Understanding Of Health Disparities Research Articles

The social aspects of illness: Children's and parents' explanations of the relation between social categories and illness in a predominantly white U.S. sample.

The COVID-19 pandemic in the United States has had a disproportionate impact on Black, low-income, and elderly individuals. We recruited 175 predominantly white children ages 5-12 and their parents (N = 112) and asked which of two individuals (differing in age, gender, race, social class, or personality) was more likely to get sick with either COVID-19 or the common cold and why. Children and parents reported that older adults were more likely to get sick than younger adults, but reported few differences based on gender, race, social class, or personality. Children predominantly used behavioral explanations, but older children used more biological and structural explanations. Thus, children have some understanding of health disparities, and their understanding increases with age.

Factors associated with social determinants of health mentions in PubMed clinical case reports from 1975 to 2022: A natural language processing analysis

Social determinants of health (SDoH) significantly influence health outcomes, accounting for nearly 40% of such outcomes globally. These determinants, pivotal in understanding health disparities, are insufficiently documented in clinical settings and academic clinical narratives. To address this gap, we examined clinical case reports from PubMed (1975–2022) to identify mentions of six specific SDoH, employing a pre-trained named-entity recognition (NER) model from Spark natural language processing (NLP). Multivariate logistic regression was utilized to investigate associations between article characteristics and the documentation of SDoH. From 463,546 reports, 4.4% mentioned SDoH, with race/ethnicity being the most dominant mention. Race/ethnicity was often cited by sub-Saharan African authors (adjusted odds ratio [AOR]: 4.47) and in general medicine (AOR: 2.18). Marital status mentions appeared predominantly in psychiatry (AOR: 2.60) and gynecology (AOR: 2.47). Sexual orientation mentions were correlated with infectious diseases (AOR: 25.00) and varied by authorship regions, with stronger associations observed in South America (AOR: 4.04) and North America (AOR: 2.15), and comparatively weaker associations noted in the Indian subcontinent and the Middle East (AOR: 0.16). Immigrant status mentions were closely related to infectious diseases (AOR: 4.51), gynecology (AOR: 4.25), and certain geographies. Homelessness mentions were more prominent in forensic medicine (AOR: 14.92) and in both infections (AOR: 6.36) and mental disorders (AOR: 5.80). Spiritual belief mentions were more prominent with sub-Saharan authors (AOR: 9.17) and psychiatry (AOR: 7.61). SDoH mentions in medical literature were also determined by the diagnosis, cultural background, and journal type. The limited SDoH registration emphasized their overlooked significance. Disproportionate emphasis on specific relationships, such as sexual orientation with infectious diseases, can perpetuate biases and stereotypes. Innovative tools such as Spark NLP offer promise in advancing research using electronic health records (EHRs), but a standardized approach to SDoH reporting and vigilant AI training is crucial for unbiased health-care analysis.

From Acute Infection to Prolonged Health Consequences: Understanding Health Disparities and Economic Implications in Long COVID Worldwide.

The COVID-19 pandemic has resulted in a growing number of patients experiencing persistent symptoms and physiological changes after recovering from acute SARS-CoV-2 infection, known as Long COVID. Long COVID is characterized by recurring symptoms and inflammation across multiple organ systems. Diagnosis can be challenging, influenced by factors like demographics, comorbidities, and immune responses. Long COVID impacts various organ systems and can have neuropsychological effects. Health disparities, particularly related to race, contribute to a higher burden of infection and ongoing symptoms in minority populations. Managing Long COVID entails addressing a spectrum of symptoms that encompass physical, cognitive, and psychological aspects. The recovery period for patients with Long COVID can vary significantly, influenced by factors like the severity of the disease, hospitalization, comorbidities, and age. Currently, there are no universally effective treatments, although certain interventions show promise, necessitating further research. Self-management and rehabilitation programs can provide relief, but more research is needed to establish their effectiveness. Preventive measures such as vaccination and the use of antiviral medications and metformin. It is imperative to conduct further research to develop evidence-based guidelines and gain a better understanding of the long-term implications of COVID-19. Long COVID could have substantial economic impact on the labor market, productivity, healthcare expenditures, and overall economic growth. To address the challenges patients with long-term complications face, there is a focus on strategies like promoting telework and flexible work arrangements to accommodate diverse symptoms, particularly chronic fatigue and other Long COVID effects. In conclusion, this review emphasizes the multifaceted complexity of Long COVID and the ongoing need to address its potential long-term health and economic impacts.

