scholarly journals Trends in Health Equity Among Children in the United States, 1997–2018

2021 ◽  
Author(s):  
Nathaniel W. Anderson ◽  
Frederick J. Zimmerman
Keyword(s):  
Health Equity ◽  
The United States ◽  
The Past ◽  
Individual Health ◽  
Income Disparities ◽  
Interview Survey ◽  
Reported Health ◽  
The Mean ◽  
Racial Ethnic ◽  
Indicator Score

Abstract Objectives Health equity is crucial to population health. To achieve this aim, extensive monitoring efforts beyond traditional disparities research are required. This analysis assesses trends in health equity for children from 1997 to 2018. Methods Health equity in a given year is calculated using a previously developed measure as the mean weighted departure of individual health from the best achievable level of health. This criterion is defined as the median health of the most socially privileged identifiable group: white, non-Latinx boys in upper-income households. Using more than 20 years of data from the National Health Interview Survey, we apply this methodology to six measures of child health: parent-reported health status, school days missed due to illness or injury in the past year, a strength and difficulties questionnaire score, emotional difficulties, a toddler mental health indicator score, and toddler depression. We separately calculate racial/ethnic and income disparities. Monte Carlo simulation is used to assess whether trends are statistically significant. Results Health equity among children increased gradually over the past 2 decades, with five of the six measures demonstrating upward trends. Improvements in health equity are stronger among younger children (age 0–3 and 4–7). Unlike previous work examining adults, both types of disparities narrowed over the study period. Conclusions for Practice Progress on health equity requires accountability to an objective metric. This analysis suggests some improvement over the past two decades, although these gains are under threat from potential decreases in government spending on programs affecting children and the COVID-19 pandemic.

scholarly journals Assessing Age-Friendly Community Progress: What Have We Learned?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 559-559
Author(s):  
Patricia Oh ◽  
Kathy Black
Keyword(s):  
Health Equity ◽  
Social Inclusion ◽  
The United States ◽  
Global Network ◽  
World Health ◽  
Evaluation Measures ◽  
The Past ◽  
Physical Environments ◽  
Reported Health ◽  
Health Organization

Abstract The Global Network of Age-friendly Cities and Communities has grown steadily over the past decade across the United States, however surprisingly little is known regarding their accomplishments to date. We utilized content analysis to assess the progress reported by American age-friendly communities (n = 30) that joined by end of year 2015 using the Age-Friendly Community Evidence-based Tool with expanded program evaluation measures including health equity as defined by the World Health Organization. We employed deductive analytic techniques to assess reported community performance in eleven thematic areas across the range of structures and processes that characterize age-friendly efforts. We found strong evidence in the areas of leadership and governance, harnessed resources, application of age-friendly framework, and in multisector collaboration as well as reported provisions. All of the communities reported health equity aims, particularly in promoting accessible physical environments and social inclusion efforts. Our analysis further revealed areas for continued improvement.

scholarly journals Equity and length of lifespan are not the same

2016 ◽  
Vol 113 (30) ◽  
pp. 8420-8423 ◽  
Author(s):  
Benjamin Seligman ◽  
Gabi Greenberg ◽  
Shripad Tuljapurkar
Keyword(s):  
Life Expectancy ◽  
Health Equity ◽  
Causes Of Death ◽  
The United States ◽  
Past Century ◽  
The Past ◽  
The United Kingdom ◽  
Mortality Improvement ◽  
Over Time ◽  
Age Of Death

Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

scholarly journals Disparities in Cancer-Related Mortality and Long-Term Survival in Adolescent and Young Adults with Hodgkin Lymphoma: A Population-Level Analysis across the United States

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4866-4866
Author(s):  
Justine M. Kahn ◽  
Theresa H.M. Keegan ◽  
Elysia Alvarez ◽  
Lori S Muffly ◽  
Helen Parsons ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Diagnosis ◽  
The United States ◽  
Term Survival ◽  
The Past ◽  
After Cancer ◽  
Year 2000 ◽  
Racial Ethnic ◽  
Cause Specific Survival

