Disparities in Obstetric Readmissions: A Multistate Analysis, 2007–2014

2021 ◽  
Author(s):  
Kathy C. Matthews ◽  
Virginia E. Tangel ◽  
Sharon E. Abramovitz ◽  
Laura E. Riley ◽  
Robert S. White
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Hospital Readmissions ◽  
Determinants Of Health ◽  
Median Income ◽  
Black Patients ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
White Patients

Background Hospital readmissions are generally higher among racial-ethnic minorities and patients of lower socioeconomic status. However, this has not been widely studied in obstetrics. Objective The aim of the study is to determine 30-day postpartum readmission rates by patient-level social determinants of health: race ethnicity, primary insurance payer, and median income, independently and as effect modifiers. Study Design Using state inpatient databases from the health care cost and utilization project from 2007 to 2014, we queried all deliveries. To produce accurate estimates of the effects of parturients' social determinants of health on readmission odds while controlling for confounders, generalized linear mixed models (GLMMs) were used. Additional models were generated with interaction terms to highlight any associations and their effect on the outcome. Adjusted odds ratios (aOR) with 95% confidence intervals are reported. Results There were 5,129,867 deliveries with 79,260 (1.5%) 30-day readmissions. Of these, 947 (1.2%) were missing race ethnicity. Black and Hispanic patients were more likely to be readmitted within 30 days of delivery, as compared with White patients (p < 0.001 and p < 0.05, respectively). Patients with government insurance were more likely to be readmitted than those with private insurance (p < 0.001). Patients living in the second quartile of median income were also more likely to be readmitted than those living in other quartiles (p < 0.05). Using GLMMs, we observed that Black patients with Medicare were significantly more likely to get readmitted as compared with White patients with private insurance (aOR 2.78, 95% CI 2.50–3.09, p < 0.001). Similarly, Black patients living in the fourth (richest) quartile of median income were more likely to get readmitted, even when compared with White patients living in the first (poorest) quartile of median income (aOR 1.48, 95% CI 1.40–1.57, p < 0.001). Conclusion Significant racial-ethnic disparities in obstetric readmissions were observed, particularly in Black patients with government insurance and even in Black patients living in the richest quartile of median income. Key Points

scholarly journals The Relationship between Social Determinants of Health and Utilization of Tertiary Rhinology Care

2017 ◽  
Vol 31 (6) ◽  
pp. 376-381 ◽  
Author(s):  
Madeleine B. Samuelson ◽  
Rakesh K. Chandra ◽  
Justin H. Turner ◽  
Paul T. Russell ◽  
David O. Francis
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Tertiary Care ◽  
College Education ◽  
Determinants Of Health ◽  
Insurance Status ◽  
Median Income ◽  
Care Hospital ◽  
Davidson County

Background Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care. Methods All adult patients diagnosed with CRS by rhinologists at a single tertiary care hospital were identified (2010–2014). Patient characteristics (age, gender, race, insurance status) were compared with population-level data from the hospital and from Davidson County, Tennessee, which includes Nashville. Rhinology utilization rates were calculated for each ZIP code within the county. The association between determinants of health (race, insurance status, education, median income) and tertiary rhinology utilization were measured by using multivariable regression analyses. Results A total of 1341 unique patients with CRS (median age, 50 years; 55% women, 80%> white, 82%> with private insurance) from Davidson County used tertiary rhinology services. These patients were significantly older and more likely to be female, white, and privately insured than patients seen hospital-wide or among the population of Davidson County (p <0.001). Utilization rates were higher in ZIP codes with a lower proportion of minorities, a higher median income, and higher rates of private insurance and college education. However, in adjusted analysis, only attainment of a college education was independently associated with utilization of tertiary rhinology services. Utilization was 4%> higher for every V/o increase in college-educated population (coefficient 0.04 [95%o CI, 0.01–0.07]; p = 0.01). Conclusion Results of this study indicated that some social determinants of health (race, income, educational level, insurance status) do affect utilization of tertiary rhinology services. Higher utilization among those with higher income and educational attainment are contradictory to the data, which indicated that lower socioeconomic status was associated with a higher CRS rate. Further study is required to understand the disparities in rhinology utilization rates.

