Disparities In Social Determinants Research Articles

236 Association Between Gait Limitation and Alzheimer’s Disease: Comparison among Elderly in Puerto Rico and Mainland U.S.

OBJECTIVES/GOALS: In 2022, 116,000 Puerto Ricans were estimated to be affected by Alzheimer’s disease (AD). Gait limitation (GL) has been associated with different stages of AD. We study the GL-AD association in two elderly populations: Hispanics residing in PR and Americans in the mainland U.S., and identify the effects, and social determinants of health. METHODS/STUDY POPULATION: We propose a cross-sectional study involving data analysis from elderly (>65 years) Hispanics in PR and Americans in the U.S. Data will come from the National Alzheimer Coordinating Center (NACC) and a cohort of AD in PR. Our analysis will consider gait parameters, cognitive performance assessments, and AD stage (mild, moderate, and severe) as determined by the Alzheimer’s Association. We will examine social determinants of health and their association with GL and cognitive performance by AD. RESULTS/ANTICIPATED RESULTS: Our analysis will evaluate data about GL and AD stages to 1) investigate the association between GL and the distinct stages of AD and 2) evaluate the effects of social determinants of health in the association between GL and AD. We seek to profoundly understand how these factors interact within elderly populations. This exploration encompasses a diverse demographic, including elderly individuals in the U.S. and PR. We seek to identify disparities in social determinants among elderly individuals experiencing GL and AD by comparing PR and US populations. Through this association analysis, our study aspires to offer insight into the connections between GL and AD while considering the effects of social determinants of health in diverse populations. DISCUSSION/SIGNIFICANCE: The prevalence of AD is higher among Hispanic populations (e.g., Puerto Ricans) in the USA when compared to other ethnic groups. Experiencing GL may affect their daily lives, leading to exacerbating AD stages. The findings from this study will contribute to possible interventions to improve their GL and AD progression.

Insights Into Eye Care Accessibility: Geospatial Distribution of Eye Care Providers and Socioeconomic Factors by ZIP Code.

In the United States, the ZIP Code has long been used to collect geospatial data revealing disparities in social determinants of health. This cross-sectional study examines the distribution of eye care access in association with local socioeconomic factors at a ZIP Code level. Data from the 2020 Centers of Medicare and Medicaid Services and American Community Survey were used to examine locations of 47,949 providers (17,631 ophthalmologists and 30,318 optometrists) and corresponding local socioeconomic variables (education, employment, and income). Multivariable zero-inflated negative binomial regression was used to model eye care provider count per capita in each ZIP Code area with socioeconomic factors as independent covariates. For every 1% increase in percentage of population over 25 years with a bachelor's degree or higher, the expected number of providers increases by 4.4% (incidence rate ratio [IRR] = 1.044; 95% confidence interval [CI], 1.041-1.046; P < 0.001). For every 1% increase in percentage unemployment, the expected number of providers decreases by 2.7% (IRR = 0.973; 95% CI, 0.964-0.983; P < 0.001). However, for every $1000 increase in median household income, the expected number of providers decreases by 1.6% (IRR = 0.984; 95% CI, 0.983-0.986; P < 0.001). Disparities in access exist in areas of lower employment and educational attainment, as both have positive correlations with eye care provider access. Conversely, areas of greater median household income have lower access to providers. This research contributes to a greater field studying social determinants of health and may inform public health strategies on allocation of providers to improve equitable access to vision care.

The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture.

Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries. PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs. Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures. The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.

Gender and Social Determinants of Health: A Mixed Method Study in Khyber Pakhtunkhwa, Pakistan

