Low-income Patients Research Articles

Access to the internet and mobile applications in a mixed population emergency department: A repeated cross-sectional survey

ObjectiveThis study aimed to assess patients' interest in education content delivered through electronic modalities and identify trends in internet access and use among emergency department patients of various socioeconomic statuses. MethodsA prospective, cross-sectional survey with 50 questions was completed by 241 English and Spanish-speaking patients in 2014 and repeated with 253 participants in 2019 at the University of California, Irvine Medical Center's Emergency Department (UCIMCED). ResultsInternet access increased from 83.8 % in 2014 to 88.1 % in 2019. Most internet-using patients owned smartphones (80.1 % in 2014, 89.7 % in 2019). Patients used electronic devices, such as fit bits and activity trackers, to obtain health information. Email was the preferred method for receiving discharge instructions. ConclusionsAs of 2019, 88.1 % of UCIMCED patients have access to the internet or email, making electronic media a reasonable venue for patient education. Given that we have a predominantly low-income patient population—61 % and 32 % of respondents in 2014 and 2019, respectively, reporting an income of less than $25,000—these results are provide new avenues to reach patients of all socioeconomic statuses. InnovationThe implications of this study can be used to develop electronic resources tailored to educate emergency department patients about their healthcare beyond the confines of a hospital.

A proposed method for identifying Interfacility transfers in Medicare claims data.

To develop a method of consistently identifying interfacility transfers (IFTs) in Medicare Claims using patients with ST-Elevation Myocardial Infarction (STEMI) as an example. 100% Medicare inpatient and outpatient Standard Analytic Files and 5% Carrier Files, 2011-2020. Observational, cross-sectional comparison of patient characteristics between proposed and existing methods. We limited to patients aged 65+ with STEMI diagnosis using both proposed and existing methods. We identified 62,668 more IFTs using the proposed method (86,128 versus 23,460). A separately billable interfacility ambulance trip was found for more IFTs using the proposed than existing method (86% vs. 79%). Compared with the existing method, transferred patients under the proposed method were more likely to live in rural (p < 0.001) and lower income (p < 0.001) counties and were located farther away from emergency departments, trauma centers, and intensive care units (p < 0.001). Identifying transferred patients based on two consecutive inpatient claims results in an undercount of IFTs and under-represents rural and low-income patients.

Bridging oral health and nutrition: Assessing produce prescription programs in pediatric dental clinics serving low-income communities.

This study assesses the needs and feasibility of conducting a produce prescription (produce Rx) program in a pediatric dental clinic setting serving low-income patients. We conducted a cross-sectional quantitative survey examining several household characteristics including demographics, benefits received, fruit and vegetable intake patterns, food security, feasibility of a produce Rx program, and respondents' answers to questions based on social cognitive theory constructs. The survey was administered at the University of Nebraska Medical Center (UNMC) pediatric dental clinic, a pediatric dental residency clinical training site. One hundred adult respondents with low income completed a 36-item questionnaire during their child's dental appointment. Almost half of respondents reported experiencing food insecurity (45%). Respondents who were food insecure experienced higher levels of nutrition insecurity (p = 0.012), less confidence in choosing fruits and vegetables (FVs) (p = 0.026), difficulty in purchasing FVs in their neighborhood (p = 0.012), and more concern that FVs cost too much (p < 0.001) when compared to respondents who were food secure. Notwithstanding the barriers they face, almost all respondents reported that they eat FVs because of health benefits (95%) and to set a good example for their family (91%). Additionally, most respondents expressed an interest in produce Rx programs (80%) and nutrition education activities (81%). This study demonstrated the potential for produce Rx program uptake in a pediatric dental clinic setting through positive caregiver-reported need and interest. Future studies should explore how produce Rx programs can be adapted most effectively in this novel setting.

Abstract 26: An Effective mHealth Intervention to Close the Guideline-to-Practice Gap in Hypertension Treatment: mGlide RCT