Abstract Background: Hodgkin lymphoma (HL) is one of the most common, and one of the most curable cancers in adolescents and young adults (AYAs) (15-39 years). Despite excellent outcomes in the majority of patients, the burden of long-term morbidity and mortality persists. Prior analyses of patients treated for HL before the year 2000 have reported mortality rates as high as 30% by 20 years. Further, this mortality risk has historically differed across different racial and ethnic groups. Over the past decade, cooperative groups have expanded the use of risk-adapted, response-based treatment in an effort to maintain high cure rates, while simultaneously reducing the burden of late effects. We examined long-term survival in AYAs with HL treated after the year 2000. Methods: We used the National Cancer Institute Surveillance, Epidemiology, and End Results registry data for 18 regions in the United States (SEER18) to examine survival in AYAs with a confirmed diagnosis of HL between 2000 and 2015. We obtained overall and cause-specific survival estimates for each year after cancer diagnosis (up to 15 years) for each racial/ethnic group with corresponding 95% confidence intervals. From these yearly survival estimates, we calculated the percentage of deaths not attributed to HL at 10- and 15-years after cancer diagnosis. Results: The final analysis included 16,868 HL patients. Racial/ethnic subgroups included: non-Hispanic white (NHW; 11,016, 65%), Hispanic (2,753, 16%), non-Hispanic black (NHB; 2,131, 13%), and Asian/Pacific Islander (API; 968, 6%) AYAs with HL. Across the full cohort, the 10-year and 15-year overall survival probabilities were 90% (95% confidence interval [95%CI]: 89 - 91) and 87% (95% CI: 86 - 88), respectively. At 10- and 15-years, overall survival was highest for NHWs (10-year: 92%: 15-year: 88%) and APIs (91%; 86%) compared to Hispanics (87%; 85%) and NHBs (82%; 78%). Overall survival, cause-specific survival, and percentage of deaths not attributed to HL by race/ethnicity are presented in the Figure. In the first year after diagnosis, 22% of deaths were due to causes other than primary disease, with the percentage of deaths not attributed to HL higher in NHWs and APIs than Hispanics and NHBs. At most time points after cancer diagnosis, a higher proportion of NHW (vs. NHB, Hispanic and API) patients died from causes other than HL. By 10 years after diagnosis, 25% of NHW patients died due to causes other than HL, vs. 20% in API, 17% in NHB, and 15% in Hispanic patients. By 15 years, 33% of all deaths were not attributed to HL. This was observed most dramatically in the NHW cohort in whom 40% of all deaths were not HL-related, compared to 24% of deaths in the NHB cohort and 26% - 27% of deaths in the Hispanic and API groups. Conclusion: In AYAs diagnosed with HL between 2000 and 2015, NHB patients had worse survival compared with NHW and API patients. The higher probability of survival in NHW patients was accompanied by a consistently higher proportion of non-cancer related death in this cohort both 10- years and 15-years after diagnosis. Studies are needed to evaluate risk factors for both short- and long-term mortality in AYAs, and to examine how these risks differ across racial/ethnic groups. Findings also suggest that despite increasing use of response-adapted therapy over the past two decades, all AYAs with HL remain at risk of death in the decades following therapy, further highlighting the need for long-term follow-up of this at-risk patient population. Figure. Figure. Disclosures Muffly: Adaptive Biotechnologies: Research Funding; Shire Pharmaceuticals: Research Funding.

Sleep health in U.S. adults before and during the COVID-19 pandemic

2020 ◽  
Author(s):  
Garrett Hisler ◽  
Jean Twenge
Keyword(s):  
Sleep Duration ◽  
Representative Sample ◽  
The United States ◽  
Future Research ◽  
Racial Groups ◽  
Sleep Health ◽  
The Past ◽  
Falling Asleep ◽  
Interview Survey ◽  
Nationally Representative

Understanding how health has changed in response to the COVID-19 pandemic is critical to reducing and recovering from the pandemic. This study focused on how sleep health in the United States may have been impacted by the COVID-19 pandemic. Sleep duration and number of days in the past week with difficulty falling asleep, difficulty staying asleep, and not feeling rested in a nationally representative sample of U.S. adults collected before the COVID-19 outbreak (2018 National Health Interview Survey, n = 19,433) was compared to the same measures in a nationally representative sample of U.S. adults collected during the COVID-19 outbreak (2020 Luc.id, n = 2,059). Sleep duration was slightly shorter in 2020 than 2018 (d = -.05). Moreover, the prevalence of insufficient sleep duration (RR = 1.20) and the number of days with difficulty falling asleep (d = .54), difficulty staying asleep (d =.36), and not feeling rested (d = .14) was greater in 2020 than 2018. Twice as many people in 2020 reported experiencing at least one night of difficulty falling asleep (RR = 1.95) or staying asleep (RR = 1.75). Adults younger than 60 and those who belonged to an Asian racial group had larger differences than other age and racial groups between 2018 and 2020. Thus, sleep health in U.S. adults was worse in 2020 than in 2018, particularly in younger and Asian adults. Findings highlight sleep as target in future research and interventions seeking to understand and reduce the effects of the spread of COVID-19.