Gender is recognized as a fundamental social determinant within the overarching framework of the World Health Organization's Social Determinants of Health (SDH). It is conceptualized as a central factor influencing population health and contributing to health inequalities. Objective: To investigate disparities based on gender in the social determinants of health and assess gender inequities in Khyber Pakhtunkhwa, Pakistan. Methods: A mixed-methods approach, comprising both a survey and an exploratory qualitative study, was employed at Mardan Medical Complex Hospital in Mardan. A total of 10 interviews were conducted with healthcare workers (HCWs), and the study included 210 patients. Results: Out of the 210 patients, the majority were female (107/210, 51%), while 103/210 (49%) were male. 80 out of 103 (77%) females were house wives. More female (30 out of 103) is illiterate than male (21 out of 107) in the study participants, men (25 out of 107) are more educated in the secondary and higher education than women (16 out of 103). Women have high literacy level in religious education (12 out of 103). Women (25 out of 103) are more prone to partner’s verbally or physical aggression than men (15 out of 107). Among female patients, predominant challenges encompass domestic concerns, experiences of violence and abuse, a deficit of trust, and socio-cultural barriers. In contrast, a prevalent social determinant of health for males was identified as financial responsibility, contributing to a notable incidence of mental health illnesses. Conclusions: In conclusion, the study sheds light on significant gender-based disparities in social determinants of health (SDH) and their profound impact on the well-being of individuals.

Longitudinal disparities in social determinants of health and COVID-19 incidence and mortality in the United States from the three largest waves of the pandemic

The United States experienced at least five COVID-19 waves linked with different mutated SARS-CoV-2 variants including Alpha, Delta and Omicron. In addition to the variants, the intensity, geographical distribution, and risk factors related to those waves also vary within socio-demographic characteristics and timeframes. In this project, we have examined the spatial and temporal pattern of COVID-19 in the USA and its associations with Social Determinants of Health (SDoH) by utilizing the County Health Rankings & Roadmaps (CHRR) dataset. Our epidemiologic investigation at the county level showed that the burden of COVID-19 cases and deaths is higher in counties with high percentages of smoking, number of preventable hospital stays, primary care physician rate, the average daily density of PM2.5 and percentages of high proportions of Hispanic residents. In addition, the analysis also demonstrated that COVID-19 incidence and mortality had distinct characteristics in their association with SDoH variables. For example, the percentages of the population 65 and older had negative associations with incidence while a significant positive association with mortality. In addition to the elderly population, median household income, unemployment, and number of drug overdose deaths showed a mixed association with COVID-19 incidence and mortality. Our findings validate several influential factors found in the existing social epidemiology literature and highlight temporal associations between SDoH variables and COVID-19 incidence and mortality not yet frequently studied.

Social determinants of health and disparate disability accumulation in a cohort of Black, Hispanic, and White patients with multiple sclerosis.

Black and Hispanic patients with multiple sclerosis (MS) have been shown to accumulate greater multiple sclerosis-associated disability (MSAD) than White patients. Disparities in social determinants of health (SDOH) among these groups have also been reported. To determine the extent to which associations of race and ethnicity with MSAD may be attributable to differences in SDOH. Retrospective chart analysis of patients at an academic MS center grouped by self-identified Black (n = 95), Hispanic (n = 93), and White (n = 98) race/ethnicity. Individual patient addresses were geocoded and matched with neighborhood-level area deprivation index (ADI) and social vulnerability index (SVI). Average Expanded Disability Status Scale (EDSS) scores at last-recorded evaluations of White patients (1.7 ± 2.0) were significantly lower than Black (2.8 ± 2.4, p = 0.001) and Hispanic (2.6 ± 2.6, p = 0.020) patients. Neither Black race nor Hispanic ethnicity was significantly associated with EDSS in multivariable linear regression models that included individual-level SDOH indicators and either ADI or SVI. Black race and Hispanic ethnicity are not significantly associated with EDSS in models that include individual and neighborhood-level SDOH indicators. Further research should elucidate mechanisms by which structural inequities affect MS disease course.

Mental Health Needs and Services Utilization among Undergraduate and Graduate Students in Texas during the COVID-19 Pandemic.

COVID-19 created a global crisis, exacerbating disparities in social determinants of health (SDOH) and mental health (MH). Research on pandemic-related MH and help-seeking is scarce, especially among high-risk populations such as college/university students. We examined self-rated MH and psychological distress, the perceived need for MH services/support, and the use of MH services across the SDOH among college/university students during the start of the pandemic. Data from the COVID-19 Texas College Student Experiences Survey (n = 746) include full- and part-time undergraduate/graduate students. Regressions examined self-rated MH, psychological distress, perceived need, and service use across SDOH, controlling for pre-pandemic MH, age, gender, and race/ethnicity. Economic stability was associated with higher risk of poor MH and need for MH services/support. Aspects of the social/community context protected student MH, especially among foreign-born students. Racial discrimination was associated with both greater psychological distress and use of services. Finally, beliefs related to the sufficiency of available institutional MH resources shaped perceived need for and use of services. Although the worst of the pandemic is behind us, the inequitable distribution of the SDOH among students is unwavering. Demand for MH support is high, requiring higher education institutions to better mobilize MH services to meet the needs of students from diverse social contexts.