Background: Suboptimal HTN control is a widespread problem particularly among minorities and socioeconomically disadvantaged groups. Objective: To determine if a mobile health (mHealth) intervention facilitating an active partnership between inter-professional care teams (including pharmacists) and patients improves HTN control in patients with uncontrolled HTN. Methods: mGlide is an NIH-funded, 2-arm RCT evaluating HTN control between a mHealth intervention (mGlide) vs. state-of-clinical-care (comparison) groups using a PROBE (Prospective Randomized Open Blinded End-point) design. Table 1 shows intervention components. High CVD risk patients with uncontrolled HTN identified by EHR query were randomized 1:1 to either mGlide or to comparison for a 6-month intervention followed by a 6-month observation period. Recruitment sites include primary care clinics and specialty stroke service in an integrated health system, community clinics (CC) and federally qualified health centers (FQHC). The FQHC and CC serve low income and minority (Hmong and Latino) patients. The primary aim tested clinical effectiveness of mGlide in reducing SBP at 6 months. Secondary outcomes include resource utilization, adverse events and medication side-effects. Results: Recruitment started in 2019. N=395 participants enrolled by August 2023. The pandemic impacted enrollment; however enrollment recovered after vaccine availability (Figure). Primary outcome was available in March 2024 on everyone except in those lost to follow-up (n=38; 9.6%). We used multiple imputation for those missing 6 month SBP. Baseline mean SBP was 143.2 vs. 143.6 mm Hg in mGlide vs. comparison. The intervention led to better HTN control (Table 2). Mean 6-month SBP was 128.1 (mGlide) vs. 134 mm Hg (comparison). Adjusting for baseline SBP and study strata, 6-month mean SBP was 5.7 mm Hg (95% CI 2.9-8.4; p = 0.0001) lower in mGlide vs. comparison. The odds of HTN control defined as “alive and SBP &lt; 130 mm Hg”, was 60% higher in the mGlide arm (OR 1.6; 95% CI 1.03-2.48; p=0.035). There was one death in each study arm. The mGlide arm had fewer ER visits (16% vs. 25%; p=0.024), fewer hospitalizations (7% vs. 13%; p=0.044) and more medication side effects (39% vs. 26%, p=0.008). Conclusions: An inexpensive mHealth intervention that used the patient’s own phone (Table 1) was implemented in diverse health systems and significantly reduced SBP and was associated with less resource utilization at 6 months (Table 2).

Abstract P318: English and Spanish-Speaking Patient Preferences on Home Blood Pressure Monitors: A Qualitative Study in an Urban Safety Net Setting

Background: Self-measured blood pressure (SMBP) monitoring improves hypertension (HTN) control. Adoption of SMBP monitoring is lower among low-income or minoritized patients, who have higher rates of uncontrolled HTN. Little is known about these patients’ preferences for or challenges with SMBP monitoring. Objective: We explored patient perspectives on SMBP monitoring among patients receiving care at an urban safety-net system. Methods: We interviewed English and Spanish-speaking patients with HTN about preferences for different BP monitoring devices and their accompanying mobile apps, past experiences sharing BP data with their clinical care team, and knowledge about home BP monitoring. Interviews were conducted in the participants’ preferred language. We also asked participants to demonstrate a home BP measurement to evaluate their measurement technique. We presented two BP monitoring devices: a Bluetooth-enabled device and a cellular-enabled device. Rapid qualitative data analysis was used to analyze data. Results: Of the 15 participants (8 English-speaking; 7 Spanish-speaking), eight identified as Latine, four as Black or African American, one as American Indian/Native American, one as Asian/Pacific Islander, and one as multi-ethnic. Highest educational attainment varied: five less than high school, five high school/GED, and five college. Most required assistance with Bluetooth pairing to share data and navigating app features. All participants valued tracking their BP and were motivated to engage in SMBP monitoring but desired more training. Nearly all participants demonstrated inadequate BP knowledge and incorrect BP measurement techniques based on AHA/AMA recommendations. Few reported receiving training on SMBP monitoring techniques. Spanish speakers reported that using apps was challenging due to language discordance and wanted translated apps and resources. Costs related to device features were a key factor in preferences. Conclusions: Patient-reported barriers to SMBP adoption include cost, insufficient training, digital exclusion, and language discordance. Addressing these challenges may increase adoption of SMBP monitoring in safety-net populations. Clinicians should consider patients’ preferences when recommending SMBP monitoring. Cellular SMBP devices that automatically transmit BP readings may mitigate challenges with digital literacy and promote data sharing with clinical care teams, though future studies are needed to evaluate usability.

54276 Gunshot Wounds Management for Low-Income Patients: A Literature Review on Current Treatment and Future Implications For Those Who Lack Access to Healthcare

54276 Gunshot Wounds Management for Low-Income Patients: A Literature Review on Current Treatment and Future Implications For Those Who Lack Access to Healthcare

Overcoming Economic Barriers: AML Treatment and Prognosis in Low-Income Patients

Overcoming Economic Barriers: AML Treatment and Prognosis in Low-Income Patients

AML-600 Overcoming Economic Barriers: AML Treatment and Prognosis in Low-Income Patients

AML-600 Overcoming Economic Barriers: AML Treatment and Prognosis in Low-Income Patients

Measuring Disparities in the Impact of COVID-19 on Pediatric Mental Health in Primary Care Settings.

