Reduction Of Disparities Research Articles

Cultural Adaptation and Psychometric Properties of the Spanish Version of the Gay Affirmative Practice Scale (GAP-ES)

Background/Objectives: Lesbian, gay, bisexual, and transgender (LGBT) individuals often face discrimination in healthcare settings, resulting in health disparities. Evaluating healthcare professionals’ affirmative practices is essential for promoting inclusive care and addressing these disparities. The aim of this study was to assess the psychometric properties of the Spanish version of the Gay Affirmative Practice Scale (GAP-ES), which measures healthcare professionals’ affirmative practices towards gay individuals. Methods: Before assessing its psychometric properties, the original Gay Affirmative Practice Scale (GAP) was translated and culturally adapted from English to Spanish. Following the translation, the psychometric properties were tested on a sample of 236 healthcare professionals. The internal consistency of the questionnaire was measured using Cronbach’s alpha and the discriminatory power index. Factor structure was evaluated with Confirmatory Factor Analysis (CFA) using the Diagonally Weighted Least Squares method. Results: The sample consisted of 152 female (64.41%) and 84 male (35.59%) participants, with 58.05% identifying as heterosexual, 28.81% as homosexual, and 13.14% as bisexual. The internal consistency of the GAP-ES was strong, with Cronbach’s alpha values of 0.915 for the Beliefs subscale and 0.902 for the Behaviors subscale. The McDonald’s Omega coefficient was 0.942, indicating high reliability. CFA confirmed a two-factor structure with satisfactory fit indices (CFI = 0.999, RMSEA = 0.071). Conclusions: The GAP-ES demonstrates strong internal consistency and a stable factor structure. It is a reliable tool for evaluating affirmative practices toward LGBT patients in Spanish-speaking healthcare contexts, supporting improved care for this population. The integration of the GAP-ES into clinical practice and training programs may support the enhancement of cultural competence among healthcare professionals, contributing to the reduction of health disparities for LGBT patients in Spanish-speaking settings.

The burden and trends of heart failure caused by ischemic heart disease at the global, regional, and national levels from 1990 to 2021

Abstract Background Ischemic heart disease (IHD) is a major cause of heart failure (HF), a condition expected to increasingly affect global health and economics. This study evaluates the global burden, trends, and disparities of HF linked to IHD, aiming to inform health policy development. Methods Data from the Global Burden of Disease Study 2021 (GBD2021) is analyzed using Joinpoint regression, decomposition analysis, and Bayesian age-period-cohort analysis (BAPC). Health disparities are assessed through the Socio-demographic Index (SDI) via the Slope Index of Inequality (SII) and the Concentration Index (CI), with future trends projected from 2022 to 2045. Results In 2021, global HF cases due to IHD were over 19.16 million, with an age-standardized prevalence rate (ASPR) of 228.31 per 100 000 [95% UI, 188.18 to 279.55] and age-standardized years lived with disability (ASYLDs) rate of 20.43 per 100 000 [95% UI, 13.55 to 28.7].In 2021, there was a 2.87% increase in ASPR and ASYLDs compared to 1990, primarily driven by population growth and aging.Significant reductions in global ASPR and ASYLDs disparities are observed, though the disease burden has intensified in countries with lower SDI levels. Projections indicate that by 2045, while the prevalence and YLDs for HF caused by IHD will increase, while the ASPR and ASYLDs are expected to decrease. Conclusion The global burden of HF from IHD remains a significant concern. Urgent improvements in the allocation of medical resources and the implementation of effective prevention and management strategies are necessary to address this issue.

School Readiness and Early Childhood Education and Care Services Among Dual Language Learners