Comparison of Demographic Characteristics and Social Determinants of Health Between Adults With Diagnosed HIV and All Adults in the U.S.

Quantifying disparities in social determinants of health between people with HIV and the total population could help address health inequities, and ensure health and well-being among people with HIV in the U.S., but estimates are lacking. Several representative data sources were used to assess differences in social determinants of health between adults with diagnosed HIV (Centers for Disease Control and Prevention Medical Monitoring Project) and the total adult population (U.S. Census Bureau's decennial census, American Community Survey, Household Pulse Survey, the Current Population Survey Annual Social and Economic Supplements; the Department of Housing and Urban Development's point-in-time estimates of homelessness; and the Bureau of Justice Statistics). The differences were quantified using standardized prevalence differences and standardized prevalence ratios, adjusting for differences in age, race/ethnicity, and birth sex between people with HIV and the total U.S. population. Overall, 35.6% of people with HIV were living in a household with an income at or below the federal poverty level, and 8.1% recently experienced homelessness. Additionally, 42.9% had Medicaid and 27.6% had Medicare; 39.7% were living with a disability. Over half (52.3%) lived in large central metropolitan counties and 20.6% spoke English less than very well based on survey responses. After adjustment, poverty (standardized prevalence difference=25.1%, standardized prevalence ratio=3.5), homelessness (standardized prevalence difference=8.5%, standardized prevalence ratio=43.5), coverage through Medicaid (standardized prevalence difference=29.5%, standardized prevalence ratio=3.0) or Medicare (standardized prevalence difference=7.8%), and disability (standardized prevalence difference=30.3%, standardized prevalence ratio=3.0) were higher among people with HIV than the total U.S. population. The percentage of people with HIV living in large central metropolitan counties (standardized prevalence difference=13.4%) or who were recently incarcerated (standardized prevalence ratio=5.9) was higher than the total U.S. population. These findings provide a baseline for assessing national-level disparities in social determinants of health between people with HIV and the total U.S. population, and it can be used as a model to assess local disparities. Addressing social determinants of health is essential for achieving health equity, requiring a multipronged approach with interventions at the provider, facility, and policy levels.

Rural-urban disparities in mortality and geriatric assessment among older adults with cancer: The cancer & aging resilience evaluation (CARE) registry

IntroductionRural-urban disparities persist in cancer mortality, despite improvement in cancer screening and treatment. Although older adults represent the majority of cancer cases and are over-represented in rural areas, few studies have explored rural-urban disparities in mortality and age-related impairments among older adults with cancer. Materials and MethodsWe included 962 newly-diagnosed older adults (≥60 years) with cancer who underwent geriatric assessment (GA) at their first pre-chemotherapy visit to an academic medical center in the Southeastern United States. We used Rural-Urban Commuting Area (RUCA) codes to classify residence at time of diagnosis into urban and rural areas. We used one-year survival and pre-treatment frailty as outcomes. We used Cox proportional hazards regression to evaluate the association between residence and one-year mortality, and logistic regression to evaluate the association between residence and pre-treatment frailty. All tests were two-sided. ResultsMedian age at GA was 68.0 (interquartile rage [IQR]: 64.0, 74.0) years; most had colorectal cancer (24.3%) with advanced stage (III/IV 73.2%) disease. Overall, 11.4% resided in rural and 88.6% in urban areas. Rural areas had a higher proportion of White and less educated participants. After adjustment for age, sex, race, education, employment status, and cancer type/stage, rural residence was associated with higher hazard of one-year mortality (hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.23, 2.57) compared to urban residence. Frailty was an effect modifier of this association (HROverall = 1.83, 95% CI = 1.27, 2.57; HRFrail = 2.05, 95% CI = 1.23, 3.41; HRNot Frail = 1.55, 95% CI = 0.90, 2.68). DiscussionAmong older adults with newly diagnosed cancer, rural residence was associated with reduced one-year survival, particularly among frail older adults. The rural-urban disparities observed in the current study may be due to frailty in conjunction with disparities in social determinants of health across rural and urban areas. Future studies should focus on understanding and intervening on underlying causes of these disparities.