To examine disparities in mental health diagnosis, depression screening, and depressive symptoms in pediatric primary care settings before and during the COVID-19 pandemic, and to evaluate the use of electronic health records to study temporal trends in pediatric mental and behavioral health (MBH). This is an IRB-approved, retrospective study of pediatric patients (n=10,866) who visited three primary care sites at an academic medical center before (2017-2019) and during (2020-2022) the COVID-19 pandemic. We used logistic regression to compare rates of diagnoses, depression screening, and depression symptom scores among demographic groups. This study demonstrates an increase in both PHQ-9A screening rates and average scores from 2017-2019 to 2020-2022. There were significant disparities in common mental health diagnoses, including higher rates of psychological distress among lower income and Hispanic patients, both before and during the pandemic, despite lower rates of screening among Hispanic patients. This suggests a need for improved equity in routine MBH screening and additional research to better understand the underlying social determinants that may be driving the greater mental health burden for certain marginalized youth.This study also highlights the strengths and challenges of utilizing EHR data to characterize disparities in pediatric mental illness. Although the nature of care delivery in an academic medical center clinic and the limitations of the EHR for collecting relevant data present challenges to this measurement, the EHR is nevertheless a promising tool for measuring and tracking pediatric mental health disparities.

The Impact of Eliminating Out-of-Pocket Payments on Asthma Medication Use.

High costs of controller therapies may be a barrier to guideline-recommended asthma treatment. We determined whether eliminating out-of-pocket (OOP) payments among low-income patients with asthma impacted controller medication use. We applied a controlled interrupted time series design to administrative claims data in British Columbia, Canada from 2017-2020. Cases were individuals with an annual household income <$13,750 in whom copays were eliminated on January 2019; there was no change in public coverage for the control group with annual income >$45,000. We evaluated trends in asthma medication costs, use, the ratio of inhaled corticosteroid (ICS)-containing medications to all asthma medications, excessive use of short-acting β-agonists (SABA) (>1 canister/month), and the proportion of days (PDC) covered by controller therapies. There were 12,940 cases (62% female, mean age 30.3 years, SD 14.9), and 71,331 controls (55% female, mean age of 31.3 years, SD 16.3). Removal of OOP payments increased monthly mean medication costs by $3.32 (95% CI $0.08 - $6.56, 2020 Canadian dollars), days supply of controller medications by 1.50 days (95% CI 0.61 - 2.40), and the ratio of ICS-containing medications to total medications by 4.20% (95% CI 0.73% - 7.66%) compared to the control group. The policy had no effect on PDC by controller therapies (0.01, 95% CI -0.01 - 0.04), but non-significantly decreased the percentage of patients with excessive SABA use (-6.37%; 95% CI -12.90% - 0.16%). Removal of OOP payments increased the dispensation of controller therapies, suggesting cost-related non-adherence could impair optimal asthma management.

Validation of Spanish-Language Surveys Utilized for the Navigator-Assisted Hypofractionation (NAVAH) Program to Aid Hispanic-American Breast Cancer Patients.

Cancer accounts for 22% of all mortality and is the leading cause of death among Hispanic and/or Latinx patients in the United States. The disparities in access to radiation therapy (RT), mortality rates, and treatment outcomes among Hispanic-American breast cancer patients compared with other populations highlight the urgent need for targeted interventions. The Navigator-Assisted Hypofractionation (NAVAH) program, with its innovative patient navigation approach and culturally sensitive survey, aims to better identify the specific barriers faced by this population. This study is a report of the NAVAH program experience piloting a Spanish-language culturally sensitive survey in Hispanic-American volunteers. Hispanic-American volunteers with fluency in Spanish were recruited to participate in survey conduction, identified from local networks. Survey information was assessed by topic category, and survey responses were amalgamated into a representative score for each category. Survey categories include acceptability (comfort and prejudice among interactions with the system), accessibility (transportation, distance to care, and health care literacy), accommodation (access to the internet, navigating transportation), affordability (financial considerations, employment, and level of education), and availability (access to a medical center, coordinating care, and overall quality of care). A total of 6 volunteers meeting inclusion criteria completed the survey; 4 in person and 2 by telephone. The median survey completion time was 12 minutes 38 seconds. Respondents noted satisfaction and trust in their interactions with medical providers; however, responses in the acceptability category highlighted a high perception of disparities in the medical system, including a high prevalence of racial and ethnic prejudice and a high prevalence of treatment differences between high-income and low-income patients in clinical settings. In the first Spanish-language survey of its kind, our findings indicate that this survey design is feasible in the Hispanic-American population. Implementation of this survey in breast cancer patients will provide more definitive and comprehensive answers regarding other categories in the survey, including financial challenges during treatment, access to accommodations, and perception of treatment during cancer care. The investigation involving patients actively receiving breast cancer RT is currently underway.