scholarly journals Trends in the investigation of social determinants of health: selected themes and methods

2011 ◽  
Vol 27 (1) ◽  
pp. 183-189 ◽  
Author(s):  
Roger Keller Celeste ◽  
João Luiz Bastos ◽  
Eduardo Faerstein
Keyword(s):  
Public Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Structural Equation ◽  
Determinants Of Health ◽  
Equation Modeling ◽  
New Methods ◽  
Causal Diagrams ◽  
Pubmed Database ◽  
Race Ethnicity

We analyze bibliometric trends of topics relevant to the epidemiologic research of social determinants of health. A search of the PubMed database, covering the period 1985-2007, was performed for the topics: socioeconomic factors, sex, race/ethnicity, discrimination/prejudice, social capital/support, lifecourse, income inequality, stress, behavioral research, contextual effects, residential segregation, multilevel modeling, regression based indices to measure inequalities, and structural equation modeling/causal diagrams/path analysis. The absolute, but not the relative, frequency of publications increased for all themes. Total publications in PubMed increased 2.3 times, while the subsets of epidemiology/public health and social epidemiologic themes/methods increased by factors of 5.3 and 5.2, respectively. Only multilevel and contextual analyses had a growth over and above that observed for epidemiology/public health. We conclude that there is clearly room for wider use of established techniques, and for new methods to emerge when they satisfy theoretical needs.

scholarly journals Impact of Social Determinants of Health and Demographics on Refill Requests by Medicare Patients Using a Conversational Artificial Intelligence Text Messaging Solution: Cross-Sectional Study

10.2196/15771 ◽  
2019 ◽  
Vol 7 (11) ◽  
pp. e15771 ◽  
Author(s):  
Rena Brar Prayaga ◽  
Ridhika Agrawal ◽  
Benjamin Nguyen ◽  
Erwin W Jeong ◽  
Harmony K Noble ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Chronic Disease ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Patient Population ◽  
Text Messaging ◽  
Determinants Of Health ◽  
English Speakers ◽  
Kaiser Permanente ◽  
Race Ethnicity

Background Nonadherence among patients with chronic disease continues to be a significant concern, and the use of text message refill reminders has been effective in improving adherence. However, questions remain about how differences in patient characteristics and demographics might influence the likelihood of refill using this channel. Objective The aim of this study was to evaluate the efficacy of an SMS-based refill reminder solution using conversational artificial intelligence (AI; an automated system that mimics human conversations) with a large Medicare patient population and to explore the association and impact of patient demographics (age, gender, race/ethnicity, language) and social determinants of health on successful engagement with the solution to improve refill adherence. Methods The study targeted 99,217 patients with chronic disease, median age of 71 years, for medication refill using the mPulse Mobile interactive SMS text messaging solution from December 2016 to February 2019. All patients were partially adherent or nonadherent Medicare Part D members of Kaiser Permanente, Southern California, a large integrated health plan. Patients received SMS reminders in English or Spanish and used simple numeric or text responses to validate their identity, view their medication, and complete a refill request. The refill requests were processed by Kaiser Permanente pharmacists and support staff, and refills were picked up at the pharmacy or mailed to patients. Descriptive statistics and predictive analytics were used to examine the patient population and their refill behavior. Qualitative text analysis was used to evaluate quality of conversational AI. Results Over the course of the study, 273,356 refill reminders requests were sent to 99,217 patients, resulting in 47,552 refill requests (17.40%). This was consistent with earlier pilot study findings. Of those who requested a refill, 54.81% (26,062/47,552) did so within 2 hours of the reminder. There was a strong inverse relationship (r10=−0.93) between social determinants of health and refill requests. Spanish speakers (5149/48,156, 10.69%) had significantly lower refill request rates compared with English speakers (42,389/225,060, 18.83%; X21 [n=273,216]=1829.2; P<.001). There were also significantly different rates of refill requests by age band (X26 [n=268,793]=1460.3; P<.001), with younger patients requesting refills at a higher rate. Finally, the vast majority (284,598/307,484, 92.23%) of patient responses were handled using conversational AI. Conclusions Multiple factors impacted refill request rates, including a strong association between social determinants of health and refill rates. The findings suggest that higher refill requests are linked to language, race/ethnicity, age, and social determinants of health, and that English speakers, whites, those younger than 75 years, and those with lower social determinants of health barriers are significantly more likely to request a refill via SMS. A neural network–based predictive model with an accuracy level of 78% was used to identify patients who might benefit from additional outreach to narrow identified gaps based on demographic and socioeconomic factors.

Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

2018 ◽  
Vol 35 (01) ◽  
pp. 090-095 ◽  
Author(s):  
Mingyang Gray ◽  
Joseph Rousso ◽  
Matthew Hirsch ◽  
Joshua Rosenberg ◽  
Collin Rozanski
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Surgical Techniques ◽  
Determinants Of Health ◽  
Surgical Approaches ◽  
Delivery Of Care ◽  
Score Improvement ◽  
Significant Difference ◽  
Patient Reported

AbstractSocial determinants of health have been widely studied throughout medicine; however, their role relating to functional rhinoplasty has not been previously evaluated. The records of 178 patients who underwent functional rhinoplasty in a single health network from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score was used to assess patient-reported symptoms, and patients with both preoperative and postoperative NOSE scores were included in this study. Basic demographics and surgical techniques were also collected. Differences between NOSE scores and surgical approaches to functional rhinoplasty on the basis of insurance type were measured. One hundred and sixteen patients were included for analysis, the mean age was 34.7 years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%) patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean, SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE scores or postoperative improvement in NOSE scores between patients with different health insurance. Furthermore, there was no statistically significant difference in surgical approaches. The majority of patients receiving functional rhinoplasty had private insurance. Medicaid patients trended toward a greater NOSE score improvement after functional rhinoplasty, but also had a closer association with a history of nasal trauma and prior surgery. Future study is needed to better understand the association between socioeconomic status and disparities in care. Understanding how social determinants of health affect patients may reveal potential inherent biases, improve delivery of care, and translate to better patient outcomes.

Social Determinants of Health May Predict End of Life Portable Orders for Life Sustaining Treatment Form Completion and Treatment Selections

2021 ◽  
pp. 104990912110415
Author(s):  
Ladawna Gievers ◽  
Sheevaun Khaki ◽  
Abby Dotson ◽  
Zunqiu Chen ◽  
Robert C. Macauley ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
End Of Life ◽  
Social Determinants ◽  
Private Insurance ◽  
Determinants Of Health ◽  
Insurance Status ◽  
Completion Rates ◽  
Full Treatment ◽  
Life Sustaining Treatment ◽  
Eol Care

Background: End of life (EOL) care planning is important for aging adults given the growing prevalence of chronic medical conditions in the US. The Portable Orders for Life Sustaining Treatment (POLST) program promotes communication between clinicians and patients with advanced illness about EOL treatment preferences. Despite growing resources for EOL care, utilization remains unequal based on social determinants of health (SDOH), including race, language, urbanization, and education. We evaluated the relationship between POLST form selections and completion rates and SDOH. Methods: Oregon POLST Registry and American Community Survey data from 2013 to 2017 were analyzed retrospectively. POLST form completion rates and selections, and various SDOH, including age, income, insurance status, urbanization, etc. were recorded. Data were merged based on ZIP codes and analyzed using χ2 or Wilcoxon-Mann-Whitney tests. Logistic regression was performed. Results: 127,588 POLST forms from 319 ZIP codes were included. POLST form completion rates were highest among urban ZIP codes, and urban registrants more often selected CPR and full treatment. ZIP codes with higher incomes tended to select CPR. ZIP codes with higher rates of private insurance completed POLST forms, and selected CPR and full treatment more frequently. ZIP codes with higher rates of Bachelor’s degrees (or higher) completed POLST forms and selected full treatment more frequently. Conclusions: Various SDOH-specifically, urbanization, insurance status, income level and educational level achieved-may influence POLST form completion rates and selections. The expanding socioeconomic diversity and growth of urban communities, highlight the need for broader access to EOL planning and POLST.