Poorer Caregiver Mental and Social Health Is Associated With Worse Respiratory Outcomes in Preschool Children With Recurrent Wheezing

Mental and social health in caregivers of preschool children has been inadequately studied, but it may influence respiratory symptom recognition and management. To identify preschool caregivers at highest risk for poor mental and social health outcomes on the basis of patient-reported outcome measures. Female caregivers 18 to 50 years old (N= 129) with a preschool child aged 12 to 59 months with recurrent wheezing and at least 1 exacerbation in the previous year completed 8 validated patient-reported outcome measures of mental and social health. k-means cluster analysis was performed using the T score for each instrument. Caregiver/child dyads were followed for 6 months. Primary outcomes included caregiver quality of life and wheezing episodes in their preschool children. Three clusters of caregivers were identified: low risk (n= 38), moderate risk (n= 56), and high risk (n= 35). The high-risk cluster had the lowest life satisfaction, meaning and purpose, and emotional support and the highest social isolation, depression, anger, perceived stress, and anxiety that persisted for more than 6 months. This cluster had the poorest quality of life and marked disparities in social determinants of health. Preschool children from caregivers in the high-risk cluster had more frequent respiratory symptoms and a higher occurrence of any wheezing episode, but a lower outpatient physician utilization for wheezing management. Caregiver mental and social health is associated with respiratory outcomes in preschool children. Routine assessment of mental and social health in caregivers is warranted to promote health equity and improve wheezing outcomes in preschool children.

Structural Racism, Social Determinants of Health, and Provider Bias: Impact on Brain Development in Critical Congenital Heart Disease.

Critical congenital heart disease (cCHD) has neurodevelopmental sequelae that can carry into adulthood, which may be due to aberrant brain development or brain injury in the prenatal and perinatal/neonatal periods and beyond. Health disparities based upon the intersection of sex, geography, race, and ethnicity have been identified for poorer pre- and postnatal outcomes in the general population, as well as those with cCHD. These disparities are likely driven by systemic racism, disparities in social determinants of health (SDOH), and provider bias, which further compound negative brain development outcomes. The current review discusses how aberrant brain development in cCHD early in life is impacted by reduced access to quality care (i.e., prenatal care and testing, postnatal care) due to divestment in non-White neighborhoods (e.g., redlining) and food insecurity, differences in insurance status, location of residence, and perceived interpersonal racism and bias which disproportionately affects pregnant people of color who have fewer economic resources. Suggestions are discussed for moving forward with implementing strategies in medical education, clinical care, research, and gaining insight into the communities served to combat disparities and bias while promoting cultural humility.

Abstract B104: Assessing disparities in social determinants of health between African Americans/Black and Whites

Abstract According to the 2020 census, the African American (AA) population reached almost 47 million habitants, comprising 14% of the total United States (U.S) population. Data has shown that amongst all racial and ethnic groups in the U.S, AA men have the highest incidences of cancer, and AA men and women have the highest death rate and worst survival for most malignancies. Historically, AAs face worse outcomes and illness compared to Whites. AAs have higher rates of lung cancer (LC), yet, are less likely to fulfill LC screening eligibility criteria. Black women, on the other hand, are almost twice as likely as White to die from breast cancer. Social determinants of health (SDH) heavily impact the health outcomes in this population. We sought to explore the differences in SDH between African Americans/Black and Whites. Survey data were obtained from the AAMC biannual Consumer Survey of Health Care Access. There were 53,523 subjects included from 2010to 2019. A chi-square comparison was conducted between Black, Hispanic, White, and other races with subsequent multivariate analysis. Numerical values were summarized as mean plus standard deviation and compared using ANOVA. A total of 5,245 participants self-identified as African American or Black. The largest group of AA participants were 25-34 years (21.7% ) versus ≥ 65 years for whites (23.3%). Most AA respondents were female, single, college graduates, employed full time and had private insurance. During the most recent medical care visit, AA reported higher rates than Whites for concerns about housing stability OR 2.37(1.52,3.69) and food insecurity OR 1.70 (1.08,2.69). Compared with Whites, AA reported significantly higher experiences of unfair treatment due to age OR 1.15 (1.01,1.30), race OR 1.62 (1.42,1.87), language OR 1.39 (1.20,1.59), culture OR 1.29 (1.11,1.50), and religion OR 1.47 (1.26,1.71). Disparities in social determinants of health have a quantifiable impact on the experiences within health care of the AA population. Perceived racial discrimination by the AA communities can negatively impact this vulnerable population's cancer diagnosis and care, widening disparities that have been present for decades. Citation Format: Coral Olazagasti, Idalid Franco, Fay Osman, Narjust Duma. Assessing disparities in social determinants of health between African Americans/Black and Whites [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B104.