Through the Looking Glass: Diversity, Equity, Inclusion, and Belonging: A Call for Action from the National Association of Pediatric Nurse Practitioners

In response to growing health disparities, social inequities, structural racism, and discrimination, the National Association of Pediatric Nurse Practitioners established a Diversity, Equity, and Inclusion Taskforce. In 2020, this group transitioned into a national committee to infuse equity across the organization and empower pediatric-focused advanced practice registered nurses as agents of change to address health disparities. Emphasizing the critical need for understanding health disparities in the context of racism and discrimination, this committee champions a paradigm shift, transcending educational initiatives, advisory roles, advocacy efforts, leadership strategies, and community services to illuminate an equitable future for all children and families.

Student and clinical supervisor perceptions of community-based dental educational experiences: A scoping review.

This scoping review was conducted to map the breadth of experiences in community-based dental education (CBDE), as reported by students and clinical supervisors. This scoping review was conducted following the structured framework proposed by Arksey and O'Malley and adhering to PRISMA-SCR guidelines for scoping reviews. Applying specified eligibility criteria, a systematic search of four electronic databases (PubMed, Scopus, Embase, and Web of Science) was followed by data extraction and data synthesis of full-text articles. Research was conducted between June 2022 and September 2022. Sixteen articles were identified for the final full-text review. Utilizing a narrative thematic review, the following five domains emerged: preparation for autonomous practice, understanding of primary care dentistry, understanding of health disparities and patient needs, clinical confidence, clinical diversity, and skill development, and perspectives on quality of teaching and assessment. Community/outreach dental education effectively supplements traditional dental school-based education from the perspectives of students and community-based clinical supervisors.

A LIFE COURSE APPROACH TO IDENTIFYING EVICTION LAWS AFFECTING OLDER ADULTS AND HISTORICALLY MARGINALIZED GROUPS

Abstract Alongside population aging, more older adults are becoming at risk of homelessness. Eviction—a type of housing instability in which a landlord initiates legal forced expulsion from a rental property—is one of the main drivers of homelessness. Evictions and homelessness disproportionately affect older adults, individuals of color, women, sexual and gender minority populations, veterans, and those with disabilities. Evictions can have devastating short- and long-term effects on tenants, and these negative consequences may be especially pronounced for individuals with multiple minoritized identities such as older LGBTQ+ adults. Older LGBTQ+ individuals face higher baseline rates of poor mental health, smoking, and health risk behaviors. In this study, key informant interviews (N=5) were utilized to identify state eviction and landlord-tenant laws that disproportionately affect older adults and other historically marginalized groups. Using a life course approach to understanding health disparities as they accumulate across the lifespan, data from LawAtlas—an online database allowing the examination of specific laws across the US—was cross-referenced with data from key informants to identify the following laws which may disproportionately affect older adults and other historically marginalized populations: nuisance property ordinances, source of income discrimination, state fair housing protections, and minimum notice-to-vacate laws. This presentation will describe how intentionally or unintentionally, these laws disproportionately affect older adults and other historically marginalized populations and may lead to negative eviction outcomes, homelessness, and poor physical and mental health. Identifying how such discriminatory laws can contribute to health disparities across the lifespan is necessary to achieve health equity.