scholarly journals The “No Wrong Door” Approach to HIV Testing: Results From a Statewide Retail Pharmacy–Based HIV Testing Program in Virginia, 2014-2016

2018 ◽  
Vol 133 (2_suppl) ◽  
pp. 34S-42S ◽  
Author(s):  
Bryan Collins ◽  
Heather Bronson ◽  
Fatima Elamin ◽  
Lauren Yerkes ◽  
Elaine Martin
Keyword(s):  
Hiv Testing ◽  
Ethnic Minority ◽  
Census Data ◽  
The United States ◽  
Poverty Level ◽  
Confirmatory Testing ◽  
The Mean ◽  
Mean Cost ◽  
Racial Ethnic ◽  
Test Result

Objective: As part of the Care and Prevention in the United States Demonstration Project (2012-2016), which aimed to reduce HIV-related morbidity and mortality among racial/ethnic minority groups in 8 states, the Virginia Department of Health (VDH) funded Walgreens to provide HIV testing in retail pharmacies in areas with large racial/ethnic minority communities and high rates of poverty. We describe this program and summarize its outcomes. We hypothesized that (1) offering walk-in HIV testing outside of traditional business hours and alongside other point-of-care tests in retail pharmacies would increase rates of first-time testers and (2) using data on social determinants of health associated with higher rates of HIV infection to locate test sites would increase the identification of people who were previously undiagnosed. Methods: Using 2010 US Census data and 2007-2011 five-year population estimates from the American Community Survey, VDH selected 32 Walgreens stores located in census tracts where at least 30% of the population was black and/or Hispanic/Latino and/or where at least 20% of the population was living at or below the federal poverty level. Pharmacists administered the INSTI HIV-1/HIV-2 Rapid Antibody Test. Clients with a reactive test result were linked to confirmatory testing and medical care. Results: Between June 1, 2014, and September 29, 2016, Walgreens pharmacists performed HIV tests on 3630 clients, of whom 1668 (46.0%) had either never been tested or were unsure if they had been tested. Of all clients tested, 30 (0.8%) had a reactive test result. Of 26 clients who also had positive confirmatory testing, 22 (84.6%) were linked to care. The mean cost per person tested was $41.79, and the mean cost per reactive result was $5057. Conclusions: Retail pharmacies may be an effective venue for those who have never been tested for HIV to access HIV testing, particularly if the pharmacies are located in priority areas or where community-based organizations are unable to operate.

Measuring the Improving Quality of Outpatient Care in Medical Oncology Practices in the United States

2013 ◽  
Vol 31 (11) ◽  
pp. 1471-1477 ◽  
Author(s):  
Michael N. Neuss ◽  
Jennifer L. Malin ◽  
Stephanie Chan ◽  
Pamela J. Kadlubek ◽  
John L. Adams ◽  
...  
Keyword(s):  
Clinical Information ◽  
The United States ◽  
Measuring Process ◽  
The Past ◽  
The Mean ◽  
Highly Correlated ◽  
American Society ◽  
Oncology Practice ◽  
Over Time

Purpose The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement. Methods The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement. Results Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time. Conclusion Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.

scholarly journals Differences in Obesity Among Men of Diverse Racial and Ethnic Background

2015 ◽  
Vol 11 (4) ◽  
pp. 984-989 ◽  
Author(s):  
Sarah E. Hill ◽  
Caryn Bell ◽  
Janice V. Bowie ◽  
Elizabeth Kelley ◽  
Debra Furr-Holden ◽  
...  
Keyword(s):  
United States ◽  
Mexican American ◽  
Ethnic Disparities ◽  
Risk Groups ◽  
The United States ◽  
Obesity Prevalence ◽  
Hispanic Men ◽  
Interview Survey ◽  
The Relationship ◽  
Racial Ethnic

Racial/ethnic disparities exist in obesity prevalence among men, with Hispanic men exhibiting the highest prevalence compared with non-Hispanic White and non-Hispanic Black men. Most studies do not parse out Hispanic groups; therefore, it is unclear whether the increases in obesity rates among Hispanic men applies to all groups or if there are particular groups of Hispanic men that are driving the increase. The goal of this study is to examine the variations in obesity among men of diverse racial/ethnic backgrounds and determine if obesity is affected by nativity. The data used in this study were from 11 years (2002-2012) of the National Health Interview Survey. Logistic regression was used to examine the relationship between race/ethnicity, obesity, and nativity. After adjusting for covariates, there are differences in obesity prevalence, with the largest prevalence among Puerto Rican men and Mexican American men. Consistent with previous literature, it has been suggested that men born in the United States are more likely to be obese than men born outside the United States. This study underscores the importance of distinguishing Hispanic groups when examining obesity, and provides information for future, targeted intervention strategies related to obesity among high-risk groups.

