Browsing by Subject "Socioeconomic status"

Now showing 1 - 7 of 7
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    Association of Socioeconomic Status With Relapse After Ponseti Method Treatment of Idiopathic Clubfeet
    (Sage, 2022-08-26) Akinyoola, Lawrence A.; Gunderson, Zachary; Sun, Seungyup; Fitzgerald, Ryan; Caltoum, Christine B.; Christman, Tyler W.; Bielski, Robert; Loder, Randall T.; Medicine, School of Medicine
    Background: The Ponseti method is today's standard treatment of idiopathic talipes equinovarus (ITEV). Compliance with foot abduction bracing (FABO) and socioeconomic factors have been shown to impact treatment outcome. We wished to further study socioeconomic factors using the Area Deprivation Index (ADI), a more comprehensive way to evaluate socioeconomic status, which has not been done before. Methods: All TEV patients from 2010 through 2019 treated with the Ponseti method were reviewed. Standard demographic variables, as well as the number of casts to complete initial correction, FABO compliance, and occurrence of relapse were tabulated. Socioeconomic level was quantified with the 2018 ADI. Results: There were 168 children; 151 had typical and 17 complex TEV. Average follow-up was 4.3 ± 1.8 years; relapse occurred in 46%. There were no significant differences in the percentage of relapse by sex, race, or ADI. FABO noncompliance was present in 46%. Relapse increased with increasing time of follow-up and FABO noncompliance (76% vs 21%, P < 10-6). Multivariate logistic regression analysis revealed that only FABO compliance and length of follow-up were associated with relapse. The OR of relapse for FABO noncompliance was 17.9 (7.6, 42.4, P < 10-6) and for follow-up >4 years the OR was 4.97 (2.1, 11.70, P = .0003). Conclusion: The outcome of the Ponseti method for TEV treatment is dependent on local circumstances. In our state, socioeconomic status, as determined by the ADI, was not associated with the occurrence of relapse. Thus, each center needs to assess its results, and analyze its own reasons for relapse. There were no other demographic variables associated with relapse except FABO compliance and length of follow-up. Parents should be strongly advised that FABO compliance and follow-up appears paramount to achieving the best results, and that complex TEV are at greater risk for relapse.
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    The Influence of Patient Race and Socioeconomic Status on Providers' Assessment and Treatment Recommendations for Chronic Pain
    (2019-05) Anastas, Tracy; Adam, Hirsh; Stewart, Jesse; Rand, Kevin
    Compared to White and high socioeconomic (SES) patients, Black and low SES patients are less likely to receive adequate pain care, including receiving fewer analgesic medications. Providers may, inadvertently or not, contribute to these disparities in pain care via biased decision-making. Prior work suggests there is a complex relationship in which race and SES uniquely and interactively affect providers’ clinical decisions, but few studies have examined the influence of patient race and SES simultaneously on providers’ pain-related decisions. Furthermore, previous studies suggest that providers’ attitudes about race and SES influence their clinical decisions. The present study examined the influence of patient race and SES and providers’ implicit and explicit attitudes about race and SES on providers' pain-related decisions. Four hundred and seven medical residents and fellows made pain assessment (interference and distress) and treatment (opioids, opioid contracts, and workplace accommodations) decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Subjects completed Implicit Association Tests to assess implicit attitudes and feeling thermometers to assess explicit attitudes about race and SES. Repeated measures ANOVAs indicated that patient race and/or SES had main effects on all pain-related decisions and had interaction effects on providers’ ratings for interference, distress, and workplace accommodations. Providers’ implicit attitudes about race and explicit attitudes about race and SES predicted their pain-related decisions, but these effects were not consistent across all decisions. The current study highlights the need to examine the effects of patient race and SES together, along with providers’ implicit and explicit attitudes, in the context of pain care. Results inform future work that can lead to the development of evidence-based interventions to reduce disparities in pain care.
