Socioeconomic Disparities In Health Care Research Articles

Informed Representation of Persons Living with Sickle Cell Disease in the US and Factors That Influence Clinical Trial Participation

Rationale: Sickle cell disease (SCD) is a group of blood disorders that results in an abnormality in the protein hemoglobin found in red blood cells. This leads to a rigid, sickle-like shape under certain circumstances. Sickle cell disease is typically inherited, and the most common type is ‘SS’ disease or sickle cell anemia. As of 2015, about 4.4m people have SCD, while 43m have the sickle cell trait. There is currently no pharmacological cure for SCD. The disease highlights racial and socioeconomic disparities in healthcare with treatment options, opportunities for clinical trial participation, and challenges associated with reimbursement. To enroll sufficient numbers of patients for SCD trials, drug developers need to identify enough patients with SCD, provide them with a compelling reason to enroll and complete these studies and make it possible for them to participate. Our proposed study aims to leverage a survey targeting patients, caregivers, patient advocacy groups (PAGs), and healthcare providers (HCPs) to ensure a representative understanding of the patient journey in the context of rare chronic diseases, focusing on: Overcoming trial participation constraints by identifying factors affecting patients' readiness to participate in SCD trials.Bridging the gap between the biopharma industry and patient needs to ensure patient-centered approaches.Evaluating select aspects of the economic impact of SCD to aid in more cost-effective treatment development.Promoting Diversity, Equity, and Inclusion in research by using feedback from diverse stakeholders.Addressing challenges in research such as the lack of a definitive pharmacological cure and instead focusing on disease management and quality of life improvements. Methods: A 20-question survey, developed by physicians with experience treating both adults and children with SCD, was distributed via social media and through purposeful distribution to subject matter experts on July 7 th, 2023, targeting patients, caregivers, PAGs, and HCPs in the US to seek a better understanding of the barriers to SCD clinical trial enrollment, retention, and access to current treatments. The range of questions covers: Barriers to clinical trialsBarriers and facilitators to clinical trial participationThe range of trials currently available to patientsBarriers to advocacyAccess to current treatmentsClinical trial impacts on the SCD communityStrategies of PAGs to advocate and provide resources to patients and caregiversLevel of the impact of PAGs on legislation and disease management considerationsEducational material resourcesCost of treatment and access to resourcesDrug safety and privacy concerns Results: Access to the survey will close on October 2 nd, 2023. Survey results will be analyzed and presented using descriptive graphics and text statistics. Interim analyses suggest individuals living with SCD hold safety and success of treatment in high importance. Final survey data are anticipated to further suggest the following: a diverse respondent demographic is vital for inclusive and relevant research efforts; acknowledgment of the importance of research and development (R&D) in creating novel treatments for chronic diseases; a need for resources to be directed towards diseases affecting marginalized communities; an understanding that chronic diseases usually lack a complete cure, focusing instead on disease modification and symptom control; and the importance of insights from a wide spectrum of respondents. The results aim to underline the necessity of patient-centric R&D, especially for vulnerable populations and disease-modifying treatments, given the difficulty of curing chronic diseases like SCD. By leveraging this data, stakeholders can better align their efforts toward creating impactful solutions for SCD patients, potentially leading to additional innovative, life-improving treatments.

Racial, Ethnic and Socioeconomic Healthcare Disparities in Orthopaedics: What about Orthopaedic Trauma?

Racial, Ethnic and Socioeconomic Healthcare Disparities in Orthopaedics: What about Orthopaedic Trauma?

Abstract 13594: A Decade Trend, Sex, Racial and Economic Disparities in Acute Myocardial Infarction Hospitalizations in the United States

