Usual Source Of Health Care Research Articles

Health system inequities in Lao People's Democratic Republic: Evidence from a nationally representative phone survey.

Despite substantial economic growth in Lao People's Democratic Republic (PDR) over the past 20 years, high levels of income inequality and poverty persist and have likely been exacerbated by the COVID-19 pandemic. In this article, we use novel survey data to assess the extent to which socioeconomic status is associated with access to quality care in Lao PDR. We utilised data from the Lao People's Voice Survey (PVS), which was designed to measure health system performance from the perspective of the population. The survey was conducted between May and August 2022. Primary outcomes of interest were having a usual source of healthcare, using a government health centre (rather than a hospital or private clinic) as the usual source for care, receiving preventive health services, experiencing unmet healthcare needs, the quality of recent healthcare visit, and confidence in accessing and affording healthcare when needed. Poverty was measured using household asset ownership. We used logit models to assess the associations between poverty and health system performance measures, and additionally assessed differences between these associations in urban vs. rural areas by interacting urban residence with poverty. Poverty was negatively associated with having a regular provider for care (adjusted odds ratio (aOR) 0.45, 95% CI 0.26-0.78), receiving preventive health services (aOR 0.54, 95% CI 0.37-0.80), and confidence in the ability to receive care (aOR 0.50, 95% CI 0.34-0.72) and afford care (aOR 0.50, 95% CI 0.34-0.73) when needed. Poverty was positively associated with using government managed health centres as a usual source or for care (aOR 2.16, 95% CI 1.35-3.48). Poverty was not significantly associated with user experience or perceived quality of care in the last visit to the health facility. No differences in the associations between poverty and access to quality care were found between rural and urban settings. The results presented in this article suggest socioeconomic disparities in health care access in Lao PDR despite major national efforts to provide universal access to care. Universal health care policies may not be reaching the poor and additional targeted efforts may be needed to meet their healthcare needs.

Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey

BackgroundEnrolment of informal sector workers in Ghana’s National Health Insurance Scheme (NHIS) is critical to achieving increased risk-pooling and attainment of Universal Health Coverage. However, the NHIS has struggled over the years to improve enrolment of this subpopulation. This study analysed effect of social capital on enrolment of informal sector workers in the NHIS.MethodsA cross-sectional survey was conducted among 528 members of hairdressers and beauticians, farmers, and commercial road transport drivers’ groups. Descriptive statistics, principal component analysis, and multinomial logit regression model were used to analyse the data.ResultsSocial capital including membership in occupational group, trust, and collective action were significantly associated with enrolment in the NHIS, overall. Other factors such as household size, education, ethnicity, and usual source of health care were, however, correlated with both enrolment and dropout. Notwithstanding these factors, the chance of enrolling in the NHIS and staying active was 44.6% higher for the hairdressers and beauticians; the probability of dropping out of the scheme was 62.9% higher for the farmers; and the chance of never enrolling in the scheme was 22.3% higher for the commercial road transport drivers.ConclusionsSocial capital particularly collective action and predominantly female occupational groups are key determinants of informal sector workers’ participation in the NHIS. Policy interventions to improve enrolment of this subpopulation should consider group enrolment, targeting female dominated informal sector occupational groups. Further studies should consider inclusion of mediating and moderating variables to provide a clearer picture of the relationship between occupational group social capital and enrolment in health insurance schemes.

Abstract A090: Association between breast cancer screening adherence and food insecurity in women with low income from California