Abstract P449: The Impact of Race and Social Determinants of Health on Imaging Biomarkers in Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kristie Bauman ◽  
Shashank Agarwal ◽  
Shadi Yaghi ◽  
Ariane Lewis ◽  
Aaron Lord ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Education Level ◽  
Determinants Of Health ◽  
Imaging Biomarkers ◽  
Median Income ◽  
Black Race ◽  
History Of ◽  
The Brain ◽  
Zip Code

Introduction: The association between race and white matter hyperintensities (WMH) and cerebral microbleeds in patients with intracerebral hemorrhage (ICH) is controversial. We examined the relationship between race and social determinants of health with WMH and microbleeds in ICH. Methods: We performed a retrospective study of patients at a tertiary care hospital between 2013 and 2020 who presented with ICH and underwent MRI of the brain. MRIs were evaluated for the presence of microbleeds and WMH severity (defined by the Fazekas scale; severe WMH defined as Fazekas 3). We assessed for an association of sex, race, ethnicity, employment status, median household income by zip code, education level, and insurance status with the severity of WMH or presence of microbleeds. Results: We identified 105 patients (median age 65.5 (IQR 53-76); 51% females; 13.2% Black) with ICH who had an MRI of the brain. Median ICH score was 1 [IQR 0-2] and median hematoma size was 15.9 ml (SD 19.7). High school graduation was the highest education level in 13.2%, and 57.5% had private insurance. Median income by zip code was $87,667 (IQR $65,900-$117,923). Severe WMH was observed in 19.8% and 52.8% of patients had microbleeds. There was no significant difference in sex, insurance status or median income for patients with or without severe WMH nor those with or without microbleeds. Severe WMH was more common among older patients (p=0.001), Black patients (p=0.03), patients with hypertension (p=0.03), and those with lower levels of education (p=0.03). In multivariable analyses, Black race was associated with severe WMH when adjusting for age and history of hypertension (OR 6.13 95% CI 1.14-25.98, p=0.01) but the effect size attenuated and the association disappears when adding education level to the model (OR 3.38 95% CI 0.48-23.76, p = 0.2). Age and history of hypertension were associated with presence of microbleeds (p<0.01 for both), but there was no association between presence of microbleeds and Black race or education level. Conclusion: Although Black race was associated with severe WMH, this association did not remain after adjusting for level of education. Our findings suggest that social determinants of health can modify the association between race and imaging biomarkers of ICH.

scholarly journals Racial, Ethnic, and Socioeconomic Factors Result in Disparities in Outcome Among Children with Acute Lymphoblastic Leukemia Not Fully Attenuated By Disease Prognosticators: A Children's Oncology Group (COG) Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 211-211
Author(s):  
Sumit Gupta ◽  
David T. Teachey ◽  
Meenakshi Devidas ◽  
Yunfeng Dai ◽  
Richard Aplenc ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Advisory Committees ◽  
Black Patients ◽  
Increased Risk ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Subsequent Addition ◽  
Hispanic White ◽  
White Patients