ImportanceDual language learners (DLL) (ie, children learning 2 or more languages) present lower school readiness than non-DLL children, putting DLL children at risk of later school difficulties and adverse outcomes. However, it is unclear whether participation in early childhood education and care (ECEC) services may reduce this gap.ObjectiveTo assess whether ECEC exposure may reduce the school readiness gap between DLL and non-DLL children in a population-based sample.Design, Setting, and ParticipantsThis census survey study was performed from February to May 2022 in the Canadian province of Quebec using data from the Quebec Survey of Child Development in Kindergarten, which includes all children who attended kindergarten in the 2021 to 2022 school year in public and private schools in Quebec (n = 80 587), except for Cree and Inuit territories.ExposureChildren’s ECEC arrangement before kindergarten was retrieved from register-based data and teachers and arrangements were categorized as exclusive parental care, childcare, pre-kindergarten only, or childcare and pre-kindergarten. Based on their mother tongue and language of instruction, children were classified as French speaking, English speaking, bilingual French-English speaking, or neither French nor English speaking (allophone) children, the last 2 groups of which represented the DLL category.Main Outcomes and MeasuresVulnerability in school readiness was defined as a score below the 10th percentile in any of the 5 domains of the validated Early Development Instrument (EDI): (1) physical health and well-being; (2) social competence; (3) emotional maturity; (4) language and cognitive development; and (5) communication skills and general knowledge.ResultsIn total, 80 587 children were surveyed, and 71 585 children were included in analyses. Mean (SD) child age was 6.0 (0.3) years, 34 911 children (48.8%) were female, and 18 341 children (25.6%) were DLL. English-speaking, bilingual French-English–speaking, and allophone children were more likely to be vulnerable in the EDI (769 of 2355 children [32.7%], 4814 of 13 981 children [34.4%], and 1622 of 4360 children [37.2%], respectively) than French-speaking children (13 664 of 50 890 children [26.9%]). In logistic regression analyses adjusted for social selection bias in ECEC arrangement, attending ECEC services was associated with a lower risk of being vulnerable among all language groups compared to parental care, with odds ratios ranging from 0.26 (95% CI, 0.25-0.27) to 0.96 (95% CI, 0.80-1.14), except in the emotional maturity domain. ECEC exposure was associated with reduction in vulnerabilities disparities between DLL and non-DLL children after adjusting for confounding factors, including socioeconomic status.Conclusions and RelevanceECEC services may foster school readiness for all children, especially DLL, and should be considered to reduce school inequalities.

Physical Fitness, Executive Functions, and Academic Performance in Children and Youth: A Cross-Sectional Study

The aim of this cross-sectional study was to investigate the relationship between physical fitness, executive function, and academic performance in children and adolescents. A total of 131 students (49% female) aged 10–15 years from a public school in Rio de Janeiro were assessed in executive functions (hearts and flowers, Corsi’s block, and digit span tasks), academic performance (Portuguese, reading, math, and overall school grade), physical tests (touch test disc, agility, lower limb and upper limb explosive strength), and anthropometric measurements. Regression results showed that the composite of sports-related fitness measures was the best predictor of executive functions (β = 0.472; t = −6.075 p < 0.001). Decision tree classifier analysis showed that the combination of factors that discriminated better and worse executive function groups were better performance in hand–eye coordination (TTD), math, and upper limb strength (ULEST). Sports-related fitness is significantly correlated with executive function. Hand–eye motor coordination has been identified as the most important predictor of improved cognitive outcomes, surpassing even academic skills. These findings should be considered in the design of physical activity programs in school settings, which may have a positive impact on child development, reflected in the reduction of academic and socioeconomic disparities.

Community Engagement in the Management of Urban Green Spaces: Prospects from a Case Study in an Emerging Economy

Urban green spaces (UGSs) play a vital role in enhancing the quality of life in cities, particularly in rapidly urbanizing regions such as the Metropolitan Region of São Paulo (MRSP). However, significant challenges related to equitable management and access persist, often exacerbated by socio-environmental inequalities. While much of the existing literature on UGS management focuses on developed economies, there is a gap in our understanding of how community engagement influences UGS outcomes in emerging economies, which face unique socio-economic and infrastructural constraints. This study addresses this gap by investigating the impact of community engagement on UGS management in the MRSP, specifically examining how increased participation correlates with improved UGS access and reduced socio-environmental inequality. Utilizing survey data from 33 municipal environmental departments across the MRSP, this research applied correlation tests, generalized linear models, and a non-parametric analysis of variance to evaluate the relationships between community engagement, UGS coverage, and inequality. The findings reveal a moderate positive correlation between community engagement and UGS coverage, alongside a negative correlation with socio-environmental inequality. Increased levels of community participation were associated with greater access to UGSs and a reduction in disparities across socio-economic groups. These results underscore the potential of fostering community involvement in UGS management to promote urban equity and environmental sustainability in emerging economies, particularly through institutional support and transparent information sharing. Future research should focus on longitudinal studies to better understand the long-term effects of sustained community engagement and incorporate qualitative data from community members to provide a more comprehensive analysis of participatory processes. Additionally, expanding the scope of analysis to include informal and private green spaces will offer a more holistic understanding of urban greening dynamics.