Healthcare Disparities in Cardiovascular Medicine.

There are significant healthcare disparities in cardiovascular medicine that represent a challenge for cardiologists and healthcare policy-makers who wish to provide equitable care. Disparities exist in both the management and outcomes of hypertension, coronary artery disease and its sequelae, and heart failure. These disparities are present along the lines of race, gender, and socioeconomic status. Despite recent efforts to reduce disparity, there are knowledge and research gaps among cardiologists with regards to both the scope of the problem and how to solve it. Solutions include increasing awareness of disparities in cardiovascular health, increasing research for optimal treatment of underserved communities, and public policy changes that reduce disparities in social determinants of health.

Exploring the intersection of structural racism and ageism in healthcare.

The American Geriatrics Society (AGS) has consistently advocated for a healthcare system that meets the needs of older adults, including addressing impacts of ageism in healthcare. The intersection of structural racism and ageism compounds the disadvantage experienced by historically marginalized communities. Structural racism and ageism have long been ingrained in all aspects of US society, including healthcare. This intersection exacerbates disparities in social determinants of health, including poor access to healthcare and poor outcomes. These deeply rooted societal injustices have been brought to the forefront of the collective public consciousness at different points throughout history. The COVID-19 pandemic laid bare and exacerbated existing inequities inflicted on historically marginalized communities. Ageist rhetoric and policies during the COVID-19 pandemic further marginalized older adults. Although the detrimental impact of structural racism on health has been well-documented in the literature, generative research on the intersection of structural racism and ageism is limited. The AGS is working to identify and dismantle the healthcare structures that create and perpetuate these combined injustices and, in so doing, create a more just US healthcare system. This paper is intended to provide an overview of important frameworks and guide future efforts to both identify and eliminate bias within healthcare delivery systems and health professions training with a particular focus on the intersection of structural racism and ageism.

The Geographical Correlation Between Historical Preterm Birth Disparities and COVID-19 Burden.

Similar to obstetric outcomes, rates of SARS-CoV-2 (COVID-19) infection are not homogeneously distributed among populations; risk factors accumulate in discrete locations. This study aimed to investigate the geographical correlation between pre-COVID-19 regional preterm birth (PTB) disparities and subsequent COVID-19 disease burden. We performed a retrospective, ecological cohort study of an upstate New York birth certificate database from 2004 to 2018, merged with publicly available community resource data. COVID-19 rates from 2020 were used to allocate ZIP codes to “low-,” “moderate-,” and “high-prevalence” groups, defined by median COVID-19 diagnosis rates. COVID-19 cohorts were associated with poverty and educational attainment data from the US Census Bureau. The dataset was analyzed for the primary outcome of PTB using ANOVA. GIS mapping visualized PTB rates and COVID-19 disease rates by ZIP code. Within 38 ZIP codes, 123,909 births were included. The median COVID-19 infection rate was 616.5 (per 100 K). PTB (all) and COVID-19 were positively correlated, with high- prevalence COVID-19 ZIP codes also being the areas with the highest prevalence of PTB (F = 11.06, P = .0002); significance was also reached for PTB < 28 weeks (F = 15.87, P < .0001) and periviable birth (F = 16.28, P < .0001). Odds of PTB < 28 weeks were significantly higher in the “high-prevalence” COVID-19 cohort compared to the “low-prevalence” COVID 19 cohort (OR 3.27 (95% CI 2.42–4.42)). COVID-19 prevalence was directly associated with number of individuals below poverty level and indirectly associated with median household income and educational attainment. GIS mapping demonstrated ZIP code clustering in the urban center with the highest rates of PTB < 28 weeks overlapping with high COVID-19 disease burden. Historical disparities in social determinants of health, exemplified by PTB outcomes, map community distribution of COVID-19 disease burden. These data should inspire socioeconomic policies supporting economic vibrancy to promote optimal health outcomes across all communities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43032-022-01076-w.