Introduction: Reports have shown socioeconomic healthcare disparities among patients with cardiovascular diseases. We studied the trends in AMI hospitalization burden and outcomes over a decade with a focus on disparities in outcomes. This would provide epidemiologic data to assess the impact of current guidelines and recommendations on the general population. Methods: This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as the reason for hospitalization using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stay (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient's zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes. Results: There were about 6,158,738 hospitalizations for AMI over the study period with females making up 38.2%. Yearly hospitalizations increased from 1,851 - 1,983 per 100,000 adult hospitalizations from 2010 to 2019 (p<0.001). There was a significant increase in hospitalizations among men from 60.4% in 2010 to 63.4% in 2019 (p<0.001). The proportion of AMI increased by 37% in Hispanics, 15% in Blacks, and 8% in Caucasians. The LIQ patients had a 6.2% increase while the HIQ had a 7.0% decrease in AMI hospitalizations. The mortality rate over the decade was 4.9%. Females had a mortality rate of 5.6% compared to 4.5% in Males. The LIQ average mortality was 5.0% compared to 4.9 in the HIQ. There was a significant decrease in the overall mortality from 5.3% in 2010 to 4.5% in 2019 (p<0.001). The mortality in females decreased by 20.3% (p<0.001) compared to 11.5% in males (p<0.001). Adjusted for inflation, there was a 41.8% increase in the THC over the study period. Conclusion: Hospitalization incidence for AMI appears to be rising among males, Hispanics, and LIQ patients. Information from this study brings awareness to ongoing disparities in AMI hospitalizations. We recommend multidisciplinary and sustained efforts to eliminate socioeconomic disparities in healthcare

Measuring the Impact of an Interprofessional and Multidisciplinary Graduate Medical Case Conference on Socioeconomic Healthcare Disparities in Nephrology

Measuring the Impact of an Interprofessional and Multidisciplinary Graduate Medical Case Conference on Socioeconomic Healthcare Disparities in Nephrology

Differences in elective epilepsy monitoring unit admission rates by race/ethnicity and primary payer in New Jersey

Elective admission to the epilepsy monitoring unit (EMU) is an essential service provided by epilepsy centers, particularly for those with drug-resistant epilepsy. Given previously characterized racial and socioeconomic healthcare disparities in the management of epilepsy, we sought to understand access and utilization of this service in New Jersey (NJ). We examined epilepsy hospitalizations in NJ between 2014 and 2016 using state inpatient and emergency department (ED) databases. We stratified admissions by race/ethnicity and primary payer and used these to estimate and compare (1) admission rates per capita in NJ, as well as (2) admission rates per number of ED visits for each group. Patients without insurance underwent elective EMU admission at the lowest rates across all racial/ethnic groups and payer types studied. Black patients with Medicaid and private insurance were admitted at disproportionately low rates relative to their number of ED visits. Hispanic/Latino and Asian/Pacific Islanders with private insurance, Hispanic/Latinos with Medicaid, and Asian/Pacific Islanders with Medicare were also admitted at low rates per capita within each respective payer category. Future studies should focus on addressing causal factors driving healthcare disparities in epilepsy, particularly for patients without adequate health insurance coverage and those who have been historically underserved by the healthcare system.

The impact of COVID-19 on Occupational Therapy services in Gauteng Province, South Africa: a qualitative study

The impact of COVID-19 on healthcare services has been widely reported, but limited information is available on its impact on rehabilitation services in South Africa. This article reports on the impact of COVID-19 on Occupational Therapy services and programmes in public and private health care as delivered by occupational therapists. A qualitative case study design was selected to explore the perceptions of occupational therapists in private and public healthcare settings regarding the impact of COVID-19 on rehabilitation services. Asynchronous on-line focus group interviews were conducted by a team of researchers. The data were thematically analysed. Three themes emerged from the data. Theme 1, the ‘impact on the practice context’, revealed that infection prevention and control protocols were a barrier to achieving rehabilitation goals. An enabler was the therapists’ creativity and new ways of practice. Theme 2 described the ‘impact on the service-users’ where isolation and physical distancing curbed access to rehabilitation services. The struggle of vulnerable populations and socio-economic disparities in healthcare was evident in these data. Theme 3 referred to changes in the ‘professional and personal self’ of the occupational therapists. Challenges to ethical practices − for example, the uncertainty of the benefit of adapted services − resulted in stress and anxiety among therapists. Constantly adapting to changes in Regulations caused compassion fatigue, but therapists also reported healthy coping strategies and resilience. Occupational Therapy rehabilitation services should be listed as essential in times of a pandemic. Better health and social support to vulnerable populations should be established, as their challenges escalated during COVID-19. Research is required to determine practice guidelines and effectiveness of novel rehabilitation practices that were identified during the COVID-19 pandemic.