What happens to imprisonment rates when a progressive prosecutor is elected: Quasi-experimental evidence from Cook County

There has been a clear recognition in recent years that the United States' extremely high rates of imprisonment, coupled with significant racial disparities, are problematic. The progressive prosecutor movement has developed in response to these issues and has gained increasing attention over the past decade. Despite the growing importance of the progressive prosecutor movement in criminal legal reform efforts, we know little about the extent to which electing a progressive chief prosecutor actually leads to reductions in overall imprisonment rates and racial disparities in imprisonment, with no studies to our knowledge using data that capture preelection differences in imprisonment trends across jurisdictions. In this study, we begin to fill this gap by examining the implications of the 2016 election of Kim Foxx in Cook County, Illinois, for overall, Black, White, and Latinx imprisonment rates. Employing a quasi-experimental synthetic control approach that accounts for preelection differences in imprisonment trends, our findings suggest that Kim Foxx's election led to a reduction in the imprisonment rate overall, as well as for Black and White individuals. However, our findings suggest that substantial racial disparities in imprisonment persisted after her election.

The Impact of Tocilizumab Coverage on Health Equity for Inpatients with COVID-19 in the USA: A Distributional Cost-Effectiveness Analysis.

We conducted a distributional cost-effectiveness analysis to evaluate how coverage of tocilizumab for inpatients with COVID-19 from 2021 to present impacted health equity in the USA. A published, payer-perspective, distributional cost-effectiveness analysis for inpatient COVID-19 treatments was adapted to include information on baseline health disparities across 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups), and county-level social vulnerability (5 geographic quintiles). The underlying cost-effectiveness analysis was updated to reflect patient characteristics at admission, standard of care outcomes, tocilizumab efficacy, and contemporary unit costs. The distributional cost-effectiveness analysis inputs for COVID-19 hospitalization and subgroup risk adjustments based on social vulnerability were derived from published estimates. Opportunity costs were estimated by converting total tocilizumab spend into quality-adjusted life-years (QALYs), distributed equally across subgroups. Tocilizumab treatment was cost effective across all subgroups. Treatment resulted in larger relative QALY gains in more socially vulnerable subgroups than less socially vulnerable subgroups, given higher hospitalization rates and inpatient mortality. Using an opportunity cost threshold of US$150,000/QALY and an Atkinson index of 11, tocilizumab was estimated to have improved social welfare by increasing population health (53,252 QALYs gained) and reducing existing overall US health inequalities by 0.003% since 2021. Use of tocilizumab for COVID-19 since 2021 increased population health while improving health equity, as more patients with lower baseline health were eligible for treatment and received larger relative health gains. Future equitable access to tocilizumab for inpatients with COVID-19 is expected to lead to continued increases in population health and reductions in disparities.

Postpartum Management of Hypertensive Disorders of Pregnancy in Six Large U.S. Hospital Systems: Descriptive Review and Identification of Clinical and Research Gaps.

Hypertensive disorders of pregnancy (HDPs) are a key contributor to maternal morbidity and mortality. Several gaps in knowledge remain regarding best practices in the postpartum management of HDPs. In this review, we describe postpartum HDPs management among six large academic U.S. hospital systems: Medical College of Wisconsin, University of Pittsburgh, University of Wisconsin-Madison, Northwestern University, University of Minnesota, and Boston Medical Center. We identified that all six health systems discharge patients with HDPs diagnosed with a blood pressure (BP) cuff and use the same two antihypertensive medications, nifedipine and labetalol, as first- and second-line treatment of HDPs. Northwestern University routinely adds oral furosemide for 5 days for patients with BP that exceeds 150/100 mm Hg. Most hospital systems administer magnesium sulfate routinely when readmission for HDPs occurs. In contrast, there was variation in BP threshold for antihypertensive treatment initiation, use of remote BP monitoring program, use of a transition clinic, delivery or lack of education on long-term cardiovascular disease risk, and BP management through the first 6 weeks postpartum and beyond. Based on the clinical review, we identified clinical gaps and formulated considerations for research priorities in the field of postpartum HDPs management. KEY POINTS: · Several gaps in knowledge remain regarding best practices in postpartum management of HDPs.. · There is a variation in the BP threshold for antihypertensive treatment initiation.. · Data are lacking on the reduction in severe maternal morbidity (SMM) and racial disparities in SMM with remote monitoring..