Impact of Neighborhood Sociodemographic Characteristics on Food Store Accessibility in the United States Based on the 2020 US Census Data.

BackgroundIt has been previously reported that access to quality food is greatly impacted by neighborhood food store quality and availability, which in turn is determined by a complex interplay of sociodemographic factors. Low-income predominantly Black neighborhoods face the most limited access to quality food. The purpose of this study was to examine the newly available 2020 Census to see if any significant change has occurred to this pattern and if any new insights can be gained by analyzing these data.Methods2020 US Census and current ReferenceUSATM food store data were merged and multivariate Negative Binomial Count Regression Models were used to establish the relationship between different types of food stores (high, medium, and low quality) and neighborhood characteristics including urbanicity, poverty level, and race/ethnicity.Results11.5% of the predominantly Non-Hispanic (NH) White census tracts (CT) (6,486 out of 56,192), 61.3% (4,002 out of 6,531) of the predominantly Non-Hispanic Black CTs, and 44.1% (3,644 out of 8,258) of the predominantly Hispanic CTs were in the high poverty category. Compared to the reference group of NH White/low-poverty group, the incident rate ratio (IRR) and 95% Confidence interval [CI] of having access to high quality food stores for NH Black was significantly lower starting at the low poverty level (0.57 [0.48, 0.67], p<0.001) and decreasing further with increasing poverty: NH Black/medium poverty (0.48 [0.42, 0.55], p<0.001); NH Black/high poverty (0.38, [0.34, 0.42], p<0.001). A similar pattern was seen with the Hispanic groups as well, though to a lesser degree. We further examined access to computer/electronic devices including smartphones from 2017 to 2020. High poverty NH Black households experienced the fastest growth from 73.6% access rate in 2017 to 82.6% in 2020, compared with 87.0% to 92.0% in the total population.ConclusionAnalyses of the 2020 Census data reveal that access to high-quality food stores in high-poverty minority neighborhoods, NH Black neighborhoods in particular, remains severely limited. Innovative interventions and emerging technologies, online grocery shopping for example, warrant further evaluation as potential strategies to improve access and decrease disparities in social determinants of healthy eating.

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Disparities in Social Determinants of Health Among Patients Receiving Liver Transplant: Analysis of the National Inpatient Sample From 2016 to 2019.

BackgroundLiver transplantation is the life-saving standard of care for those with end-stage liver disease. Unfortunately, many patients on the liver transplant list die waiting. Several studies have demonstrated significant differences based on disparities in race, gender, and multiple socioeconomic factors. We sought to evaluate recent disparities among patients receiving liver transplants using the latest available data from the National Inpatient Sample (NIS), the largest publicly available inpatient care database in the United States.MethodsWe performed an analysis of discharge data from the NIS between 2016 and 2019. We identified adult patients with chronic liver disease who underwent a liver transplant using the International Classification of Diseases, 10th revision (ICD-10) codes. Multivariate logistic regression was used to adjust for differences in race, gender, socioeconomic status, and comorbidities among those who received a liver transplant.ResultsA total of 24,595 liver transplants were performed over the study period. Female gender was independently associated with decreased transplant rates (adjusted odds ratio (AOR) 0.83, 95% confidence interval (CI), 0.78-0.89, P < 0.001). Compared to White patients, Black patients had decreased transplant rates (AOR 0.86, 95% CI, 0.75-0.99, P = 0.034), as did Native Americans (AOR 0.64; 95% CI, 0.42-0.97, P = 0.035). Hispanics and Asian Americans had increased rates of liver transplantation (AOR 1.16, 95% CI 1.02-1.32, P = 0.022, and 1.36, 95% CI 1.11-1.67, P = 0.003; respectively). The increase in income quartile was associated with an incremental increase in transplant rates. Additionally, patients with private insurance had much higher transplant rates compared to those with Medicare (AOR 2.50, 95% CI 2.31-2.70, P < 0.001) while patients without insurance had the lowest rates of transplantation (AOR 0.18, 95% CI 0.12-0.28, P < 0.001).ConclusionsOur analysis demonstrates that race, gender, and other social determinants of health have significant impacts on the likelihood of receiving a liver transplant. Our study, on a national level, confirms previously described disparities in receiving liver transplantation. Patient-level studies are needed to better understand how these variables translate into differing liver transplantation rates.