Abstract IA019: Implementation science as an opportunity to address cancer equity

Abstract The past decade of research has continued to identify and understand health disparities for cancer prevention and control. Although emerging, progress in addressing these disparities continues to fall short achieving equity. Specifically, for cancer prevention and control, Khan and colleagues in 2021 showed a 15-year lag in implementation of evidence-based interventions (i.e., HPV vaccinations, cancer screenings, etc.). This gap highlights the lack of attention towards the implementation of scientific evidence, the complexity and fragmentation of health systems, and lays bare the structural causes of inequities that continue to persist from a population perspective. Integrating implementation science in cancer prevention and control research can provide a pathway to reduce the time to translation while addressing and advancing cancer equity. Implementation science is defined as the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve the impact on population health. Implementation science has pushed the cancer prevention and control field to pay close attention to how we dissemination scientific information towards the adoption of interventions (i.e., dissemination research) and how we systematically study strategies (i.e., the building blocks) that aid in the implementation, scale-up, and sustainability of interventions (i.e., implementation science). With implementation research, there has been a push towards hybrid designs that considers intervention effectiveness and its implementation within the same study. Given the dearth of literature around the implementation of interventions, the science of implementation continues to build on a foundational theoretical base that further provide important opportunities for the promoting equitable outcomes for cancer prevention and control research. In this educational session, we will discuss why and how applying a health equity lens to implementation science is crucial to achieve equity in cancer prevention and control. Using ongoing and completed research studies as examples, this session will help attendees learn about core elements of implementation science including theories, models, and frameworks; implementation strategies; and focal areas of adaptations and de-implementation. Citation Format: Prajakta Adsul. Implementation science as an opportunity to address cancer equity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA019.

The impact of metastatic breast cancer (mBC) treatment on patient reported productivity loss among patients with HER2+ mBC in the U.S.

352 Background: Little is known about the impact of treatments and other factors on productivity loss among HER2+ mBC patients. This study aimed to assess the work productivity and activity impairment among employed women with HER2+ mBC. Methods: A cross-sectional survey was completed by the members of two patient advocacy organizations in the U.S. Those who were employed for paid work (≥20 hours/week) and receiving systemic treatments for HER2+ mBC for the past 3-months were recruited. Participants self-reported their sociodemographic, clinical and treatment history, time burden related to disease management, and completed the work productivity and activity impairment (WPAI) and Functional Assessment of Cancer Therapy Breast (FACT-B) quality of life (QoL) questionnaires. Patients were grouped based on their current regimen: (1) Oral only, (2) one parenteral drug (1 IV), (3) 2 IVs, (4) 3+ IVs. Association between WPAI scores and sociodemographic and clinical characteristics was assessed using simple linear regression. Results: A total of 118 HER2+ mBC patients participated [mean (SD) age 47.2 (9.5) years, 69.5% were employed full-time and 30.5% part-time, 89% were White, 13.6% resided in rural area]. Among 118 patients, 38 (32.2%) were on 1 IV, 38 (32.2%) on 2 IVs, 31 (26.6%) on 3+ IVs and 11 (9.3%) on oral only regimen. The median travel time (4 hrs vs. 6 hrs) and time spent at healthcare visits (7.3 hrs vs.13.4 hrs) was numerically higher among those on 3+ IVs than those on 1 IV. The median percent work time missed (7.7% vs. 5.8%), overall work impairment (38.2% vs.31.3%) and activity impairment (40.0% vs. 30.0%) in the past 7 days was numerically higher in patients on 3+ IVs than on 1 IV. Working part-time, residing in rural area, having low household income (<25K vs. >75K) and non-commercial insurance was associated with greater overall work impairment (all p-values <0.05). Longer time since mBC diagnosis, longer time on treatment and higher QoL score were associated with lower overall work impairment (all p-values <0.05). Working part-time, low household income, non-commercial insurance, longer time on treatment and higher QoL score were similarly associated with activity impairment (all p-values <005). Conclusions: Socioeconomic and geographical factors were important determinants of work productivity loss among HER2+ mBC patients. IV treatment is the mainstay of therapy for HER2+ mBC patients and being on a simpler regimen for a longer time is likely to reduce work productivity loss and activity impairment. Improving access to novel monotherapy infusion treatment in rural community oncology practices may offer an opportunity to reduce patient time burden and work productivity loss among HER2+ mBC patients and improve health-related quality of life. Additional research from a larger diverse sample is warranted to further understand health disparities in HER2+ mBC patients.