Health disparities in service delivery in the intensive care unit: A critical ethnographic study.

The intensive care unit has structural complexities, and critically ill patients are exposed to disparities. Thus, the intensive care unit can be a potential health disparity setting. This study explored cultural knowledge associated with health disparities in the intensive care unit. This critical ethnographic study was conducted using Carspecken's approach. It was carried out in intensive care units in Western Iran from 2022 to 2023. Data collection and analysis were conducted in three interconnected stages. The initial stage involved over 300 h of field observation. In the subsequent stage, a horizon analysis was performed. Conversations with 17 informants were recorded in the final stage to enrich the dataset further. Then, the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity. This research revealed the following themes: (a) extension of the impact of political, social, and cultural powers, (b) being influenced by individual diversity, (c) balancing services based on the consideration of benefits and consequences, (d) departure from professional behaviour and (e) insufficient organizational discipline. The findings of this study showed that individual diversity, political, social and cultural powers within a context of insufficient organizational discipline, and departure from professional behaviour influence the service delivery culture in the intensive care unit. Moreover, the benefits and consequences of service delivery impact its execution. These stereotypes have the potential to contribute to the emergence of health disparities. Cultural transformation is challenging because of deep-rooted stereotypes, but the reduction of disparities is possible through awareness, critical self-reflection and cultural competence. The findings of this research can prompt staff self-reflection in situations prone to disparities. Health leaders can use these findings to shape health policies at both macro and micro levels.

Trends in severe maternal morbidity following an institutional team goal strategy for disparity reduction

BackgroundRacial disparities in maternal pregnancy outcomes, specifically in morbidity and mortality, are persistent in the U.S., and a multifaceted approach to mitigating these disparate outcomes is critical. In 2020, our health system committed to reducing severe maternal morbidity (SMM) in Black patients, employing multiple strategic interventions including implicit bias training, regular reporting of a composite SMM metric stratified by race and ethnicity, standardization of best practices, focused efforts for hemorrhage risk reduction, and system-wide team building. ObjectiveThe goal of this study is to investigate trends in SMM by race across this period of concentrated interventions to improve maternal outcomes overall, and specifically for Black patients. Study DesignThis is a retrospective cohort study evaluating all delivery admissions at an academic, urban, tertiary-care hospital in Philadelphia—one site of a health system encompassing five delivery hospitals—over a 3-year period from 2019 to 2021. Data including patient demographics, clinical features, and outcomes were extracted from the electronic medical record (EMR). Self-reported race was categorized as Black vs non-Black as documented in the EMR. SMM was defined according to established CDC indicators as well as additional codes identified by Vizient for common sources of SMM including hemorrhage, infection, and embolism. Data were analyzed by year with a multivariable logistic regression model including insurance type and obstetric comorbidity index (OB-CMI), a weighted scoring system accounting for numerous chronic medical conditions and antepartum pregnancy complications. ResultsIn total, 12,339 deliveries were included, 64.6% (N=8012) of which were to Black patients. Median OB-CMI score was higher for Black patients at 3 (interquartile range [IQR] 1–5) compared to 2 (IQR 1–4) for non-Black patients, P<.01. There was a significant decrease in SMM for the entire cohort over the study period (8.5% in 2019 to 6.5% in 2021, P=.001), driven by a decreased rate specifically among Black patients (8.9% in 2019 to 6.6% in 2021, P=.005) with a nonsignificant decrease for non-Black patients (7.8% in 2019 to 6.3% in 2021, P=.21). The adjusted model similarly demonstrated decreased risk of SMM over time for Black patients (2020 vs 2019 adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI] 0.69–0.96; 2021 vs 2019 aOR 0.73, 95% CI 0.62–0.86). ConclusionDedicated efforts to improve equity in maternal outcomes over a 2-year period (2020–2021) in this hospital serving a Black patient majority were associated with a significant decline in SMM, especially among Black patients. This finding demonstrates the success of a high-level, coordinated, and systematic approach in reducing SMM and associated disparities, and is highly consequential in light of the ongoing major epidemic of racial disparities in obstetric outcomes.