Comparison between machine learning methods for mortality prediction for sepsis patients with different social determinants

BackgroundSepsis is one of the most life-threatening circumstances for critically ill patients in the United States, while diagnosis of sepsis is challenging as a standardized criteria for sepsis identification is still under development. Disparities in social determinants of sepsis patients can interfere with the risk prediction performances using machine learning.MethodsWe analyzed a cohort of critical care patients from the Medical Information Mart for Intensive Care (MIMIC)-III database. Disparities in social determinants, including race, sex, marital status, insurance types and languages, among patients identified by six available sepsis criteria were revealed by forest plots with 95% confidence intervals. Sepsis patients were then identified by the Sepsis-3 criteria. Sixteen machine learning classifiers were trained to predict in-hospital mortality for sepsis patients on a training set constructed by random selection. The performance was measured by area under the receiver operating characteristic curve (AUC). The performance of the trained model was tested on the entire randomly conducted test set and each sub-population built based on each of the following social determinants: race, sex, marital status, insurance type, and language. The fluctuations in performances were further examined by permutation tests.ResultsWe analyzed a total of 11,791 critical care patients from the MIMIC-III database. Within the population identified by each sepsis identification method, significant differences were observed among sub-populations regarding race, marital status, insurance type, and language. On the 5783 sepsis patients identified by the Sepsis-3 criteria statistically significant performance decreases for mortality prediction were observed when applying the trained machine learning model on Asian and Hispanic patients, as well as the Spanish-speaking patients. With pairwise comparison, we detected performance discrepancies in mortality prediction between Asian and White patients, Asians and patients of other races, as well as English-speaking and Spanish-speaking patients.ConclusionsDisparities in proportions of patients identified by various sepsis criteria were detected among the different social determinant groups. The performances of mortality prediction for sepsis patients can be compromised when applying a universally trained model for each subpopulation. To achieve accurate diagnosis, a versatile diagnostic system for sepsis is needed to overcome the social determinant disparities of patients.

Clinical perspectives and strategies for confronting disparities in social determinants of health for Hispanic bilinguals with aphasia

Disparities in social determinants of health (SDOH) such as socioeconomic status and access to quality healthcare present serious barriers to enrollment in clinical rehabilitation programs for individuals who have experienced a stroke, especially for those who identify with a racial-ethnic minority group. Hispanic bilinguals with aphasia (HBWA) are one marginalized group who face even greater enrollment challenges since post-stroke language impairment and limited English proficiency make it difficult to advocate for one's needs and identify appropriate rehabilitation programs. Given the increasing representation of Hispanic individuals in the U.S. (projected to be 30% of the population in 2050), it is imperative that clinicians counter disparities in stroke care by facilitating access to clinical services for HBWA. However, the Hispanic population remains largely understudied in the stroke and aphasia literature, due in part to reduced opportunities to enroll in large-scale clinical research studies. In this paper we highlight how our team at Boston University has designed and implemented a variety of recruitment practices, assessment modifications, and treatment accommodations to circumvent the known barriers to participation in clinical research experienced by HBWA. Furthermore, we discuss the importance of cultural responsiveness and demonstrate how including principles of sensitivity and humility in clinical trial protocols improves participant enrollment and retention. Although clinical adjustments in this study were developed for use with HBWA, the effectiveness of the procedures suggests they may be useful blueprints for expanding access to research opportunities for various marginalized groups.