An Improved Measure for Exploring Sociospatial Inequalities in Access to Online Fresh Food

This study aims to compare racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients and non-health center patients. Data for the study came from the 2002 Community Health Center User Survey and the 2003 National Healthcare Disparities Report. Descriptive analysis was performed using nationally representative survey data pertaining to access to care and quality of care for people of different races, ethnicities, incomes, and education levels. Results of the study show that health center patients experience fewer racial/ethnic and socioeconomic disparities in access to care and quality of care, compared with non-health center patients nationally. Racial/ethnic disparities favoring whites occur in non-health center patients in every measure of quality and access included in this study. Conversely, there are few disparities favoring whites among health center users. Education and income-related disparities occur for several measures of access and quality in both health center and non-health center patients; however, the magnitude of these disparities is usually greater among non-health center patients compared with health center patients. In conclusion, health centers have been touted for cost-efficient, high-quality care. This study adds to growing evidence that health centers may also help eliminate racial/ethnic and socioeconomic disparities in access to care and quality of care.

Purpose: The purpose of this study was to use data collected from a recent Metropolitan Chicago Breast Cancer Task Force (MCBCTF) survey to explore racial/ethnic and socioeconomic disparities in access to screening and diagnostic services for breast cancer in Illinois and to compare equitable access to services for Chicago versus the rest of the state. Methods: Facilities that performed mammography were recruited to participate in a quality improvement project that included completing a facility survey. Participants who completed surveys received an increased mammogram reimbursement for Medicaid patients to equal the Medicare rate from the Illinois Department of Healthcare and Family Service. The survey included the following data elements: number of digital and analog machines, number of radiologists dedicated (>75% of their time) to breast imaging and number of general radiologists, number of dedicated and general mammography technicians, monthly volumes of screening and diagnostic mammograms, and whether breast ultrasound, MRI, or image-guided biopsy services were available at the site. In addition, sites reported the percentage of patients who were African-American (AA) or Hispanic, and the percentage of patients who were uninsured and on Medicaid, in categories of >10, 10-25, 25-40, 40-60, 60-75, 75-90, and >90%. Within each patient group defined by ethnicity and health insurance status, we estimated the number of screening mammograms performed separately for facilities with none, partial and sole reliance on dedicated radiologists, and separately by facility availability of breast MRI and image-guided biopsy. In all, 156 out of 359 facilities accredited by the Food and Drug Administration completed the survey, representing approximately 8.2 million screening mammograms conducted in calendar year 2012 in Illinois. Results: Overall, about 3/4 of screening mammograms were performed in nH whites and 4/5 in privately insured patients. Within the city of Chicago, 47% and 30% were performed in ethnic minorities and those without private insurance, compared to 21% and 15% in the rest of the state. Within Chicago, mammograms were more than twice as likely to be performed at facilities relying solely on dedicated radiologists when compared to the rest of the state (39% vs. 17%). In Chicago, non-Hipanic Whites were more likely than their AA and Hispanic counterparts to be screened at facilities relying solely on dedicated radiologists (50% vs. 27% and 15%, respectively) and at facilities with MRI (90% vs. 57% and 71%) and biopsy services (92% vs. 63% and 79%). In a similar manner, privately insured patients were more likely than Medicaid and uninsured patients to be screened at facilities that relied solely on dedicated radiologists (44% vs. 13% and 18%, respectively). When examining equitable access to these services for the rest of the state as a whole, very little was noted in the way of disparities by race/ethnicity or insurance status. Conclusions: Disparities in equitable access to breast cancer screening and diagnostic services exist within Chicago that are generally absent outside of the city. The concentration of academic medical centers within Chicago, while increasing access to quality breast healthcare, has also introduced racial/ethnic and socioeconomic disparities due to unequal access to these academic medical centers. Citation Format: Bethliz Irizarry, Katherine Y. Tossas-Milligan, Garth Rauscher, Anne Marie Murphy. Racial/ethnic and socioeconomic disparities in access to screening mammograms in a statewide sample of mammography facilities in Illinois. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B84.