The Mauli Ola Study: A Unique Academic-Community Partnership With MA'O Organic Farms to Understand and Address Health Inequities Among Native Hawaiians and Other Pacific Islanders in Hawai'i.

Indigenous peoples, including Native Hawaiians and Pacific Islanders (NHPIs), experience significant cardiometabolic health disparities arising in large part from rapid changes to their diets and food systems. Innovative food sovereignty initiatives led by NHPIs are needed to address these disparities. This article describes a community-based participatory research study that incorporates social and biological measures to examine the impact of an Indigenous-led land-based food sovereignty youth leadership program on health disparities among NHPI youth in Hawai'i. Grounded in the Indigenous knowledge that holistic health and wellbeing of people is inseparable from that of the environment and to counter rampant food insecurity in their community of Wai'anae, O'ahu, MA'O Organic Farms developed a Youth Leadership Training (YLT) program that offers education, nutrition, physical activity, and access to health care. The program also engages YLT interns and their social networks in health education and research in the ongoing Mauli Ola study. Preliminary data from this study affirm the need to address the disproportionately high rates of obesity, type 2 diabetes mellitus (T2D), and poor mental health conditions among young NHPIs in the Wai'anae community, and how the YLT program may provide an effective approach to address this need. Our unique academic-community partnership underscores the importance of social and biomedical research to understand health disparities in the NHPI population, which present novel avenues to enable disease prevention. The outcomes of the Mauli Ola study may serve as a valuable model for health disparities research while leveraging ongoing social programs that support Indigenous food sovereignty.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

This study compared the prevalence of adverse childhood experiences (ACEs) across intersections of sexual orientation, gender, race/ethnicity, and economic status. Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate ACE prevalence estimates. Unadjusted one-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative ACE measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted to estimate ACE scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status. Compared to straight participants, adolescents with same-sex attractions and adults who identified with a sexual minority group reported more ACEs overall, though associations varied by ACE type. Strikingly, ACE scores were higher among White than Black youth with same-sex attractions, more economically advantaged than poor bisexual adults, and poor White than poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A MAIHDA interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative ACE scores whereas gender and race/ethnicity did not. The results show that ACE disparities can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that ACEs are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

Health Disparities in Hand and Upper Extremity Surgery: A Scoping Review

Social determinants of health (SDOH) are linked to poor health care outcomes across the different medical specialties. We conducted a scoping review to understand the existing literature and identify further areas of research to address disparities within hand surgery. A systematic search of PubMed, Scopus, and Cochrane was conducted. Inclusion criteria were English studies examining health disparities in hand surgery. The following were assessed: the main SDOH, study design/phase/theme, and main disease/injury/procedure. A previously described health disparities research framework was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Studies were categorized according to themes outlined at the National Institute of Health and American College of Surgeons: Summit on Surgical Disparities. The initial search yielded 446 articles, with 49 articles included in final analysis. The majority were detecting-type (31/49, 63%) or understanding-type (12/49, 24%) studies, with few reducing-type studies (6/49, 12%). Patient factors (31/49, 63%) and systemic/access factors (16/49, 33%) were the most frequently studied themes, with few investigating clinical care/quality factors (4/49, 8%), clinician factors (3/49, 6%), and postoperative/rehabilitation factors (1/49, 2%). The most commonly studied SDOH include insurance status (13/49, 27%), health literacy (10/49, 20%), and social deprivation (6/49, 12%). Carpal tunnel syndrome (9/49, 18%), upper extremity trauma (9/49, 18%), and amputations (5/49, 10%) were frequently assessed. Most investigations involved retrospective or database designs (29/49, 59%), while few were prospective, cross-sectional, or mixed-methods. Despite an encouraging upward trend in health disparities research, existing studies are in the early phases of investigation. Most of the literature focuses on patient factors and systemic/access factors in regard to insurance status. Further work with prospective, cross-sectional, and mixed-method studies is needed to better understand health disparities in hand surgery, which will inform future interventions.

