Nonminority Communities Research Articles

Evaluation of STEMI Regionalization on Access, Treatment, and Outcomes Among Adults Living in Nonminority and Minority Communities

Cardiac care regionalization, specifically for patients with ST-segment elevation myocardial infarction (STEMI), has been touted as a potential mechanism to reduce systematic disparities by protocolizing the treatment of these conditions. However, it is unknown whether such regionalization arrangements have widened or narrowed disparities in access, treatment, and outcomes for minority communities. To determine the extent to which disparities in access, treatment, and outcomes have changed for patients with STEMI living in zip codes that are in the top tertile of the Black or Hispanic population compared with patients in nonminority zip codes in regionalized vs nonregionalized counties. This cohort study used a quasi-experimental approach exploiting the different timing of regionalization across California. Nonpublic inpatient data for all patients with STEMI from January 1, 2006, to October 31, 2015, were analyzed using a difference-in-difference-in-differences estimation approach. Exposure to the intervention was defined as on and after the year a patient's county was exposed to regionalization. Access to percutaneous coronary intervention (PCI)-capable hospital, receipt of PCI on the same day and at any time during the hospitalization, and time-specific all-cause mortality. This study included 139 494 patients with STEMI; 61.9% of patients were non-Hispanic White, 5.6% Black, 17.8% Hispanic, and 9.0% Asian; 32.8% were women. Access to PCI-capable hospitals improved by 6.3 percentage points (95% CI, 5.5 to 7.1 percentage points; P < .001) when patients in nonminority communities were exposed to regionalization. Patients in minority communities experienced a 1.8-percentage point smaller improvement in access (95% CI, -2.8 to -0.8 percentage points; P < .001), or 28.9% smaller, compared with those in nonminority communities when both were exposed to regionalization. Regionalization was associated with an improvement to same-day PCI and in-hospital PCI by 5.1 percentage points (95% CI, 4.2 to 6.1 percentage points; P < .001) and 5.0 percentage points (95% CI, 4.2 to 5.9 percentage points; P < .001), respectively, for patients in nonminority communities. Patients in minority communities experienced only 33.3% and 15.1% of that benefit. Only White patients in nonminority communities experienced mortality improvement from regionalization. Although regionalization was associated with improved access to PCI hospitals and receipt of PCI treatment, patients in minority communities derived significantly smaller improvement relative to those in nonminority communities.

The Impact of the Coronavirus (Covid-19) Pandemic Exposes the Inequalities and Inequities on Marginalized Communities

This essay speaks to the inequalities and inequities that have had a major impact on the political, economic and social fabric of the world in general and the United States in particular.These disparities and inequities came to the forefront in the world and our country as a consequence of the coronavirus (covid-19) pandemic.The pandemic exposed the inefficiencies in our government and its institutions that were unable to abate the pandemic in a timely manner. These inefficiencies resulted in many citizens becoming ill and tragically it was reported there were over 100,000 deaths and rising at the time of this writing. Minorities were affected more than non-minority communities. The pandemic also highlighted the nation’s dependence on the work force that keeps the country safe and supplies the food and products that keep the economy going. First responders, health care workers and employees in the food supply chain became essential workers and were branded as heroes,” God bless them”. It is my hope that this essay will share some issues and circumstances that are not normally found in political discourse.

Green infrastructure site selection in the Walnut Creek wetland community: A case study from southeast Raleigh, North Carolina