Epidemiological, clinical and therapeutic aspects of edematous maculopathies in Cadeso/Donka

Objective: To study the epidemiological, clinical and therapeutic aspects of edematous maculopathy at CADES/O. Material and Methods: This was a descriptive cross-sectional study lasting six (6) months from April 1, 2021 to September 30, 2021 All patients with oedematous maculopathy without distinction and who had undergone at least one angiogram and/or optical coherence tomography (OCT) were included in our study. Results: During our study we received 4988 patients, of whom 180 or 3.6% had edematous maculopathies. The age group from 60 to 69 years old (30.5%) was the most represented. The mean age was 55.9± 14.2 years (20 and 89 years). Females (55%) were predominant with a sex ratio of 0.8. The majority of our patients were housewives (35.5%). 83% of our patients came from rural areas. More than half of our patients were married, a frequency of 74.4%. Hypertension was the leading cause of ATCD (67.7%) followed by age-related macular degeneration (66.6%) and diabetes (32.2%). The main reason for consultation was blurred vision (88.3%). OCT found non-cystoid macular edema and cystoid macular edema. According to the ALFEDIAM classification, OM was mainly mixed (45%), diffuse (36.1%) and focal (18.8%). 92.2% of our patients received anti-VEGF-based treatment, the evolution was favorable. Conclusion: OM is due to a loss of retinal homeostasis leading to an imbalance between fluid inputs and outputs and to altered retinal hydraulic conductivity. During our study, the prevalence of edematous maculopathies was low. Older women have been the most affected. The cost of managing edematous maculopathy should be reviewed within the reach of low-income patients to allow for adequate management. Keywords: Oedematous maculopathy, Epidemiology, Clinical, Therapeutic.

Economic Disparities in Utilization and Outcomes of Structural Heart Disease Interventions in the United States

BackgroundDisparities in access to care cause negative health consequences for underserved populations. Economic disparities in structural heart disease (SHD) interventions are not well characterized. ObjectivesThe objective of this study was to evaluate economic disparities in the utilization and outcomes of SHD interventions in the United States. MethodsWe queried the National Inpatient Sample (2016-2020) to examine economic disparities in the utilization, in-hospital outcomes, length of stay, and cost of SHD interventions among patients ≥65 years of age. Outcomes were determined using logistic regression models. ResultsA total of 401,005 weighted hospitalizations for transcatheter aortic valve replacement, left atrial appendage occlusion, transcatheter mitral valve repair, and transcatheter mitral valve replacement were included. Utilization rates (number of procedures performed per 100,000 hospitalizations) were higher in patients with high income compared with medium and low income for transcatheter aortic valve replacement (559 vs 456 vs 338), left atrial appendage occlusion (148 vs 136 vs 99), transcatheter mitral valve repair (65 vs 54 vs 41), and transcatheter mitral valve replacement (7.7 vs 6.7 vs 1.2) (all P < 0.01). Low- and medium-income patients had distinctive demographic and clinical risk profiles compared with high-income patients. There were no significant differences in the adjusted in-hospital mortality, key complications, or length of stay between high-, medium-, and low-income patients following any of the 4 SHD interventions. High-income patients incurred a modestly higher cost with any of the 4 SHD interventions compared with medium- and low-income patients. ConclusionsEconomic disparities exist in the utilization of SHD interventions in the United States. Nonetheless, adjusted in-hospital outcomes were comparable among high-, medium-, and low-income patients. Multifaceted implementation strategies are needed to attenuate these utilization disparities.

Effect of Medicaid expansion on cancer treatment and survival among Medicaid beneficiaries and the uninsured.