Disparate impact of risk assessment instruments: A systematic review.

One concern about the use of risk assessment instruments in legal decisions is the potential for disparate impact by race or ethnicity. This means that one racial or ethnic group will experience harsher legal outcomes than another because of higher or biased risk estimates. We conducted a systematic review of the literature to synthesize research examining the real-world impact of juvenile and adult risk instruments on racial/ethnic disparities in legal decision making. Given the nature of research synthesis, we did not test formal hypotheses. Our systematic literature search as of July 2023 identified 21 articles that investigated the disparate impact of 13 risk assessment instruments on various legal outcomes. Most of these instruments were actuarial pretrial screening instruments. Our narrative synthesis indicated that there is not strong evidence of risk instruments contributing to greater system disparity. Ten articles indicated that adopting risk instruments did not create (or exacerbate preexisting) disparities, and eight articles found that instrument use reduced disparities in legal decision making. Three articles reported evidence of disparate impact of risk instruments; only one of these studies received a strong study quality assessment score. We observed a scarcity of high-quality articles that employed what we deem to be the gold standard approach for examining the disparate impact of risk instruments (i.e., pretest-posttest design). The evidence signals that risk instruments can contribute to reductions in disparities across multiple stages of legal decision making. Yet study quality remains low, and most research has been conducted on decisions during the pretrial stage. More rigorous research on disparate impact across diverse legal decision points and approaches to risk assessment is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Numerical study on induction heating enhanced methanol steam reforming for hydrogen production

Electromagnetic induction heating technology, characterized by its non-contact thermal heat transfer, diminished thermal inertia, and facile temperature management, is applied in this study to enhance catalytic methanol steam reforming (MSR) reaction process. A two-dimensional reactor model was developed integrating electromagnetic field coupling with MSR reactions, fluid dynamics and heat transfer. In the reactor, heat is induced instantaneously on the magnetic material through an electromagnetic induction process, which generated by renewable electricity. Results showed that the Internal - Double Row Cylinder (IN-DRC, cylinder means that the shape of induction heating element is cylindrical.) highest heating efficiency is 38.3%, which is limited by the kinetics of MSR reaction. Here, thermal efficiency reaches its maximum with the reaction channel outlet temperature reaching about 580 K. Internal - Double Row Cylinder (IN-DRC) and Internal - Double Row Ball (IN-DRB, ball means that the shape of induction heating element is spherical) methanol conversions are virtually identical, with a maximum value close to 100%. Furthermore, the findings that the adoption of internal induced heating, in contrast to external heating, across the four reactor designs can effectively mitigate temperature gradient within the reactors. This reduction in thermal disparity significantly amplifies methanol conversion within the reactor, thereby markedly enhancing its overall performance in hydrogen production.Therefore, non-contact internal induction heating method has the potential for substantially hydrogen production processes.

Abstract C076: Increased AID results in mutations at the CRLF2 locus implicated in Latin American ALL health disparities

Abstract Activation-induced cytidine deaminase (AID) is a B cell-specific mutator required for antibody diversification. However, it is also implicated in the etiology of several B cell malignancies. Evaluating the AID-induced mutation load in patients at-risk for certain blood cancers is critical in assessing disease severity and treatment options. We have developed a digital PCR (dPCR) assay that allows us to quantify mutations resulting from AID modification or DNA double-strand break (DSB) formation and repair at sites known to be prone to DSBs. Implementation of this new assay showed that increased AID levels in immature B cells increased genome instability at loci linked to chromosomal translocation formation. This included the CRLF2 locus that is often involved in translocations associated with a subtype of acute lymphoblastic leukemia (ALL) that disproportionately affects Hispanics, particularly those with Latin American ancestry. Using dPCR, we characterized the CRLF2 locus in B cell-derived genomic DNA from both Hispanic ALL patients and healthy Hispanic donors and found increased mutations in both, suggesting that vulnerability to DNA damage at CRLF2 may be driving this health disparity. Our ability to detect and quantify these mutations will potentiate future risk identification, early detection of cancers, and reduction of associated cancer health disparities. Citation Format: Valeria Rangel, Fabiola Quintero-Rivera, Sora Tanjasiri, Selma Masri, Angela Fleischman, Nicholas R. Pannunzio. Increased AID results in mutations at the CRLF2 locus implicated in Latin American ALL health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C076.