DNA-based screening and population health: a points to consider statement for programs and sponsoring organizations from the American College of Medical Genetics and Genomics (ACMG)

DNA-based screening and population health: a points to consider statement for programs and sponsoring organizations from the American College of Medical Genetics and Genomics (ACMG)

999 Patients with which high risk complication benefits the most from patient navigation?

Maternal Morbidity Review Committees recognize social determinants of health contribute to poor maternal outcomes. Historically, low income women have a poor postpartum follow up (49.4%) and contraception use rate (47.5%). Racial disparities are prevalent within low income population. Our objective was to determine which group of patients with high risk conditions in our low income population had improvement in perinatal outcomes as a result of patient navigation. A retrospective cohort study was performed on low income pregnant patients from January 2016 to December 2017. Our patient navigation model was an interdisciplinary team, consisting of a physician, care coordinator, patient navigator, and social worker. Cohorts were determined by high risk condition: history of obstetric vs. medical complications. The primary outcomes were delivery at our institution and postpartum follow up. Secondary outcomes included rates of breastfeeding, contraception use, > 4 prenatal visits, and prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination. Outcomes were compared using bivariate analysis. 724 patients were included in analysis. Baseline demographics were similar between groups. 691 (95%) of patients delivered at the institution where they had obtained prenatal care. Overall postpartum follow up rate was 72%. There was a significant difference in postpartum follow up rate, and delivery at home institution between the two groups. There were no significant differences found between contraception use or breast feeding. There was a high rate of delivery at a single urban institution. The postpartum follow up, contraception use, and breastfeeding rates in both groups was higher than historically reported in a similar population. This suggests that patient navigation models can be used to mitigate socio-economic disparities in healthcare. There was a statistically significant lower postpartum follow up rate in the obstetric complication group, which may reflect a need to increase education regarding recurrences risk in future pregnancies.

Highly vulnerable communities and the Affordable Care Act: Health insurance coverage effects, 2010-2018.

Initially implemented in 2014 in some U.S. states, the Medicaid expansions under the Affordable Care Act (ACA) aimed to make health insurance coverage more accessible to the low-income population. This paper aims to quantify the impact of the ACA Medicaid expansions on insurance coverage among racial/ethnic minorities, immigrants, single mothers, veterans, and low-education whites-i.e., the sectors of the population identified with some of the highest healthcare needs. We focus on individuals 18-64 years of age earning 138% or less of the federal poverty level from the American Community Survey, 2010-2018 (n=2,927,402). We use difference-in-differences (DD) and difference-in-difference-in-differences (DDD) approaches with propensity scores matched comparison groups to estimate pre-post ACA insurance coverage differences between individuals living in states that participated in the ACA Medicaid expansions and those living in non-participating states, and to estimate if such differences vary across subgroups. We find that insurance coverage rates increased for all subgroups; yet, the ACA benefits have not been evenly distributed across them. Low-education whites, non-Hispanic whites, females, and non-Hispanic Native Americans exhibited the highest improvements in insurance coverage. Our results contribute to the understanding of recent trends in racial and socioeconomic disparities in healthcare and the appropriate policy prescriptions to ameliorate them.

The Ethnogeriatric Implications of the COVID-19 Pandemic.

Disproportionate impact of COVID-19 is another in a long line of racial, ethnic, and socioeconomic disparities throughout the many realms of health care. The reasons for the disparities are manifold, with social determinants of health contributing heavily. Older adults have been identified as being at high risk of significant complications from COVID-19, and age coupled with other factors seems to put older adults belonging to underserved minorities at greatly heightened risk of those complications. The COVID-19 pandemic has magnified yet again racial and ethnic differences in health care that still must be addressed. This will require a multi-pronged approach to move beyond identifying racial, ethnic, and socioeconomic disparities in health care to full-force design and implementation of interventions that address this important issue. The next generation of clinicians, researchers, leaders, and policymakers can help advance the cause of eliminating fundamentally unjust health disparities, and our nation's older adults should not be left behind.

Disparities in advanced-stage breast cancer: The socioeconomic and geographic contributions.

134 Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.