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    Stress and Alcohol Intake among Hispanic Adult Immigrants in the U.S. Midwest
    (MDPI, 2022-12-04) Rodriguez, Jacqueline; Golzarri-Arroyo, Lilian; Rodriguez, Cindy; Maupomé, Gerardo
    Alcohol intake and Alcohol Use Disorder (AUD) among recent and very recent Hispanic immigrants are not well characterized, in particular in the context of perceived stress among such groups. The objective of the present study was to shed light on alcohol intake and AUD overall, as well as potential modifications derived from varying levels of stress and socioeconomic status (SES). The study population was immigrants with six or fewer months of having arrived in the American Midwest, and members of their peer networks who had been in the U.S. for 2+ years. We found that AUD and alcohol intake spanned from very high to a considerable proportion who abstained; perceived stress did not have an obvious impact on AUD or alcohol intake. Moreover, neither New vs. Established immigrant statuses, or SES levels, were associated with AUD or alcohol intake. Future research should examine in a more finely-grained approach the components of SES to verify if the complex circumstances of recent immigrants are in fact amenable to SES classification using standard quantification approaches—even using the functional descriptions of the SES surrogates we used.
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    The Association Between Socioeconomic Status, Sex, Race / Ethnicity and In-Hospital Mortality Among Patients Hospitalized for Heart Failure
    (Elsevier, 2022) Averbuch, T.; Mohamed, M. O.; Islam, S.; DeFilippis, E. M.; Breathett, K.; Alkhouli, M. A.; Michos, E. D.; Martin, G. P.; Kontopantelis, E.; Mamas, M. A.; Van Spall, H. G. C.; Medicine, School of Medicine
    Background: The association between socioeconomic status (SES), sex, race / ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated. Methods and results: We analyzed HF hospitalizations in the United States National Inpatient Sample between 2015 and 2017. Using a hierarchical, multivariable Poisson regression model to adjust for hospital- and patient-level factors, we assessed the association between SES, sex, and race / ethnicity and all-cause in-hospital mortality. We estimated the direct costs (USD) across SES groups. Among 4,287,478 HF hospitalizations, 40.8% were in high SES, 48.7% in female, and 70.0% in White patients. Relative to these comparators, low SES (homelessness or lowest quartile of median neighborhood income) (relative risk [RR] 1.02, 95% confidence interval [CI] 1.00-1.05) and male sex (RR 1.09, 95% CI 1.07-1.11) were associated with increased risk, whereas Black (RR 0.79, 95% CI 0.76-0.81) and Hispanic (RR 0.90, 95% CI 0.86-0.93) race / ethnicity were associated with a decreased risk of in-hospital mortality (5.1% of all hospitalizations). There were significant interactions between race / ethnicity and both, SES (P < .01) and sex (P = .04), such that racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients. The median direct cost of admission was lower in low vs high SES groups ($9324.60 vs $10,940.40), female vs male patients ($9866.60 vs $10,217.10), and Black vs White patients ($9077.20 vs $10,019.80). The median costs increased with SES in all demographic groups primarily related to greater procedural utilization. Conclusions: SES, sex, and race / ethnicity were independently associated with in-hospital mortality during HF hospitalization, highlighting possible care disparities. Racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients.