The Affordable Care Act expanded Medicaid coverage for people with low income in the United States. Expanded insurance coverage could promote more timely access to cancer treatment, which could improve overall survival (OS), yet the long-term effects of Medicaid expansion (ME) remain unknown. We evaluated whether ME was associated with improved timely treatment initiation (TTI) and 3-year OS among patients with breast, cervical, colon, and lung cancers who were affected by the policy. Medicaid-insured or uninsured patients aged 40-64 with stage I-III breast, cervical, colon, or non-small cell lung cancer within the National Cancer Database (NCDB). A difference-in-differences (DID) approach was used to compare changes in TTI (within 60 days) and 3-year OS between patients in ME states versus nonexpansion (NE) states before (2010-2013) and after (2015-2018) ME. Adjusted DID estimates for TTI and 3-year OS were calculated using multivariable linear regression and Cox proportional hazards regression models, respectively. ME was associated with a relative increase in TTI within 60 days for breast (DID = 4.6; p < 0.001), cervical (DID = 5.0 p = 0.013), and colon (DID = 4.0, p = 0.008), but not lung cancer (p = 0.505). In Cox regression analysis, ME was associated with improved 3-year OS for breast (DID hazard ratio [HR] = 0.82, p = 0.009), cervical (DID-HR = 0.81, p = 0.048), and lung (DID-HR = 0.87, p = 0.003). Changes in 3-year OS for colon cancer were not statistically different between ME and NE states (DID-HR, 0.77; p = 0.075). Findings suggest that expanded insurance coverage can improve treatment and survival outcomes among low income and uninsured patients with cancer. As the debate surrounding ME continues nationwide, our findings serve as valuable insights to inform the development of policies aimed at fostering accessible and affordable healthcare for all.

Exploring the Insights: Unraveling the Knowledge, Attitude, and Practice of Diabetics Regarding Diabetes and Diabetic Retinopathy in Hail, Saudi Arabia

Background: Diabetes Mellitus is a metabolic disorder causing high blood glucose levels and is a major health concern in Saudi Arabia (SA). Aims &amp; objectives: This study aimed to assess the knowledge, attitude, and practices of diabetic patients towards diabetes and diabetic retinopathy (DR) in Hail, SA. Methods: A descriptive cross-sectional survey using an anonymous, structured, validated, and pilot-tested questionnaire was conducted between February and June 2023 from adult diabetic patients in Hail and analyzed using RStudio. Associations between variables were evaluated, with statistical significance set at p &lt; 0.05. Results: 280 participants took part in the survey, with 57.0% females and 51.4% aged between 18 to 34 years. Poor knowledge was significantly higher among participants aged 35 to 50 years (92.8%). Negative attitudes were more prevalent in males (37.8% vs 24.7%, p = 0.019) and those with lower income levels (16.7%, 29.5%, and 62.5% among high-, middle-, and low-income groups, respectively, p = 0.008). Conclusions: The study revealed a lack of knowledge and negative attitudes towards diabetes, particularly among lower-income patients. There is a significant relationship between education and good disease control, highlighting the need for improved education and awareness of DM and DR in Hail.

Improving patient-centered mental health promotion in primary care in vulnerable communities through mindfulness training in Rio de Janeiro, Brazil.

Brazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC. To discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil. The intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups. Sixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy. Mindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.

Poverty Governance in the Delegated Welfare State: Privatization, Commodification, and the U.S. Health Care Safety Net

Abstract Due to forces of retrenchment and fiscal austerity in the contemporary U.S. welfare state, the federal government has increasingly delegated the funding of public programs to private entities. How does privatization influence the way marginalized populations experience the social safety net? To develop insights on delegated poverty governance, this study examines a longstanding public-private program—Federally Qualified Health Centers (FQHCs)—which comprise a nationwide network of clinics serving over thirty million predominantly low-income patients in medically underserved areas. I conducted a case study drawing on in-depth interviews with patients and staff in a small-town FQHC in the Rust Belt. Unlike other social welfare programs, I found a pronounced absence of stigma associated with the FQHC, largely due to features of the delegated policy design, the blended institutional setting, and strategic organizational decisions. However, low-income patients were also unaware of their rights to treatment when encountering paternalistic enforcement of overdue billing rules, which resulted in delayed or foregone health care. Due to underlying tensions surrounding commodification, I argue that privatization of the safety net may quell the stigma of government programs among the poor while simultaneously disentitling individuals from their rights of social citizenship.