Abstract Background: Food insecurity has been associated with delayed breast cancer screening among low-income individuals and communities in the United States (US). However, it is unclear if this association is due to poverty and related factors more generally (e.g., education, access to health care) or food insecurity specifically. Hence, we tested the association of food insecurity with being up-to-date with breast cancer screening recommendations in women with low-income from California. Methods: Individual-level information on breast cancer screening and food security status from females ages 50-74 years with an annual household income below 200% of the federal poverty level (FPL) was obtained from 2015-2016 California Health Interview Survey publicly available data. Bivariate and multivariate weighted logistic regression models were employed to test the association between breast cancer screening adherence and food insecurity, factoring in sociodemographic covariates including age, race/ethnicity, English use and proficiency, poverty level (dichotomized as 0-99% vs. 100-199% FPL), educational attainment, marital status, health insurance status, usual source of care, working status, and rurality. Results: The total sample included 3598 women with low-income from California, the majority of whom reported to be ages 50-59 years old (46.6%), Hispanic (50.5%), have health insurance (89.0%) and a usual source of health care (84.5%), live in an urban area (91.6%), and identify as food secure (51.1%). Most women reported being up-to-date with breast cancer screening (78.3%), of which 52.8% had food security and 47.2% experienced food insecurity. In comparison, among women not up-to-date with screening (21.7%), only 44.9% had food security while a majority of 55.1% experienced food insecurity. In the multivariable model, food insecurity was associated with lower odds of being up-to-date with breast cancer screening (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.44–1.07) at a suggestive level of statistical significance. This observed difference may be explained by the correlation between food insecurity and other important factors known to be associated with screening behavior, including history of cancer and other socioeconomic metrics such as income amount, financial security, and housing instability. Conclusions: Food insecurity was inversely associated with being up-to-date with breast cancer screening. There is an imperative need to address breast cancer screening among low-income women in California, especially those who experience food insecurity. Impact: Future studies should combine food insecurity and breast cancer screening interventions to improve screening rates. Citation Format: Charlotte L. Bergheimer, Laura Fejerman. Association between breast cancer screening adherence and food insecurity in women with low income from California [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 A090.

Access to Primary Healthcare and Discussion of Memory Loss with a Healthcare Provider in Adults with Subjective Cognitive Decline: Does Race/Ethnicity Matter?

Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, p < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting.

Usual Source of Care and Contraceptive Use.

A high proportion of people in the United States at risk of unintended pregnancy also have limited primary care access. We pooled data for analyses from separate 2015-2017 and 2017-2019 waves of the National Survey of Family Growth. Multivariable logistic regression was used to estimate associations between the usual source of health care and self-reported use of a comprehensive range of contraceptive options, as well as alignment between patient preference and the current method. Compared with having a private doctor or Health Maintenance Organization, not having a usual source of care was associated with lower odds of using short-term hormonal methods (OR=0.54, 95% CI: 0.40-0.73, for an 11 percentage point lower rate); higher odds of using time-based methods (OR=1.47, 95% CI: 1.10-1.97, for a 6 percentage point higher rate); and higher odds of preferring a contraceptive method other than the one most recently used (OR=1.39, 95% CI: 1.01-1.90, for a 6 percentage point higher probability). Reliance on an emergency department as a usual source of care was not associated with contraceptive use or satisfaction with the method used. Reliance on urgent care was associated only with higher odds of using time-based methods (OR=1.60, 95% CI: 1.03-2.50, for a 7 percentage point higher rate). Clinic-based usual care was not associated with any differences in contraceptive use but was associated with preferring a contraceptive method other than the one most recently used (OR=1.65, 95% CI: 1.21-2.25, for an 8 percentage point higher probability). All sources of usual care can improve contraceptive access.

The Association Between Self-Reported Hearing Loss and Loss of Usual Source of Health Care Among Older Medicare Beneficiaries: Evidence From the National Health and Aging Trends Study.

The purpose of the study is to investigate the association of hearing loss (HL) with maintaining a usual source of care (USOC). In this study we implemented a time-to-event analysis using data from the National Health and Aging Trends Study (NHATS), a nationally representative study of older Medicare beneficiaries in the United States. The study sample included 2 114 older adults, aged 65+ years, 58.9% female, 20.4% Black, who reported having a USOC during the baseline round of NHATS and who remained community-dwelling during the 2011-2018 study period. Based on self-report measures at baseline, individuals' hearing status was classified into 3 categories: no HL, treated HL (hearing aids users), and untreated HL (nonhearing aid users who reported having hearing difficulties). Time-to-event was computed as the time elapsed between baseline and the study round in which the respondent first reported no longer having a USOC. Discrete-time proportional hazard models were estimated. In fully adjusted models, untreated HL at baseline was associated with a hazard ratio (HR) for losing one's USOC 1.60 (95% confidence interval: 1.01, 2.56) times higher than that of participants with no HL. We found no HR differences between the treated- and no-HL group. Untreated HL at baseline was associated with a higher probability of losing one's USOC over time. Noninvasive interventions such as hearing aids may be beneficial for maintaining a USOC.