Decrease in Socioeconomic Disparities in Self-Rated Oral Health among Brazilian Adults between 2013 and 2019: Results from the National Health Survey.

This cross-sectional study assessed the magnitude of inequalities in self-rated oral health (SROH) among different socioeconomic groups in Brazil. Secondary data from interviews with a sample of adults (≥18 years) from the national health survey 2013 (n = 64,308) and 2019 (n = 88,531) were analyzed. Positive SROH was considered when participants selected the good or very good options. Socioeconomic indicators were monthly household income and years of education. The magnitude of inequalities among socioeconomic groups was estimated using the Slope (SII) and Relative Index of Inequality (RII). Interaction term assessed changes in SII/RII over time. Estimates were adjusted for sex and age. The prevalence of SROH was 67.50% in 2013 and 69.68% in 2019. Individuals with lower socioeconomic indicators had a lower prevalence of positive SROH. Significant reductions in the magnitude of the education-based RII between 2013 (1.58) and 2019 (1.48) in Brazil, as well as in north (1.70; 1.45) and northeast (1.50; 1.41) regions and reduction in the income-based RII in the north (1.71; 1.51) were observed. Socioeconomic inequalities in SROH persist across different Brazilian regions, although there was a reduction in disparities among education groups in 2019 compared with 2013. The findings of this study suggest that equitable Brazilian oral health policies may have contributed to reducing SROH inequality over time.

Estimated Health and Economic Outcomes of Racial and Ethnic Tuberculosis Disparities in US-Born Persons

Despite significant progress made toward tuberculosis (TB) elimination, racial and ethnic disparities persist in TB incidence and case-fatality rates in the US. To estimate the health outcomes and economic cost of TB disparities among US-born persons from 2023 to 2035. Generalized additive regression models projecting trends in TB incidence and case-fatality rates from 2023 to 2035 were fit based on national TB surveillance data for 2010 to 2019 in the 50 US states and the District of Columbia among US-born persons. This baseline scenario was compared with alternative scenarios in which racial and ethnic disparities in age- and sex-adjusted incidence and case-fatality rates were eliminated by setting rates for each race and ethnicity to goal values. Additional scenarios were created examining the potential outcomes of delayed reduction of racial and ethnic disparities. The potential benefits of eliminating disparities from differences between baseline and alternative scenario outcomes were quantified. Data were analyzed from January 2010 to December 2019. Non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Black, Hispanic, non-Hispanic Native Hawaiian or Other Pacific Islander, or non-Hispanic White race and ethnicity. TB cases and deaths averted, quality-adjusted life years gained, and associated costs from a societal perspective. The study included 31 811 persons with reported TB from 2010 to 2019 (mean [SD] age, 47 [24] years; 20 504 [64%] male; 1179 [4%] American Indian or Alaska Native persons; 1332 [4%] Asian persons; 12 152 [38%] Black persons; 6595 [21%] Hispanic persons; 299 [1%] Native Hawaiian or Other Pacific Islander persons; and 10 254 [32%] White persons). There were 3722 persons with a reported TB death. Persistent racial and ethnic disparities were associated with an estimated 11 901 of 26 203 TB cases among US-born persons (45%; 95% uncertainty interval [UI], 44%-47%), 1421 of 3264 TB deaths among US-born persons (44%; 95% UI, 39%-48%), and an economic cost of $914 (95% UI, $675-$1147) million from 2023 to 2035. Delayed goal attainment reduced the estimated avertable TB outcomes by 505 (95% UI, 495-518) TB cases, 55 (95% UI, 51-59) TB deaths, and $32 (95% UI, $24-$40) million in societal costs annually. In this modeling study of racial and ethnic disparities of TB, these disparities were associated with substantial future health and economic outcomes of TB among US-born persons without interventions beyond current efforts. Actions to eliminate disparities may reduce the excess TB burden among these persons and may contribute to accelerating TB elimination within the US.