The contribution of household income to rectal cancer patient characteristics, treatment, and outcomes from 2010 to 2020

BackgroundThere is a paucity of recent literature investigating the sole effect of income level on the treatment and survival of patients with rectal cancer. MethodsWe analyzed all cases of rectal cancer in the Rectal Cancer PUF of the NCDB from 2010 to 2020. We utilized the Median Income Quartiles 2016–2020 to define our income levels. The two lower quartiles were combined to create a lower income group, with the upper two quartiles creating the higher income group. The total cohort included 201,329 patients, with 116,843 and 84,486 in the higher and lower income groups, respectively. ResultsLower income patients were more often black (17 % vs 6 %), lived farther from the nearest hospital (33.5 miles vs 25.7 miles) despite being more likely to live in urban areas (25 % vs 7 %), and had lower levels of private insurance (36 % vs 49 %). They underwent more APRs (17 % vs 14 %) and had a 13 % higher chance of undergoing an open operation (OR 1.13, CI 1.09–1.17). Higher income patients had a 12 % reduction in 90-day (OR 0.88, 95 % CI 0.82–0.96) and overall mortality (OR 0.88, 95 % CI 0.86–0.89). ConclusionsClinicians should be aware that lower income patients are often faced with unique challenges that may impact care delivery.

Persistent income-based disparities in clinical outcomes of cardiac surgery across the United States: A contemporary appraisal

ObjectiveAlthough national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade. MethodsAll adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database. Patients were stratified into quartiles of income, with records in the 76th to 100th percentile designated as highest and those in the 0 to 25th percentile as lowest. To evaluate the change in adjusted risk of in-hospital mortality, complications, and readmission over the study period, estimates were generated for each income level and year. ResultsOf approximately 1,848,755 hospitalizations, 406,216 patients (22.0%) were classified as highest income and 451,988 patients (24.4%) were classified as lowest income. After risk adjustment, lowest income remained associated with greater likelihood of in-hospital mortality (adjusted odds ratio, 1.61, 95% CI, 1.51-1.72), any postoperative complication (adjusted odds ratio, 1.19, CI, 1.15-1.22), and nonelective readmission within 30 days (adjusted odds ratio, 1.07, CI, 1.05-1.10). Overall adjusted risk of mortality, complications, and nonelective readmission decreased for both groups from 2010 to 2020 (P < .001). Further, the difference in risk of mortality between patients of lowest and highest income decreased by 0.2%, whereas the difference in risk of major complications declined by 0.5% (both P < .001). ConclusionsAlthough overall in-hospital mortality and complication rates have declined, low-income patients continue to face greater postoperative risk. Novel interventions are needed to address continued income-based disparities and ensure equitable surgical outcomes.

Prevalence and Risk Factors of Distal Symmetric Polyneuropathy Among Predominantly Non-Hispanic Black, Low-Income Patients.

Distal symmetric polyneuropathy (DSP) is a disabling, often painful condition associated with falls and reduced quality of life. Non-Hispanic Black people and people with low income are underrepresented in existing DSP studies; therefore, it is unknown whether data accurately reflect the prevalence, risk factors, and burden of disease in these populations. Patients older than 40 years presenting to an outpatient internal medicine clinic predominantly serving Medicaid patients in Flint, Michigan, were enrolled in a cross-sectional study. Demographics, clinical characteristics, including medication use, anthropomorphic measurements, fasting lipids, and hemoglobin A1c were collected. DSP was defined using the modified Toronto Clinical Neuropathy Score (mTCNS). Multivariable logistic regression was performed to model DSP and undiagnosed DSP as a function of potential risk factors age, metabolic syndrome, and race. DSP burden was measured using Peripheral Neuropathy Quality of Life Instrument-97. Two hundred participants were enrolled, and 169 (85%) completed all data collection. The population was 55% female of mean age (SD) 58.2 years (10.4) and 69% non-Hispanic Black. Among the population, 50% had diabetes, 67% had metabolic syndrome, and 47% had a household income <$20,000. DSP was present in 73% of the population, of which 75% were previously undiagnosed. Neuropathic pain was documented in 57% of participants with DSP. DSP based on mTCNS criteria was associated with older age (odds ratio [OR] 1.1 [95% confidence interval (CI) 1.03-1.2]) and metabolic syndrome (OR 4.4 [1.1-18.1]). Non-Hispanic Black participants had lower odds of DSP (OR 0.1 [0.01-0.4]) than non-Hispanic White and Hispanic participants. DSP burden was high, including increased pain, health-related worry, and poorer quality of life (all p < 0.001). DSP is extremely common and often underrecognized in this predominantly non-Hispanic Black, low-income population and leads to substantial disease burden. Metabolic syndrome is a highly prevalent, modifiable risk factor in this population that should be managed to lower DSP prevalence.