The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups

BackgroundRacial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans).MethodsThis study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates—including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19—four sets of weighted binary logistic regressions were conducted.ResultsThe rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05).ConclusionOur study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.

Health vulnerabilities in female sex workers in Brazil, 2016.

Female sex workers (FSW) suffer stigma and discrimination that negatively impact their physical and mental health and affect access to health care services. This paper aims to describe selected health indicators among FSW in 12 Brazilian cities in 2016. Brazilian cross-sectional Biological Behavioral Surveillance Survey was conducted in 2016 among 4328 FSW recruited by respondent-driven sampling. The sample weighing was inversely proportional to participant’s network sizes and the seeds were excluded from the analysis. Health indicators were estimated with 95% confidence interval and included indicators of health status, symptoms of depression, antenatal care, pap smear coverage, signs and symptoms of sexually transmitted infection, contraception and regular condom use, number of births and children alive per women, human immunodeficiency virus and syphilis testing, usual source of care, and perception of discrimination. Most participants self-rated their health as very good/good (65.8%) and 27.7% were positively screened for major depressive disorder episode on Patient Health Questionnaire-2. Antenatal coverage was 85.8% and 62.3% of FSW had access to pap smear exam in the past 3 years. A total of 67.0% of FSW were using some contraceptive method at the time of the study. Male condom was the most common method (37.1%), followed by oral pill (28.9%). A total of 22.5% FSW had never been tested for HIV and the main reasons were “not feeling at risk” (40.4%) and “being afraid or ashamed” (34.0%). The vast majority of FSW used Brazilian National Health System as their usual source of health care (90.2%). Approximately one-fifth of the participants felt discriminated against or were treated worse for being FSW (21.4%) and only 24.3% disclose their sex work status in health services. The vulnerability of FSW is expressed in all health indicators. Indicators of health status, antenatal care, pap smear coverage, and contraception were worse than in the Brazilian population, and point out to the importance of increase FSW’s access to health care services. Also, stigma and discrimination emerged as an important barrier to FSW’s health care in all dimensions and need to be struggled.

Effects of family history of alcohol problems on alcohol consumption: Stronger for medically underserved men

Family history (FH), informed by genetics and family environment, can be used by practitioners for risk prediction. This study compares the associations of FH with alcohol outcomes for medically underserved (MUS) men and women with the associations for non-underserved individuals to assess the utility of FH as a screening tool for this high-priority group. Data were from 29,993 adult lifetime drinkers in the Wave 1 (2001−2002) and Wave 2 (2004–2005) National Epidemiologic Survey on Alcohol and Related Conditions. All variables except FH were measured at Wave 2. Dependent variables were 12-month alcohol consumption and alcohol use disorder (AUD). FH scores (FH-SCORE) measured the proportion of first- and second-degree biological relatives with alcohol problems. MUS status was defined by household income at or below 100% of the federal poverty line and participants reporting no usual source of health care. Multivariate linear and logistic regression models tested main and interaction effects. Models showed a significant interaction of FH-SCORE with MUS status (p < .01), with a stronger effect of FH on alcohol consumption for the MUS group. This moderating effect was weaker for women than for men (FH-SCORE x MUS x Sex three-way interaction: p < .01). AUD models showed a significant positive association with FH-SCORE (p < .001) but no association with MUS status and no significant interaction effects. In this sample of lifetime drinkers, FH was associated with higher alcohol consumption, especially for MUS men. These results encourage additional validation of FH scores to prioritize MUS adults at high risk for alcohol problems to receive preventive interventions.

