0.62 (0.46-0.84) or higher aRR 0.50 (0.35-0.71)], while being single [aRR 1.45 (95% CI, 1.18-1.77)] and having low health literacy were associated with a greater risk of metabolic syndrome [aRR 1.98 (95% CI, 1.28-3.07)]. Conclusions: Over a short interval following first pregnancy, participants accumulated high proportions of cardiovascular risk factors and metabolic syndrome, with some risk associated with SDOH. The impact of interventions addressing SDOH in pregnant people on cardiometabolic health should be tested as a means of reducing health inequities at the population level.Item Catalyzing Restructure of a Broken Healthcare System(American Heart Association, 2024) Breathett, Khadijah; Manning, Kimberly D.; Medicine, School of MedicineItem Correction: Taking action to advance the study of race and ethnicity: the Women’s Health Initiative (WHI)(Springer Nature, 2022-11-25) Garcia, Lorena; Follis, Shawna; Thomson, Cynthia A.; Breathett, Khadijah; Wiley Cené, Crystal; Jimenez, Monik; Kooperberg, Charles; Masaki, Kamal; Paskett, Electra D.; Pettinger, Mary; Aragaki, Aaron; Dilworth‑Anderson, Peggye; Stefanick, Marcia L.; Medicine, School of MedicineCorrection: Women’s Midlife Health 8, 1 (2021) https://doi.org/10.1186/s40695-021-00071-6Item Creation of the American Heart Association Journals Equity, Diversity, and Inclusion Editorial Board: Next Step to Achieving 2024 Impact Goal(American Heart Association, 2022) Lewis, Eldrin F.; Beatty, Christine; Boltze, Johannes; Breathett, Khadijah; Clair, Walter K.; de las Fuentes, Lisa; Essien, Utibe R.; Goodell, Heather; Hinson, H. E.; Kershaw, Kiarri N.; Knowles, Joshua W.; Mazimba, Sula; Mujahid, Mahasin; Okafor, Henry E.; Park, Kyung Woo; Schultz, Jonathan; Medicine, School of Medicine