IntroductionMedication use during pregnancy is common, and socioeconomic disparities in access may contribute to maternal and fetal health inequalities. This study examines socioeconomic disparities in access to and expenditure on medications dispensed through Australia’s Pharmaceutical Benefits Scheme (PBS), evaluating its role in promoting equal access to medications for pregnant women.MethodsWe analysed the Maternity1000 linked administrative dataset, which includes data on 57 443 women who gave birth in Queensland, Australia, between 1 July 2017 and 30 June 2018. Socioeconomic quintiles were assigned using the Index of Relative Socioeconomic Disadvantage. Medication prevalence rates, usage proportions and costs (2022/2023 Australian dollar) were calculated, followed by concentration curves and indices to assess inequality.ResultsMedication prevalence was higher among more disadvantaged women (Q1 (most disadvantaged): 67% vs Q5 (least disadvantaged): 60%), who were also dispensed a higher average number of medications per pregnancy (Q1: 2.8 (95% CI 2.7 to 2.9) vs Q5: 2.4 (95% CI 2.3 to 2.5)). However, the total medication cost (patient contribution amount plus public subsidy) was, on average, lower for these women (Q1: $45 (95% CI 43 to 46) vs Q5: $52 (95% CI 50 to 54)), indicating potential disparities in access to newer, higher cost treatments. The unadjusted concentration index suggested mild pro-poor inequality in access (CI=−0.031; p<0.001), which was attenuated and statistically insignificant after adjusting for maternal demographic and clinical characteristics (CINA=−0.007; p=0.089). Government expenditure on medications showed no significant socioeconomic inequality (unadjusted CI=0.001; p=0.965).ConclusionThe PBS facilitates equitable access to publicly funded medications for pregnant women. However, the uniform distribution of public funds across socioeconomic groups suggests possible limitations in progressivity, as public subsidies are not disproportionately benefiting the most disadvantaged women overall. This may reflect missed opportunities to distribute public funds more effectively and efficiently, particularly if disadvantaged women are under-represented in access to newer, higher cost therapies, and warrants ongoing evaluation.

BackgroundType 1 diabetes is a complex chronic condition which requires lifelong treatment with insulin. Health outcomes are dependent on ability to self-manage the condition. Socioeconomic inequalities have been demonstrated in access to treatment and health outcomes for adults with type 1 diabetes; however, there is a paucity of research exploring how these disparities occur. This study explores the influence of socioeconomic factors in gaining access to intensive insulin regimens for adults with type 1 diabetes.MethodsWe undertook a qualitative descriptive study informed by a phenomenological perspective. In-depth face-to-face interviews were conducted with 28 patients and 6 healthcare professionals involved in their care. The interviews were analysed using a thematic approach. The Candidacy theory for access to healthcare for vulnerable groups framed the analysis.ResultsAccess to intensive insulin regimens was through hospital-based specialist services in this sample. Patients from lower socioeconomic groups had difficulty accessing hospital-based services if they were in low paid work and because they lacked the ability to navigate the healthcare system. Once these patients were in the specialist system, access to intensive insulin regimens was limited by non-alignment with healthcare professional goals, poor health literacy, psychosocial problems and poor quality communication. These factors could also affect access to structured diabetes education which itself improved access to intensive insulin regimens. Contact with diabetes specialist nurses and attendance at structured diabetes education courses could ameliorate these barriers.ConclusionsAccess to intensive insulin regimens was hindered for people in lower socioeconomic groups by a complex mix of factors relating to the permeability of specialist services, ability to navigate the healthcare system and patient interactions with healthcare providers. Improving access to diabetes specialist nurses and structured diabetes education for vulnerable patients could lessen socioeconomic disparities in both access to services and health outcomes.