Exploring Preventive Healthcare in a High-Risk Vulnerable Population.

This study describes preventive care behaviors and explores opportunities to deliver preventive sexual healthcare to a high-risk vulnerable population. Data from the National HIV Behavioral Surveillance (NHBS) system high-risk heterosexuals (HET) cycle (2019) in Houston, Texas, was used to describe preventive care utilization and assess the relationship between healthcare utilization and sociodemographic characteristics. More than 47% reported having no usual source of healthcare, and 94.6% reported receiving no non-HIV STI testing in the past 12 months. Additionally, many sociodemographic factors were associated with healthcare utilization and having a usual source of healthcare. Future efforts should be targeted at increasing preventive healthcare utilization among high-risk vulnerable populations as well as implementing more preventive sexual healthcare services in the community health centers where these populations most frequently encounter healthcare.

Disruption of Pediatric Emergency Department Use during the COVID-19 Pandemic.

There is evidence of substantial declines in pediatric emergency department (ED) utilization in the United States in the first several months of the coronavirus disease 2019 (COVID-19) pandemic. Less is known about whether utilization changed differentially for socioeconomically disadvantaged children. This study examined how changes in pediatric ED visits during the initial months of the COVID-19 pandemic differed by two markers of socioeconomic disadvantage: minoritized race (MR) (compared with non-Hispanic White [NHW]), and publicly insured (compared with privately insured). This study used electronic medical records from a large pediatric ED for the period January to June 2020. Three time periods in 2020 were compared with corresponding time periods in 2019. Changes in overall visits, visits for MR versus NHW children, and Medicaid-enrolled versus privately insured children were considered, and changes in the acuity mix of ED visits and share of visits resulting in inpatient admits were inspected. Compared with 2019, total ED visits declined in time period (TP) 1 and TP2 of 2020 (54.3%, 48.9%). Declines were larger for MR children (57.3%, 57.8%) compared with NHW children (50.5%, 39.3%), and Medicaid enrollees (56.5%, 52.0%) compared with privately insured (48.3%, 39.0%). The MR children group experienced steeper percentage declines in high-acuity visits and visits, resulting in inpatient admissions compared with NHW children. In contrast, there was little evidence of difference between TP0s of 2019 and 2020. The role of socioeconomic disadvantage and the potential effects on pediatric ED visits during COVID-19 is understudied. Because disadvantaged children sometimes lack access to a usual source of health care, this raises concerns about unmet health needs and worsening health disparities.

Abstract EP23: Age-related Disparities In Access To A Usual Source Of Healthcare Among Adults With Atherosclerotic Cardiovascular Disease: National Health And Nutrition Examination Survey 2013-2018

Introduction: Among patients with atherosclerotic cardiovascular disease (ASCVD), regular follow-up is integral to secondary prevention. Lack of a usual source of healthcare may contribute to healthcare disparities, particularly among young adults with ASCVD. Methods: Using pooled data from National Health and Nutrition Examination Survey (NHANES; 2013-2018), the prevalence of a usual healthcare source among US adults with ASCVD was estimated overall and by age (20-39 years, 40-64 years, 65+ years). Covariates for demographic, socioeconomic, and health-related characteristics were obtained. Logistic regression was used to determine the association between age and having a usual source of healthcare among US adults with ASCVD with adjustment for socioeconomic, demographic variables, and health-related variables. Results: Among all adults with ASCVD (weighted N= 55,501,274.0), 95.2% had a usual source of healthcare. Adults with a usual source of healthcare were older adults, had history of high cholesterol, and more healthcare visits in the prior 12 months, compared to those without a usual source. Among adults aged 20-39 years 85.8% had usual source of healthcare, compared to 93.6% of adults 40-64 years and 96.5% of adults 65+. After full adjustment, adults 40-64 years and 65+ were more likely to have a usual source of healthcare (OR 5.1, 95% CI [1.3,19.7]; OR 6.5, 95% CI [1.6,26.5]), compared to adults 20-39 years. Additionally, among adults with ASCVD food insecurity was associated with a lower prevalence of a usual source of healthcare. Discussion: The majority of US adults with ASCVD had access to a usual source of healthcare. However, fewer young adults with ASCVD had access to a usual source of health care. Younger adults represent a vulnerable population, and face barriers to care that differ from older patients. Regular access to a usual source of healthcare represents a modifiable factor impeding the care of younger adults with ASCVD.