scholarly journals Racial and Ethnic Disparities in Health of Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018

2020 ◽  
Author(s):  
Shiwani Mahajan ◽  
César Caraballo ◽  
Yuan Lu ◽  
Dorothy Massey ◽  
Karthik Murugiah ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Health Status ◽  
Health Equity ◽  
National Health Interview Survey ◽  
Functional Limitation ◽  
Ethnic Disparities ◽  
Insufficient Sleep ◽  
Interview Survey ◽  
Racial Ethnic ◽  
Hispanic White

ABSTRACTImportanceThirty-five years ago, the Heckler Report described health disparities among minority populations in the US. Since then, policies have been implemented to address these disparities. However, a recent evaluation of progress towards improving the health and health equity among US adults is lacking.ObjectivesTo evaluate racial/ethnic disparities in the physical and mental health of US adults over the last 2 decades.DesignCross-sectional.SettingNational Health Interview Survey data, years 1999–2018.ParticipantsAdults aged 18–85 years.ExposureRace/ethnicity subgroups (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic).Main outcome and measuresProportion of adults reporting poor/fair health status, severe psychological distress, functional limitation, and insufficient sleep. We also estimated the gap between non-Hispanic White and the other subgroups for these four outcomes.ResultsWe included 596,355 adults (mean age 46 years, 51.8% women), of which 69.7%, 13.8%, 11.8% and 4.7% identified as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian, respectively. Between 1999 and 2018, Black individuals fared worse on most measures of health, with 18.7% (95% CI 17.1–20.4) and 41.1% (95% CI 38.7–43.5) reporting poor/fair health and insufficient sleep in 2018 compared with 11.1% (95% CI 10.5– 11.7) and 31.2% (95% CI 30.3–32.1) among White individuals. Notably, between 1999–2018, there was no significant decrease in the gap in poor/fair health status between White individuals and Black (−0.07% per year, 95% CI −0.16–0.01) and Hispanic (−0.03% per year, 95% CI −0.07– 0.02) individuals, and an increase in the gap in sleep between White individuals and Black (+0.2% per year, 95% CI 0.1–0.4) and Hispanic (+0.3% per year, 95% CI 0.1–0.4) individuals. Additionally, there was no significant decrease in adults reporting poor/fair health status and an increase in adults reporting severe psychological distress, functional limitation, and insufficient sleep.Conclusions and RelevanceThe marked racial/ethnic disparities in health of US adults have not improved over the last 20 years. Moreover, the self-perceived health of US adults worsened during this time. These findings highlight the need to re-examine the initiatives seeking to promote health equity and improve health.

scholarly journals Nativity and Country of Origin Variations in Life Expectancy With Functional Limitations Among Older Hispanics in the United States

2020 ◽  
Vol 42 (7-8) ◽  
pp. 199-207 ◽  
Author(s):  
Marc A. Garcia ◽  
Adriana M. Reyes ◽  
Catherine García ◽  
Chi-Tsun Chiu ◽  
Grecia Macias
Keyword(s):  
United States ◽  
Life Expectancy ◽  
National Health Interview Survey ◽  
Puerto Ricans ◽  
Functional Limitations ◽  
Country Of Origin ◽  
The United States ◽  
Foreign Born ◽  
Interview Survey ◽  
Racial Ethnic

This study examined racial/ethnic, nativity, and country of origin differences in life expectancy with and without functional limitations among older adults in the United States. We used data from the National Health Interview Survey (1999–2015) to estimate Sullivan-based life tables of life expectancies with functional limitations and without functional limitations by sex for U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, foreign-born Cubans, and U.S.-born Whites. We find that Latinos exhibit heterogeneous life expectancies with functional limitations. Among females, U.S.-born Mexicans, foreign-born Mexicans, and foreign-born Cubans spend significantly fewer years without functional limitations, whereas island-born Puerto Ricans spend more years with functional limitations. For men, U.S.-born Puerto Ricans were the only Latino subgroup disadvantaged in the number of years lived with functional limitations. Conversely, foreign-born Cubans spend significantly fewer years without functional limitations. To address disparities in functional limitations, we must consider variation in health among Latino subgroups.

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