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    The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center: A Retrospective Cohort Analysis
    (Wolters Kluwer, 2021) Powers, Benjamin D.; Fulp, William; Dhahri, Amina; DePeralta, Danielle K.; Ogami, Takuya; Rothermel, Luke; Permuth, Jennifer B.; Vadaparampil, Susan T.; Kim, Joon-Kyung; Pimiento, Jose; Hodul, Pamela J.; Malafa, Mokenge P.; Anaya, Daniel A.; Fleming, Jason B.; Surgery, School of Medicine
    Objective: To assess the impact of a granular measure of SED on pancreatic surgical and cancer-related outcomes at a high-volume cancer center that employs a standardized clinic pathway. Summary of background data: Prior research has shown that low socioeconomic status leads to less treatment and worse outcomes for PDAC. However, these studies employed inconsistent definitions and categorizations of socioeconomic status, aggregated individual socioeconomic data using large geographic areas, and lacked detailed clinicopathologic variables. Methods: We conducted a retrospective cohort study of 1552 PDAC patients between 2008 and 2015. Patients were stratified using the area deprivation index, a validated dataset that ranks census block groups based on SED. Multivariable models were used in the curative surgery cohort to predict the impact of SED on (1) grade 3/4 Clavien-Dindo complications, (2) initiation of adjuvant therapy, (3) completion of adjuvant therapy, and (4) overall survival. Results: Patients from high SED neighborhoods constituted 29.9% of the cohort. Median overall survival was 28 months. The rate of Clavien-Dindo grade 3/4 complications was 14.2% and completion of adjuvant therapy was 65.6%. There was no evidence that SED impacted surgical evaluation, receipt of curative-intent surgery, postoperative complications, receipt of adjuvant therapy or overall survival. Conclusions: Although nearly one-quarter of curative-intent surgery patients were from high SED neighborhoods, this factor was not associated with measures of treatment quality or survival. These observations suggest that treatment at a high-volume cancer center employing a standardized clinical pathway may in part address socioeconomic disparities in pancreatic cancer.
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    Understanding online K-12 students through a demographic study
    (Contact Nord, 2014-12) Corry, Michael; Dardick, William; Ianacone, Robert; Stella, Julie; Technology and Leadership Communication, School of Engineering and Technology
    Online K-12 learning opportunities have proliferated, but much remains to be understood about the characteristics of participating students. This study presents a demographic profile of fulltime, K-12 online learners today and compares them with public school students nationwide in the United States. The data was collected from a parent survey that produced 119,155 valid responses/records for students enrolled full-time in online K-12 public schools in 43 states. The study shows that the online student population includes somewhat more females than males, and more middle school than elementary or high school students. White students are overrepresented among full-time online learners compared with their share of the nationwide student population, while Hispanic/Latino and Asian/Pacific Islander students are underrepresented. Gifted and talented students and English language learners (ELLs) are also underrepresented. These data provide a baseline for more detailed explorations and can assist practitioners, policy makers, and researchers in making important decisions about online education that have implications for all students.
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    The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions
    (Oxford University Press, 2020-10-01) Anastas, Tracy M.; Miller, Megan M.; Hollingshead, Nicole A.; Stewart, Jesse C.; Rand, Kevin L.; Hirsh, Adam T.; Psychology, School of Science
    Background: Compared to White and high socioeconomic status (SES) patients, Black and low SES patients receive less adequate pain care. Providers may contribute to these disparities by making biased decisions that are driven, in part, by their attitudes about race and SES. Purpose: We examined the effects of patient race and SES on providers' chronic pain decisions and the extent to which providers' implicit and explicit attitudes about race and SES were related to these decisions. Methods: Physician residents/fellows (n = 436) made pain care decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Physicians also completed measures assessing implicit and explicit attitudes about race and SES. Results: There were three significant race-by-SES interactions: (a) For high SES patients, Black (vs. White) patients were rated as having more pain interference; the opposite race difference emerged for low SES patients. (b) For high SES patients, Black (vs. White) patients were rated as being in greater distress; no race difference emerged for low SES patients. (c) For low SES patients, White (vs. Black) patients were more likely to be recommended workplace accommodations; no race difference emerged for high SES patients. Additionally, providers were more likely to recommend opioids to Black (vs. White) and low (vs. high) SES patients, and were more likely to use opioid contracts with low (vs. high) SES patients. Providers' implicit and explicit attitudes predicted some, but not all, of their pain-related ratings. Conclusion: These results highlight the need to further examine the effects of patient race and SES simultaneously in the context of pain care.