Abstract P032: Initiating Hypertension Treatment To Prevent Incident Cardiovascular Disease: A Population Estimate Using The Cardiovascular Disease Policy Model

Background: Hypertension is a leading preventable cause of CHD, stroke, and heart failure (HF). WHO hypertension guidelines recommend initiating first dose medication in hypertensive adults with access to healthcare, yet many US adults with a usual source of care are not receiving treatment. We estimate the population impact of initiating hypertensive therapy in untreated US adults with uncontrolled blood pressure (BP) and access to usual healthcare on incident CVD. Methods: We used the CVD Policy Model, a dynamic state-transition model of CVD risk factors, events, and outcomes to simulate the impact over 10 years of treating uncontrolled BP in our target population of US adults 35-94 years of age with no prior CVD, baseline systolic BP ≥140mmHg, and no current hypertensive medication use, estimated from National Health and Nutrition Examination Survey years 2015-2018. We initiated first dose medication in the target population reporting access to a usual source of healthcare and at least two visits per year. We used the Law, Morris and Wald equation to estimate the systolic BP effect size for a standard first dose of medication. Results: Initiating hypertension medications in those with currently untreated but with regular healthcare access would prevent 214,000 incident CVD events in the US, a quarter of which (52,000) are incident heart failure (Table 1). First dose treatment (and maintenance) would be expected to reduce incident CHD by 9.1%, HF by 6.1%, ischemic stroke by 8.1%, and hemorrhagic stroke by 11.3% over the decade, compared to no treatment. Treatment of hypertension would have the greatest relative benefit in the prevention on incident CVD events in those younger than 65, compared with those over 65 years of age. Conclusion: In the US population with regular access to healthcare, initiating first dose medications for hypertension in those with elevated blood pressure but currently untreated would reduce incident CVD in both sexes and all age groups, with particular benefit for prevention in those less than 65 years of age.

Race/ethnic inequities in conjoint monitoring and screening for U.S. children 3 and under.

Non-White children with developmental disabilities are frequently identified later than White children and therefore miss out on opportunities for early intervention (EI). Recent research indicates that conjoint monitoring and screening is more strongly associated with EI receipt than monitoring or screening alone. To determine if there are racial/ethnic inequities in the conjoint receipt of monitoring and screening. A series of survey weighted and stratified logistic regression analyses were conducted on National Surveys of Children's Health (2016-2018) data with conjoint monitoring and screening, screening alone, monitoring alone, and non-receipt as outcomes for children aged 9-23 months of age. The primary predictor was child race/ethnicity (Black, Hispanic, Other, and White). Additional co-variates included child (e.g., Age), caretaker/family (e.g., poverty level), healthcare (e.g., usual source of healthcare), state EI policies, and city metropolitan status. Bivariate analyses indicated significant variation in conjoint monitoring and screening across racial/ethnic groups and covariates. Bivariate analyses showed that Black and Hispanic children had significantly lower odds of conjoint monitoring and screening receipt than White children. Multivariate analyses showed that this relationship was better accounted by co-variates. The health service variable, usual source of healthcare, had the strongest relationship with receipt of conjoint monitoring and screening. Black and Hispanic children are less likely to receive conjoint monitoring and screening than White children. Analyses investigating the role of usual source of healthcare seem particularly promising for understanding the sources of inequities in monitoring and screening receipt.

Healthcare access, utilization, and quality after a disaster: results from the Brumadinho Health Project.