Consideration of social context in understanding health disparities in pediatric dermatology

Consideration of social context in understanding health disparities in pediatric dermatology

Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021

Maternal mortality and severe maternal morbidity (SMM) are important focus areas in public health. Further understanding trends, health disparities, and risk factors for these adverse outcomes is vital to public health decision-making. To describe trends and risk factors for delivery-related maternal deaths and SMM in the United States. This is a retrospective cross-sectional study using data from a large, geographically diverse, all-payer hospital administrative database. Hospital discharges from January 2008 to December 2021 with any Medicare Severity Diagnosis Related Group, International Classification of Diseases, Ninth Revision, Clinical Modification, or International Classification of Diseases, Tenth Revision, Clinical Modification delivery diagnosis or procedure code were included. Data analysis took place from February 2021 to March 2023. Year, quarter (Q), age, race and ethnicity, delivery method. Maternal mortality, SMM during delivery-related hospitalization. Overall, 11 628 438 unique hospital discharges were analyzed, with a mean (SD) age of 28 (6) years. There were 437 579 (3.8%) Asian, 92 547 (0.8%) American Indian, 1 640 355 (14.1%) Black, 1 762 392 (15.2%) Hispanic, 83 189 (0.7%) Pacific Islander, and 6 194 139 (53.3%) White patients. Regression-adjusted maternal mortality per 100 000 discharges declined from 10.6 deaths in Q1 2008 to 4.6 deaths in Q4 2021. Mortality was significantly higher among patients with advanced maternal age (eg, age 35-44 years vs 25-34 years: adjusted odds ratio [aOR], 1.49; 95% CI, 1.22-1.84). Other significant risk factors for mortality included cesarean delivery, comorbid conditions, complications, and COVID-19 diagnosis (eg, cesarean delivery: aOR, 2.28; 95% CI, 1.87-2.79). The prevalence of any SMM increased from 146.8 per 10 000 discharges in Q1 of 2008 to 179.8 per 10 000 discharges in Q4 of 2021. SMM risk factors included age 24 years or younger or age 35 years or older, belonging to a racial or ethnic minority group, cesarean delivery, Medicaid insurance, and having 1 or more comorbidities (eg, age 10-19 years: aOR, 1.39; 95% CI, 1.36-1.42). This cross-sectional study found that delivery-related mortality in US hospitals decreased for all racial and ethnic groups, age groups, and modes of delivery during 2008 to 2021, likely demonstrating the impact of national strategies focused on improving maternal quality of care provided during delivery-related hospitalizations. SMM prevalence increased for all patients, with higher rates for racial and ethnic minority patients of any age. Advanced maternal age, racial or ethnic minority group status, cesarean delivery, and comorbidities were associated with higher odds of mortality and SMM.

1242-P: Obesity Disparities in a Multiracial Sample of Asian American and Pacific Islander (API) Adults

Background: Asians have higher diabetes rates than Non-Hispanic white (NHW) people, despite having lower BMI. Studies on Asians often present monoracial groups. We examined obesity rates among mono- and multiracial APIs. Methods: We examined obesity and other factors by self-reported race using case-control data from two integrated healthcare systems with large API populations. Results: Obesity varied by race, ranging from 8.5% (Chinese) to 53.5% (Other Pacific Islander) (Table 1). Obesity was high for multiracial API. Demographic, behavioral, and clinical factors explained some, but not all the differences in obesity rates (Table 2). Conclusion: Multiracial API people had higher obesity rates than monoracial API and NHW people. Robust data on multiracial people are needed to understand health disparities among this group. Disclosure A.M.Bacong: None. S.L.Gibbs: None. T.B.Frankland: Research Support; Pfizer Inc., Stock/Shareholder; AbbVie Inc., Pfizer Inc., CVS Health Corp, Regeneron Pharmaceuticals Inc. J.Li: None. Y.G.Daida: Research Support; GlaxoSmithKline plc. S.P.Fortmann: Research Support; Pfizer Inc. L.Palaniappan: None. Funding National Heart, Lung, and Blood Institute (R01HL126172)

Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective.