Socioeconomic disparities in access to care coordination have been noted among children with special health care needs (CSHCN). Following recent policy developments and technological innovation, care coordination has become more widespread, possibly leading to reduced disparity in care coordination access. This study investigates whether child and household characteristics remain associated with unmet need for care coordination among CSHCN. CSHCN (aged <18 years) requiring ≥2 types of health services in the past year were identified in the 2016 National Survey of Children's Health (NSCH). Care coordination was defined as help with arranging the child's care among different doctors or services. Children were classified as not needing care coordination, receiving sufficient care coordination (met need), or needing but not receiving care coordination (unmet need). Weighted multinomial logistic regression examined the association of child characteristics with this outcome. The analysis included 5622 children with no need for care coordination, 1466 with a met need, and 980 with unmet needs. Children with mental health conditions were more likely to have unmet rather than met needs for care coordination (odds ratio = 4.1; 95% confidence interval: 2.7, 6.1; P < 0.001). After multivariable adjustment, race/ethnicity, income, family structure, insurance coverage, place of birth, and use of English in the home were not associated with having unmet rather than met needs for care coordination. Among CSHCN, the latest data from NSCH reveal no evidence of previously described socioeconomic disparities in access to care coordination. Nevertheless, unmet needs for care coordination remain prevalent, especially among children with mental health conditions.

Socio-economic disparities in access to assisted reproductive technologies in Australia

Background: Disparities in preventive healthcare access remain a persistent public health concern in the United States. Objective: This study examined racial and socioeconomic differences in routine healthcare utilization and cholesterol screening among U.S. adults from 2009 to 2018, using data from the National Health and Nutrition Examination Survey (NHANES). Methods: A complete-case analysis was conducted on 7,010 adults (unweighted sample). Survey weights were applied to generate nationally representative estimates of approximately 68.2 million adults. Weighted descriptive statistics and survey-adjusted F- and t-tests compared sociodemographic characteristics by healthcare utilization. Multivariable logistic regression models estimated associations between race/ethnicity, socioeconomic status, and preventive care outcomes, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Having insurance (OR: 2.98; 95% CI: 2.30–3.87) and female sex (OR: 2.16; 95% CI: 1.75–2.68) were strong predictors of having a usual place for care. Cholesterol screening within the past year was associated with insurance (OR: 2.18; 95% CI: 1.73–2.75), older age, higher income-to-poverty ratio, and female sex. Non-Hispanic White adults were less likely than Mexican Americans to receive cholesterol screening (OR: 0.76; 95% CI: 0.63–0.93). Conclusion: Persistent disparities in preventive healthcare utilization by race and socioeconomic status underscore the need for targeted policies to improve equity in access and outcomes.

Living kidney transplant is the most effective renal replacement therapy for patients with end-stage kidney disease. Community-level factors contribute to pervasive socioeconomic and racial disparities in access to living donor kidney transplantation. Little is known about social and environmental conditions between living donors and recipients. Further understanding of these relationships may enhance opportunities for transplantation. From 2010 to 2020, 59 575 living kidney donor-recipient pairs (≥18 y old) were identified using the Scientific Registry of Transplant Recipients. Living donors and recipients were geocoded to area-level social deprivation index (SDI). The primary outcome was difference between recipient and donor SDI. We used multivariable logistic regression to examine recipient and donor characteristics association with residence in different SDI communities. Living kidney donation occurs across all strata of social deprivation; including when donors, recipients or both reside in more disadvantaged communities. Donor-recipient race combination and biological relationship are associated with differences in SDI. When compared with White recipients of White donors, Black and Hispanic recipients were more likely to reside in more disadvantaged areas (odds ratio = 2.41 [2.19-2.66] and 1.97 [1.78-2.19]). Recipients in anonymous and paired donations were more likely to reside in areas of more disadvantage than their donors (odds ratio = 1.27 [1.15-1.40] and 1.32 [1.23-1.41] compared with biological); attenuating socioeconomic disparities in access to living donor transplantation. Findings illustrate the social and environmental relationships between living kidney donor-recipient pairs that are important to develop targeted approaches and address barriers to living kidney transplantation. Best practices from areas of high deprivation with successful living kidney transplantation can be shared.

Evidence of Geospatial and Socioeconomic Disparities in Access to Online Grocery Shopping for Fresh and Frozen Produce in North Carolina

Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19

The purpose of this study was to examine racial and socioeconomic disparities in access to primary care among people with chronic conditions. Data for this study were taken from the household component of the 2010 Medical Expenditure Panel Survey. The analysis primarily focused on adults ≥ 18 years old. Logistic regressions were conducted among people with chronic conditions to compare primary care attributes between each minority group and their non-Hispanic white counterparts and between individuals with high, above average, or below average socioeconomic status and their low socioeconomic status counterparts, controlling for other individual factors. Racial disparities were found in having usual source of care (USC), USC provider type, and USC location. However, no disparities were found in ease of contacting or getting to USC as well as the services received. Furthermore, very limited socioeconomic disparities were found after controlling for other individual characteristics, in particular race and insurance status. More efforts need to be devoted to racial/ethnic minorities with chronic conditions to improve their access to continuous and high-quality primary care.