Disparities in advanced stage breast cancer: The socioeconomic and geographic contributions.

e19055 Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). The early stage patients were 4.0 times more likely to have private insurance than late stage patients. Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). The late stage patients were 1/10 as likely to have regular screening for mammogram as early stage patients. 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.

Use of CT Scans for Abdominal Pain in the ED: Factors in Choice

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CT is a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers' decision regarding CT use in the evaluation of abdominal pain. After evaluating a patient for acute abdominal pain, ED providers filled in a form in which the primary diagnosis and index of suspicion were recorded. Bivariate and multivariate analyses were used to identify predictors of outcomes. The CT scan utilization rate was 54.82 per cent. Whereas 34.11 per cent of CT scans were normal, 30 per cent yielded an acute abdominal pathology. Tenderness and rebound tenderness were positive predictors of high index of suspicion [odds ratio (OR) 2.09 and 2.54, respectively]. These variables were also predictive of obtaining a CT scan [OR 2.64 and 3.41, respectively]. Compared with whites, the index of suspicion was 26 per cent and 56 per cent less likely to be high when patients were black [OR 0.73] or Hispanic [OR 0.44] respectively. Blacks and Hispanics were less likely to have CT scans performed than whites [OR 0.58 and 0.48, respectively]. Leukocytosis significantly affected the index of suspicion for acute abdominal pathology, obtaining a CT scan and the acuity of CT scan diagnosis on multivariate analysis. Patients aged ≥60 years had 2.03 odds of acute CT finding compared with those aged <60 years. There is a need for committed efforts to optimize CT scan utilization and eliminate socioeconomic disparities in health care.

Physician Incentives and Sex/Gender Differences in Depression Care: An Interrupted Time Series Analysis.

Introduction: Physician incentives have been shown to reduce socioeconomic disparities in health care. The impact on sex/gender inequalities, however, has rarely been investigated. Using population-based data, this study investigated sex/gender differences in depression care and the impact of physician incentives.Methods: Deidentified health data from physician claims, hospitals, vital statistics, prescription database, and insurance plan registries in British Columbia, Canada, were examined, retrospectively. Individuals with depression were identified and their use of mental health services was tracked for 12 months following initial diagnosis. The following indicators were assessed: (1) counseling/psychotherapy (CP), (2) minimally adequate counseling/psychotherapy (MACP), (3) antidepressant therapy (AT), and (4) minimally adequate antidepressant therapy (MAAT). Sex/gender differences in these indicators before (January 2005–December 2007) and after (January 2008–December 2012) the introduction of physician incentives were estimated using interrupted time series analysis.Results: Preintervention, the percentage of individuals with depression who received CP was higher among males (CP: 58.4%, MACP: 13.6%) than females (CP: 57.1%, MACP: 10.9%). In contrast, the percentage who received AT was higher among females (AT: 57.7%, MAAT: 47.4%) than males (AT: 53.6%, MAAT: 41.9%). These statistically significant sex/gender differences remain unchanged postintervention.Conclusions: Sex/gender differences in depression care persist despite the introduction of physician incentives.

More women are medicated while more men are talked out: Persistent gender disparities in mental health care

IntroductionPhysician incentives have been shown in previous studies to help reduce socioeconomic disparities in health care. Its impact on gender disparities, however, has rarely been investigated.AimThe impact of physician incentives on gender disparities in mental health care was investigated in this retrospective study.MethodDe-identified health administrative data from physician claims, hospital separations, vital statistics, prescription database, and insurance plan registries were linked and examined. Monthly cohorts of individuals with depression who were residing in British Columbia, Canada were identified and their use of mental health services tracked for 12 months following receipt of initial diagnosis. indicators that assess receipt of the following services were created:– counseling/psychotherapy (CP);– minimally adequate counseling/psychotherapy (MACP);– antidepressant therapy (AT);– minimally adequate antidepressant therapy (MAAT).interrupted time series analysis was used to estimate changes in these indicators before (01/2005–12/2007) and after (01/2008–12/2012) physician incentives were introduced.ResultsAt the beginning of the study period, the percentage of individuals diagnosed with depression who received counseling/psychotherapy was higher, on average, among men (CP: 58.4%, MACP: 13.6%) than women (CP: 57.1%, MACP: 10.9%). in contrast, the percentage who received antidepressant therapy was higher among women (AT: 57.7%, MAAT: 47.4%) than men (AT: 53.6%, MAAT: 41.9%). Levels for these indicators have changed over time but the statistically significant differences between men and women were virtually the same before and after incentives were introduced.ConclusionsGender disparities in mental health care persist despite the introduction of physician incentives designed to enhance access to mental health services in primary care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Activation of persons living with HIV for treatment, the great study.