Recent findings have shown that minority communities are frequently underserved by green infrastructure developments relative to non-minority communities, as local installations of green infrastructure often follow patterns of gentrification. Antipathy from these communities toward existing environmental management efforts present further obstacles related to green infrastructure placement. While hydrologic modeling has been highly utilized in decision support for green infrastructure placement, this technique does not consider ownership, access concerns, or the importance of visibility. Alternatively, participatory geographic information systems (PPGIS) can provide a different perspective from hydrologic models, as they have the potential to forecast community perceptions of green infrastructure utility, rather than hydrological benefit. We use a mixed-methods approach to optimize green infrastructure site-selection that considers hydrologic vulnerabilities in the context of place-based knowledge and historical realities. Residents’ perceptions of the locations of nuisance flooding were reported via participatory mapping within a paper-based survey (n = 95) conducted in the communities surrounding Walnut Creek, a historically African-American community in Raleigh, North Carolina. Hotspot analysis was used to identify statistically significant clustering, which was related to a correspondence between participant-indicated nuisance flooding sites and high flow accumulation cells. Comparison of the participatory and hydrologic hotspot analyses show some geospatial overlap for potential green infrastructure placement. We propose that, when undertaken with community input, green infrastructure installation in these downstream areas may help offset localized flooding patterns while facilitating greater trust with stormwater and environmental practitioners.

Partnering With Community Institutions to Increase Access to Healthful Foods Across Municipalities

BackgroundLow-income and minority communities have higher rates of nutrition-related chronic diseases than do high-income and nonminority communities and often have reduced availability to healthful foods. Corner store initiatives have been proposed as a strategy to improve access to healthful foods in these communities, yet few studies evaluating these initiatives have been published.Community ContextSuburban Cook County, Illinois, encompasses 125 municipalities with a population of more than 2 million. From 2000 through 2009, the percentage of low-income suburban Cook County residents increased 41%; African-American populations increased 20%, and Hispanic populations increased 44%. A 2012 report found that access to stores selling healthful foods was low in several areas of the county.MethodsBeginning in March 2011, the Cook County Department of Public Health recruited community institutions (ie, local governments, nonprofit organizations, faith-based institutions) who recruited corner stores to participate in the initiative. Corner stores were asked to add new, healthful foods (May–June 2011) to become eligible to receive new equipment, marketing materials, and enhanced community outreach (July 2011–February 2012).OutcomesNine community institutions participated. Of the 53 corner stores approached, 25 (47%) participated in the trial phase, which included offering 6 healthful foods in their stores. Of those, 21 (84%) completed the conversion phase, which included expansion of healthful foods through additional equipment and marketing and promotional activities.InterpretationCommunity institutions can play a key role in identifying and engaging corner stores across jurisdictions that are willing and able to implement a retail environment initiative to improve access to healthful foods in their communities.

Exploring Lack of Trust in Care Providers and the Government as a Barrier to Health Service Use

We examined associations between trust of health care providers and the government and health service use and outcomes. Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs concerning the creation of AIDS, information being withheld about the disease, and trust of care providers. Trust in care providers was associated with increased HIV-related out-patient clinic visits, fewer emergency room visits, increased use of antiretroviral medications, and improved reported physical and mental health. Trusting the government was associated with fewer emergency room visits and better mental and physical health. More than one quarter of the respondents believed that the government created AIDS to kill minorities, and more than half believed that a significant amount of information about AIDS is withheld from the public. Ten percent did not trust their provider to give them the best care possible. Distrust may be a barrier to service use and therefore to optimal health. Distrust is not isolated in minority communities but also exists among members of nonminority communities and equally interferes with their use of services and health outcomes.

Predictors of antidepressant prescription and early use among depressed outpatients.

The rates of antidepressant recommendation and use were determined in outpatients with major depression receiving services in mental health clinics. Site of service and the patients' sociodemographic and clinical characteristics were investigated as possible predictors. Patients admitted to six outpatient clinics were recruited through a two-stage sampling procedure. Patients with major depressive disorder (N = 124) according to the Structured Clinical Interview for DSM-IV--Patient Edition were assessed at admission and 3 months later. Drug therapy was recommended for most patients (71%), and minimal use (at least 1 week) was recorded for 59% of the subjects. White patients were nearly three times as likely to receive a recommendation for antidepressants. Antidepressant recommendation was also associated with severity of depressed mood, recent medication use, and clinic type. Recent antidepressant use was the only variable that predicted whether the patient actually took the recommended medication. Many patients with depression seeking treatment at community mental health clinics do not receive antidepressant drug therapy. The offer of medication is predicted by patient ethnicity, clinic type, and symptom severity. Minority patients are less likely to be offered antidepressant treatment.