Significant socio-economic disparities have been reported in survival from colorectal cancer in a number of countries, which remain largely unexplained. We assessed whether possible differences in access to treatment among socio-economic groups may contribute to those disparities, using a population-based approach. We retrospectively studied 71 917 records of colorectal cancer patients, diagnosed between 1997 and 2000, linked to area-level socio-economic information (Townsend index), from three cancer registries in UK. Access to treatment was measured as a function of delay in receipt of treatment. We assessed socio-economic differences in access through logistic regression models. Based on relative survival < or =3 years after diagnosis, we estimated excess hazard ratios (EHRs) of death for different socio-economic groups. Compared with more affluent patients, deprived patients had poorer survival [EHR = 1.20; 95% confidence interval (CI) 1.16-1.25], were less likely to receive any treatment within 6 months [odds ratio (OR) = 0.87, 95% CI 0.82-0.92] and, if treated, were more likely to receive late treatment. No disparities in survival were detected among patients receiving treatment within 1 month from diagnosis. Disparities existed among patients receiving later or no treatment (EHR = 1.30; 95% CI 1.22-1.39), and persisted after adjustment for age and stage at diagnosis (EHR = 1.15; 95% CI 1.08-1.24). Tumour stage helped explain socio-economic disparities in colorectal cancer survival. Disparities were also greatly attenuated among patients receiving early treatment. Aspects other than those captured by our measure of access, such as quality of care and patient preferences in relation to treatment, might contribute to a fuller explanation.

Socioeconomic Disparities in Access for Watchman Device Insertion in Patients with Atrial Fibrillation and at Elevated Risk of Bleeding

The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.

e16337 Background: HCC is a leading indication for liver transplantation (LT) and a major contributor to cancer-related mortality worldwide. Access to LT is often shaped by social determinants of health, including insurance status, employment, and geographic region, which can impact waitlist duration and post-transplant survival. Methods: We retrospectively analyzed 20,492 adult patients with HCC listed for LT in the United Network for Organ Sharing (UNOS) database. Socioeconomic variables assessed at registration included highest education level, employment status, and primary payer type (public vs. private insurance). We used multivariable logistic regression, adjusted for clinical covariates, to examine associations between these factors and (1) waitlist duration and (2) post-transplant survival. Results: Patients with public insurance had longer median wait times (7.9 vs. 7.2 months, p &lt; 0.01) and shorter post-transplant survival (37.3 vs. 44.9 months, p &lt; 0.01) compared with those with private insurance. Male sex was independently associated with worse survival (HR 1.15, 95% CI 1.06–1.25, p &lt; 0.01). Compared with White patients, African American patients had an increased risk of mortality (HR 1.19, 95% CI 1.07–1.33, p &lt; 0.01), while Hispanic (HR 0.90, 95% CI 0.82–0.99, p = 0.03) and Asian (HR 0.69, 95% CI 0.59–0.81, p &lt; 0.01) patients exhibited lower risks. Employment was protective factor of survival(HR 0.73, 95% CI 0.68–0.79, p &lt; 0.01). Education level was not significantly associated with survival. Regional differences in median wait times were significant (p &lt; 0.01), ranging from 8.9 months in the northeast region to 6.8 months in the south region. In patients undergoing two or more LTs, there was no significant difference in survival by sex (p = 0.59). Among males, employment rates decreased after the first LT (34.0% vs. 19.8%; p &lt; 0.001), while among females, employment rates increased (22.0% vs. 85.1%; p &lt; 0.001). Conclusions: Socioeconomic factors—particularly insurance status, employment, race/ethnicity, and region—continue to drive disparities in both access and survival outcome to LT for HCC. Targeted approaches, such as patient navigation services, expanded financial support, and systemic policy reforms, are critical to closing these gaps and improving patient outcomes.