BackgroundPatient empowerment represents a potent tool for addressing racial, ethnic and socioeconomic disparities in health care, particularly for chronic conditions such as HIV infection that require active patient engagement. This multimodal intervention, developed in concert with HIV patients and clinicians, aims to provide HIV patients with the knowledge, skills, attitudes and tools to become more activated patients.Methods/DesignRandomized controlled trial of a multimodal intervention designed to activate persons living with HIV. The intervention includes four components: 1) use of a web-enabled hand-held device (Apple iPod Touch) loaded with a Personal Health Record (ePHR) customized for HIV patients; 2) six 90-minute group-based training sessions in use of the device, internet and the ePHR; 3) a pre-visit coaching session; and 4) clinician education regarding how they can support activated patients. Outcome measures include pre- post changes in patient activation measure score (primary outcome), eHealth literacy, patient involvement in decision-making and care, medication adherence, preventive care, and HIV Viral Load.DiscussionWe hypothesize that participants receiving the intervention will show greater improvement in empowerment and the intervention will reduce disparities in study outcomes. Disparities in these measures will be smaller than those in the usual care group. Findings have implications for activating persons living with HIV and for other marginalized groups living with chronic illness.Trial registrationClinicalTrials.gov Identifier: NCT02165735, 6/13/2014.

Racial Disparities in Obstetric Outcomes: We Still Have Work to Do

Racial, ethnic, and socioeconomic disparities in healthcare are widespread. In some fields, across-the-board improvements in quality have resulted in

Why The Nation Needs A Policy Push On Patient-Centered Health Care

The phrase "patient-centered care" is in vogue, but its meaning is poorly understood. This article describes patient-centered care, why it matters, and how policy makers can advance it in practice. Ultimately, patient-centered care is determined by the quality of interactions between patients and clinicians. The evidence shows that patient-centered care improves disease outcomes and quality of life, and that it is critical to addressing racial, ethnic, and socioeconomic disparities in health care and health outcomes. Policy makers need to look beyond such areas as health information technology to shape a coordinated and focused national policy in support of patient-centered care. This policy should help health professionals acquire and maintain skills related to patient-centered care, and it should encourage organizations to cultivate a culture of patient-centeredness.

Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in Health Care

Increasing patient cost sharing is a commonly employed mechanism to contain health care expenditures. To explore whether the impact of increases in prescription drug copayments differs between high- and low-income areas. Using a database of 6 million enrollees with employer-sponsored health insurance, econometric models were used to examine the relationship between changes in drug copayments and adherence with medications for the treatment of diabetes mellitus (DM) and congestive heart failure (CHF). Individuals 18 years of age and older meeting prespecified diagnostic criteria for DM or CHF were included. Median household income in the patient's ZIP code of residence from the 2000 Census was used as the measure of income. Adherence was measured by medication possession ratio: the proportion of days on which a patient had a medication available. Patients in low-income areas were more sensitive to copayment changes than patients in high- or middle-income areas. The relationship between income and price sensitivity was particularly strong for CHF patients. Above the lowest income category, price responsiveness to copayment rates was not consistently related to income. The relationship between medication adherence and income may account for a portion of the observed disparities in health across socioeconomic groups. Rising copayments may worsen disparities and adversely affect health, particularly among patients living in low-income areas.

Reducing Racial, Ethnic, and Socioeconomic Disparities in Health Care: Opportunities in National Health Reform

Policy often focuses on reducing health care disparities through interventions at the patient and provider level. While unquestionably important, system-wide reforms to reduce uninsurance, improve geographic availability of services, increase workforce diversity, and promote clinical best practices are essential for progress in reducing disparities.