Human populations adapting to diverse aspects of their environment such as climate and pathogens leave signatures of genetic variation. This principle may apply to people of West Central African descent in the United States, who are at increased risk of certain chronic conditions and diseases compared to their European counterparts. Less well known is that they are also at reduced risk of other diseases. While discriminatory practices in the United States continue to affect access to and the quality of healthcare, the health disparities affecting African Americans may also be due in part to evolutionary adaptations to the original environment of sub-Saharan Africa, which involved continuous exposure to the vectors of potentially lethal endemic tropical diseases. Evidence is presented that these organisms selectively absorb vitamin A from the host, and its use in parasite reproduction contributes to the signs and symptoms of the respective diseases. These evolutionary adaptations included (1) sequestering vitamin A away from the liver to other organs, to reduce accessibility to the invaders; and (2) reducing the metabolism and catabolism of vitamin A (vA), causing it to accumulate to subtoxic concentrations and weaken the organisms, thereby reducing the risk of severe disease. However, in the environment of North America, lacking vA-absorbing parasites and with a mainly dairy-based diet that is high in vA, this combination of factors is hypothesized to lead to the accumulation of vA and to increased sensitivity to vA as a toxin, which contribute to the health disparities affecting African Americans. vA toxicity is linked to numerous acute and chronic conditions via mitochondrial dysfunction and apoptosis. Subject to testing, the hypothesis suggests that the adoption of traditional or modified West Central African-style diets that are low in vA and high in vA-absorbing fiber hold promise for disease prevention and treatment, and as a population-based strategy for health maintenance and longevity.

Accounting for historical injustices in mathematical models of infectious disease transmission: An analytic overview

Differences in infectious disease risk, acquisition, and severity arise from intersectional systems of oppression and resulting historical injustices that shape individual behavior and circumstance. We define historical injustices as distinct events and policies that arise out of intersectional systems of oppression. We view historical injustices as a medium through which structural forces affect health both directly and indirectly, and are thus important to study in the context of infectious disease disparities. In this critical analysis we aim to highlight the importance of incorporating historical injustices into mathematical models of infectious disease transmission and provide context on the methodologies to do so. We offer two illustrations of elements of model building (i.e., parameterization, validation and calibration) that can allow for a better understanding of health disparities in infectious disease outcomes. Mathematical models that do not recognize the historical forces that underlie infectious disease dynamics inevitably lead to the individualization of our focus and the recommendation of untenable individual-behavioral prescriptions to address the burden of infectious disease.

Understanding Health Disparities in Preeclampsia: A Literature Review.

Preeclampsia is a multifactorial pathology with negative outcomes in affected patients in both in the peripartum and postpartum period. Black patients in the United States, when compared to their white and Hispanic counterparts, have higher rates of preeclampsia. This paper aims to review the current literature to investigate how race, social determinants of health, and genetic profiles influence the prevalence and outcomes of patients with preeclampsia. Published studies utilized in this review were identified through PubMed using authors' topic knowledge and a focused search through a Medline search strategy. These articles were thoroughly reviewed to explore the contributing biosocial factors, genes/biomarkers, as well as negative outcomes associated with disparate rates of preeclampsia. Increased rates of contributing comorbidities, including hypertension and obesity, which are largely associated with low access to care in Black patient populations lead to disparate rates of preeclampsia in this population. Limited research shows an association between increased rate of preeclampsia in Black patients and specific APOL1, HLA-G, and PP13 gene polymorphisms as well as Factor V Leiden mutations. Further research is required to understand the use of certain biomarkers in predicting preeclampsia within racial populations. Understanding contributing biosocial factors and identifying genes that may predispose high-risk populations may help to address the disparate rates of preeclampsia in Black patients as described in this review. Further research is required to understand if serum, placental, or urine biomarkers may be used to predict individuals at risk of developing preeclampsia in pregnancy.

Children with severe sepsis: relationship between community level income and morbidity and mortality.