In January 2019 a dam at the Córrego do Feijão mine suffered a catastrophic failure that killed 270 people and caused extensive damage. It is unknown how exposure to such a disaster might affect healthcare utilization. We assessed survey data from the Brumadinho Health Project, a cohort study that includes people who were exposed to the dam failure and two comparison groups: people unexposed to mining or the disaster and people from a mining community, but not exposed to the disaster. Main outcomes include any doctor visit or hospitalization in the past year, having a usual source of healthcare, having blood pressure and blood sugar checked, and being up to date with vaccinations, for adults 18 years and over. We used survey-weighted robust Poisson regression to assess differences between those exposed and the two comparison groups while controlling for confounders. In multivariable models, the exposed group had a 15% higher chance of having a doctor visit than the unexposed group. For hospitalization and reports of blood pressure and blood sugar assessments, there was no significant difference among any of the groups. The exposed group had a 24% higher chance and the unexposed mining community had a 143% higher chance of being up to date with immunizations, as compared to the unexposed group. There were some differences in healthcare utilization among individuals exposed to the dam failure. Continued monitoring of the situation is warranted, as the full consequences of such a traumatic event may take considerable time to unfold.

Reasons for Uncontrolled Blood Pressure Among US Adults: Data From the US National Health and Nutrition Examination Survey.

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Factors Associated With Not Having a Healthcare Visit in the Past Year Among US Adults With Hypertension: Data From NHANES 2013-2018.

Not having a healthcare visit in the past year has been associated with a higher likelihood of uncontrolled blood pressure (BP) among individuals with hypertension. We examined factors associated with not having a healthcare visit in the past year among US adults with hypertension using data from the US National Health and Nutrition Examination Survey 2013-2018 (n = 5,985). Hypertension was defined as systolic BP (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, or antihypertensive medication use. Having a healthcare visit in the past year was self-reported. Overall, 7.0% of US adults with hypertension reported not having a healthcare visit in the past year. Those without vs. with a healthcare visit in the past year were less likely to be aware they had hypertension (45.0% vs. 83.9%), to be taking antihypertensive medication (36.7% vs. 91.4%, among those who were aware they had hypertension), and to have controlled BP (SBP/DBP <140/90 mm Hg; 9.1% vs. 51.7%). After multivariable adjustment, not having a healthcare visit in the past year was more common among US adults without health insurance (prevalence ratio [PR]: 2.22; 95% confidence interval [CI] 1.68-2.95), without a usual source of healthcare (PR: 5.65; 95% CI 4.16-7.67), who smoked cigarettes (PR: 1.34; 95% CI 1.02-1.77), and with heavy vs. no alcohol consumption (PR: 1.55; 95% CI 1.16-2.08). Also, not having a healthcare visit in the past year was more common among those without diabetes or a history of atherosclerotic cardiovascular disease, and those not taking a statin. Interventions should be considered to ensure all adults with hypertension have annual healthcare visits.

40 Facemasks: Perceptions and Use in an Emergency Department Population During COVID-19

During the COVID-19 pandemic, the use of facemasks by the general population has become a significant issue despite evidence that shows that facemask use is associated with reduced transmission of SARS-CoV-2, the causative organism of COVID-19. We assessed beliefs, access, and practices of mask wearing across an ED population. This was a cross sectional survey of ED patients conducted from 12/14/20 - 2/22/21 at 15 geographically diverse safety net EDs. The survey asked questions regarding COVID-19 vaccine and the use of facemasks. In this analysis, the primary outcome was reporting the responses to survey questions regarding mask wearing practice and patient access to masks. Of 2513 patients approached, 2239 (89.1%) agreed to participate. The median age of respondents was 48 years (IQR 34 - 62). The race and ethnicity reported for participants were: 40% White, 29% Black, 24% Latinx and 5% Asian. All other categories each accounted for 1% or less of the respondents. 14.8% reported that they had previously been diagnosed with COVID-19. Most respondents (81%) had primary care doctors or clinics. Of those without primary care, 64% used the ED as their usual source of health care. 78% of respondents reported wearing masks “all of the time” and 17% reported wearing masks >50% of the time. Subjects with primary care providers (PCPs) were more likely to report wearing masks at least most of the time as compared to subjects without primary care (97% vs 92%) Those with no PCP reported more difficulties obtaining masks compared to those who have a PCP (13% vs 6%, p < 0.001). The primary reasons respondents cited for not wearing masks were that they do not believe that masks work, masks are uncomfortable, and masks make it hard to breathe. Subjects with a PCP and those without a PCP both reported that the most common source of masks was through purchasing at a store or pharmacy. Subjects without a PCP were more likely to get masks from a shelter or food bank as compared to those without a PCP (6.5% vs 2.1%). Surveys were administered exclusively in urban EDs, and there may be response bias towards mask wearing in the hospital setting. Overall, respondents in the study reported a high rate of facemask wearing. Having a PCP was associated with higher proportion of respondents who reported wearing a mask at least 50% of the time. Respondents without a PCP also reported greater barriers in obtaining masks than those with a PCP. The results of this study inform on the acceptance rate of facemask usage in a large population of ED patients primarily in an urban setting. Having a PCP provides opportunities for education and distribution of facemasks. There is an opportunity to increase facemask usage through increased education and availability.