Abstract Introduction: Health disparities are major issue for racial, ethnic, and socioeconomically disadvantaged groups. Though outcomes in childhood acute lymphoblastic leukemia (ALL) have steadily improved, identifying persistent disparities is critical. Prior studies evaluating ALL outcomes by race or ethnicity have noted narrowing disparities or that residual disparities are secondary to differences in leukemia biology or socioeconomic status (SES). We aimed to identify persistent inequities by race/ethnicity and SES in childhood ALL in the largest cohort ever assembled for this purpose. Methods: We identified a cohort of newly-diagnosed patients with ALL, age 0-30.99 years who were enrolled on COG trials between 2004-2019. Race/ethnicity was categorized as non-Hispanic white vs. Hispanic vs. non-Hispanic Black vs. non-Hispanic Asian vs. Non-Hispanic other. SES was proxied by insurance status: United States (US) Medicaid (public health insurance for low-income individuals) vs. US other (predominantly private insurance) vs. non-US patients (mainly jurisdictions with universal health insurance). Event-free and overall survival (EFS, OS) were compared across race/ethnicity and SES. The relative contribution of disease prognosticators (age, sex, white blood cell count, lineage, central nervous system status, cytogenetics, end Induction minimal residual disease) was examined with Cox proportional hazard multivariable models of different combinations of the three constructs of interest (race/ethnicity, SES, disease prognosticators) and examining hazard ratio (HR) attenuation between models. Results: The study cohort included 24,979 children, adolescents, and young adults with ALL. Non-Hispanic White patients were 13,872 (65.6%) of the cohort, followed by 4,354 (20.6%) Hispanic patients and 1,517 (7.2%) non-Hispanic Black patients. Those insured with US Medicaid were 6,944 (27.8%). Five-year EFS (Table 1) was 87.4%±0.3% among non-Hispanic White patients vs. 82.8%±0.6% [HR 1.37, 95 th confidence interval (95CI) 1.26-1.49; p&lt;0.0001] among Hispanic patients and 81.9%±1.2% (HR 1.45, 95CI 1.28-1.56; p&lt;0.0001) among non-Hispanic Black patients. Outcomes for non-Hispanic Asian patients were similar to those of non-Hispanic White patients. US patients on Medicaid had inferior 5-year EFS as compared to other US patients (83.2%±0.5% vs. 86.3%±0.3%, HR 1.21, 95CI 1.12-1.30; p&lt;0.0001) while non-US patients had the best outcomes (5-year EFS 89.0%±0.7%, HR 0.78, 95CI 0.71-0.88; p&lt;0.0001). There was substantial imbalance in traditional disease prognosticators (e.g. T-cell lineage) across both race/ethnicity and SES, and of race/ethnicity by SES. For example, T-lineage ALL accounted for 17.6%, 9.4%, and 6.6% of Non-Hispanic Black, Non-Hispanic White, and Hispanic patients respectively (p&lt;0.0001). Table 2 shows the multivariable models and illustrates different patterns of HR adjustment among specific racial/ethnic and SES groups. Inferior EFS among Hispanic patients was substantially attenuated by the addition of disease prognosticators (HR decreased from 1.37 to 1.17) and further (but not fully) attenuated by the subsequent addition of SES (HR 1.11). In contrast, the increased risk among non-Hispanic Black children was minimally attenuated by both the addition of disease prognosticators and subsequent addition of SES (HR 1.45 to 1.38 to 1.32). Similarly, while the superior EFS of non-US insured patients was substantially attenuated by the addition of race/ethnicity and disease prognosticators (HR 0.79 to 0.94), increased risk among US Medicaid patients was minimally attenuated by the addition of race/ethnicity or disease prognosticators (HR 1.21 to 1.16). OS disparities followed similar patterns but were consistently worse than in EFS, particularly among patients grouped as non-Hispanic other. Conclusions: Substantial disparities in survival outcomes persist by race/ethnicity and SES in the modern era. Our findings suggest that reasons for these disparities vary between specific disadvantaged groups. Additional work is required to identify specific drivers of survival disparities that may be mitigated by targeted interventions. Figure 1 Figure 1. Disclosures Gupta: Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees. Teachey: NeoImmune Tech: Research Funding; Sobi: Consultancy; BEAM Therapeutics: Consultancy, Research Funding; Janssen: Consultancy. Zweidler-McKay: ImmunoGen: Current Employment. Loh: MediSix therapeutics: Membership on an entity's Board of Directors or advisory committees.

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