Health disparities surrounding pediatric severe sepsis outcomes remains unclear. We aimed to measure the relationship between indicators of socioeconomic status and mortality, hospital length of stay (LOS), and readmission rates among children hospitalized with severe sepsis. Children 0-18 years old, hospitalized with severe sepsis in the Nationwide Readmissions Database (2016-2018) were included. The primary exposure was median household income by ZIP Code of residence, divided into quartiles. We identified 15,214 index pediatric severe sepsis hospitalizations. There was no difference in hospital mortality rate or readmission rate across income quartiles. Among survivors, patients in Q1 (lowest income) had a 2 day longer LOS compared to those in Q4 (Median 10 days [IQR 4-21] vs 8 days [IQR 4-18]; p < 0.0001). However, there was no difference after adjusting for multiple covariates. Children living in Q1 had a 2 day longer LOS versus their peers in Q4. This was not significant on multivariable analysis, suggesting income quartile is not driving this difference. As pediatric severe sepsis remains an important source of morbidity and mortality in critically ill children, more sensitive metrics of socioeconomic status may better elucidate any disparities. Children with severe sepsis living in the lowest income ZIP Codes may have longer hospital stays compared to peers in higher income communities. More precise metrics of socioeconomic status are needed to better understand health disparities in pediatric severe sepsis.

Health Literacy, Health Outcomes and Equity: A Trend Analysis Based on a Population Survey.

Health literacy continues to be an issue among minority groups. Population surveys are one strategy used to help better understand health disparities. The Behavioral Risk Factor Surveillance System (BRFSS) in Kansas added health literacy questions to the survey in 2012. This study examined population health literacy levels and health trends from 2012 to 2018. The health status variables included health care coverage status, general health rating, presence of chronic conditions, and length of time since the last check-up. The percentage of individuals reporting low health literacy decreased from 67% in 2012 to 51% in 2018. The percentage of participants with income levels less than $15 000 was 9% in 2012 and 7% in 2018. Health literacy was lowest among the age group 18 to 24-year-olds, those who identified as multiracial, separated, not graduated from high school, out of work for more than 1 year, income less than $10 000, with other living arrangements, and living in a suburban county of metropolitan statistical area. Additionally, many health conditions improved, and those reporting health insurance increased slightly. The study demonstrates how health literacy continues to be an issue, and how education and primary prevention are necessary to improve limited health literacy and health outcomes. Findings from both state-level and national BRFSS population surveys can help educate the public health and clinical health services workforce to provide better care and address health disparities for highrisk populations.

Integrative approaches to methods training for early-career scientists: Rationale and process evaluation of the first cohort of the Michigan Integrative Well-Being and Inequality Training Program.

The Michigan Integrative Well-Being and Inequality (MIWI) Training Program aims to provide state-of-the-art, interdisciplinary training to enhance the methodological skills of early-career scientists interested in integrative approaches to understanding health disparities. The goals of this paper are to describe the scientific rationale and core design elements of MIWI, and to conduct a process evaluation of the first cohort of trainees (called "scholars") to complete this program. Mixed methods process evaluation of program components and assessment of trainee skills and network development of the first cohort (n = 15 scholars). The program drew 57 applicants from a wide range of disciplines. Of the 15 scholars in the first cohort, 53% (n = 8) identified as an underrepresented minority, 60% (n = 9) were within 2 years of completing their terminal degree, and most (n = 11, 73%) were from a social/behavioral science discipline (e.g., social work, public health). In the post-program evaluation, scholars rated their improvement in a variety of skills on a one (not at all) to five (greatly improved) scale. Areas of greatest growth included being an interdisciplinary researcher (mean = 4.47), developing new research collaborations (mean = 4.53), and designing a research study related to integrative health (mean = 4.27). The qualitative process evaluation indicated that scholars reported a strong sense of community and that the program broadened their research networks. These findings have implications for National Institutes of Health (NIH) efforts to train early-career scientists, particularly from underrepresented groups, working at the intersection of multiple disciplines and efforts to support the formation of research networks.