Screening for Colorectal Cancer in the United States: Correlates and Time Trends by Type of Test.

It is strongly recommended that adults aged 50-75 years be screened for colorectal cancer. Recommended screening options include colonoscopy, sigmoidoscopy, CT colonography, guaiac fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), or the more recently introduced FIT-DNA (FIT in combination with a stool DNA test). Colorectal cancer screening programs can benefit from knowledge of patterns of use by test type and within population subgroups. Using 2018 National Health Interview Survey (NHIS) data, we examined colorectal cancer screening test use for adults aged 50-75 years (N = 10,595). We also examined time trends in colorectal cancer screening test use from 2010-2018. In 2018, an estimated 66.9% of U.S. adults aged 50-75 years had a colorectal cancer screening test within recommended time intervals. However, the prevalence was less than 50% among those aged 50-54 years, those without a usual source of health care, those with no doctor visits in the past year, and those who were uninsured. The test types most commonly used within recommended time intervals were colonoscopy within 10 years (61.1%), FOBT or FIT in the past year (8.8%), and FIT-DNA within 3 years (2.7%). After age-standardization to the 2010 census population, the percentage up-to-date with CRC screening increased from 61.2% in 2015 to 65.3% in 2018, driven by increased use of stool testing, including FIT-DNA. These results show some progress, driven by a modest increase in stool testing. However, colorectal cancer testing remains low in many population subgroups. These results can inform efforts to achieve population colorectal cancer screening goals.

The Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients Study

Study objectiveEmergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites, and willingness to get the vaccine as part of ED care.MethodsThis was a cross-sectional survey conducted from December 10, 2020, to March 7, 2021, at 15 safety net US EDs. Primary outcomes were COVID-19 vaccine hesitancy, reasons for vaccine hesitancy, and sites (including EDs) for potential COVID-19 vaccine receipt.ResultsOf 2,575 patients approached, 2,301 (89.4%) participated. Of the 18.4% of respondents who lacked a regular source of medical care, 65% used the ED as their usual source of health care. The overall rate of vaccine hesitancy was 39%; the range among the 15 sites was 28% to 58%. Respondents who lacked a regular source of medical care were more commonly vaccine hesitant than those who had a regular source of medical care (47% versus 38%, 9% difference, 95% confidence interval 4% to 14%). Other characteristics associated with greater vaccine hesitancy were younger age, female sex, Black race, Latinx ethnicity, and not having received an influenza vaccine in the past 5 years. Of the 61% who would accept a COVID-19 vaccine, 21% stated that they lacked a primary physician or clinic at which to receive it; the vast majority (95%) of these respondents would accept the COVID-19 vaccine as part of their care in the ED.ConclusionED patients who lack a regular source of medical care are particularly hesitant regarding COVID-19 vaccination. Most COVID-19 vaccine acceptors would accept it as part of their care in the ED. EDs may play pivotal roles in COVID-19 vaccine messaging and delivery to highly vulnerable populations.