Reduction of Pediatric Gastrostomy Tube Healthcare Utilization and Socioeconomic Disparities: Longitudinal Benefits of Quality Improvement

BackgroundDisparities in emergency department (ED) utilization after gastrostomy (G-) tube placement were previously demonstrated at our children’s hospital. We aimed to reduce postoperative G-tube dislodgements and ED visits with a particular focus on socially vulnerable children. MethodsOur improvement team implemented a G-tube care bundle (6/2018-9/2019) targeting caregiver preparedness and standardizing care in the pre-, intra-, and post-operative periods. Patients who had G tubes placed between 1/2011-8/2022 were categorized to either pre- or post-intervention groups. Primary outcomes were tracked prospectively. National area deprivation index (ADI) was assigned retrospectively and employed to evaluate social risk. Univariate comparisons were made between pre- and post-intervention groups, and between High ADI (≥80) and Low ADI (<80) subgroups in both pre- and post- intervention periods. We used statistical process control methods to further analyze change over time. Results396 children were included (188 pre-intervention, 208 post-intervention). The post-intervention cohort demonstrated a lower rate of outpatient dislodgement at 90 days following G-tube placement (21.3% vs 10.1%, p=0.002) and fewer G-tube-related ED visits per G-tube placed within one year of placement (mean 0.8 visits vs 0.6 visits, p=0.012). Pre-intervention, children from high ADI neighborhoods had significantly greater healthcare utilization compared to those from lower ADI neighborhoods. Post-intervention, previously statistically significant disparities were no longer present. Outpatient G-tube dislodgements within 90 days were particularly mitigated. ConclusionsA longstanding quality improvement initiative has led to sustained reductions in overall G-tube-related health care utilization. Care standardization and improvement may mitigate outcome disparities related to socioeconomic advantage. Type of studyRetrospective Comparative Study and Prospective Quality Improvement Level of EvidenceLevel III

Closing the gap? Results-based financing and socio-economic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) programme, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilization of health services. This study leverages the staggered rollout of the programme as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilizing pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section and family planning. Specifically, the RBF programme is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, P < 0.01), first-trimester prenatal care (-0.033, P < 0.01), delivery by caesarean section (-0.028, P < 0.005) and family planning (-0.033, P < 0.005). Additionally, the programme is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, P < 0.01). These effects are more pronounced among lower socio-economic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritizing expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

Economic growth and regional disparities: A long-term perspective for the state of Sergipe, Brazil

This paper aims to build and evaluate long-term scenarios within the economy of the state of Sergipe so as to identify sectors with a greater capacity to leverage the state's economic growth and mitigate regional disparities. We use a dynamic and inter-regional CGE model, calibrated for the year 2015 and 41 sectors. Our simulations capture he effects of sectorial shocks in the state and explore the direct and indirect effects of such shocks throughout the economy. The main results show that sectors such as Agriculture, Transport, Financial intermediation, and Public Utility Industrial Services all have an above average impact on the state’s GDP and contribute to a reduction in regional disparities.

Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data.

Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic. This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points. Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age. For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking. Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women.

Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.

To determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid. We used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017. We conducted a retrospective observational study using a differences-in-differences method to compare changes in outcome disparities between dual-eligible and non-dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program. The primary outcome was LEJR complications. Secondary outcomes included 90-day readmissions and mortality. We identified hospitals in the US market areas eligible for CJR. We included beneficiaries in the intervention group who received joint replacement at hospitals in markets randomized to participate in CJR. The comparison group included patients who received joint replacement at hospitals in markets who were eligible for CJR but randomized to control. The study included 1,603,555 Medicare beneficiaries (mean age, 74.6 years, 64.3% women, 11.0% dual-eligible). Among participant hospitals, complications decreased between baseline and intervention periods from 11.0% to 10.1% for dual-eligible and 7.0% to 6.4% for non-dual-eligible beneficiaries. Among nonparticipant hospitals, complications decreased from 10.3% to 9.8% for dual-eligible and 6.7% to 6.0% for non-dual-eligible beneficiaries. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual-eligible and non-dual-eligible beneficiaries (-0.9 percentage points, 95% CI -1.6 to -0.1). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model. There were no differential changes in 90-day readmissions or mortality. Mandatory participation in a bundled payment program was associated with reduced disparities in joint replacement complications for Medicare beneficiaries with low income. To our knowledge, this is the first evidence of reduced socioeconomic disparities in outcomes under value-based payments.