The Digital Divide Amongst High-Need High-Risk Veterans

Abstract High-need high-risk (HNHR) veterans are medically complex and at the highest risk of hospitalization and long-term institutionalization. Technology can mitigate challenges these veterans have in accessing healthcare. Willingness to use technology as well as access and ability to use technology were assessed in this study. At the time of the survey, 2543 Miami VAHS veterans were listed as HNHR. 634 veterans ultimately completed the questionnaire, and 602 answered the “willingness to use video-visits” question. Of the 602 respondents, 327 (54.3%) reported they were willing for video-visits with the VA, while 275 (45.6%) were not. Those who were willing were significantly younger (P<0.001), with higher educational qualifications (P=0.002), and more health literate than those not willing (P<0.001). They were more also capable of using the Internet, more likely to use email and be enrolled in the VA’s patient portal, My HealtheVet (P<0.001). However, of the veterans who were willing, 248 (75.8%) had a device with video-capable technology. Those with video-capable technology were younger (P=0.004), more health literate (P=0.01), and less likely to be Black or African American (P=0.007). They were more capable of using the Internet, more likely to use email, and be enrolled in My HealtheVet than those without (P<0.001). Half of the respondents were willing for video-visits but a quarter of those willing lacked requisite technology, thereby making only about 41.2% of the respondents willing and video-capable. To minimize the digital divide, especially during the ongoing COVID-19 pandemic, targeted measures need to address these disparities in this vulnerable population.

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Gap in Willingness and Access to Video-visit Use Among High-Risk Veterans: A Cross-sectional Study (Preprint)

10.2196/preprints.32570 ◽

2021 ◽

Author(s):

Stuti Dang ◽

Kiranmayee Muralidhar ◽

Shirley Li ◽

Fei Tang ◽

Michael Mintzer ◽

...

Keyword(s):

African American ◽

High Risk ◽

Physical Health ◽

Digital Divide ◽

Associate Degree ◽

Daily Living ◽

Healthcare Access ◽

The Internet ◽

Black African ◽

Virtual Care

BACKGROUND The recent shift to virtual care has exacerbated disparities in healthcare access especially among High-Need High-Risk (HNHR) adults. Developing data-driven approaches to achieve appropriate virtual care scale-up necessitate a deeper understanding of HNHR adults’ attitudes toward video-visits and access to technology. OBJECTIVE This study aimed to identify the willingness, access, and ability of HNHR Veterans to use video-visits for healthcare. METHODS We designed a questionnaire that was conducted via mail or in-person. Among HNHR Veterans identified using predictive modeling with national Veterans Affairs (VA) data, we assessed willingness to use video-visits for healthcare, access to necessary equipment, and comfort with using technology. We evaluated physical health including frailty status, physical function, performance of Activities of Daily Living (ADL’s) and Instrumental Activities of Daily Living (IADL’s); mental health; and social needs including area deprivation index, transportation, social support and social isolation. RESULTS Average age of the 602 HNHR Veterans respondents was 70.6±9.2 (39-100); 367 (61.0%) White, 217 (36.0%) Black/African American; 104 (17.3%) Hispanic/Latino; 188 (31.2%) held at least an associate degree and 290 (48.2%) were confident filling medical forms. Of the 602, 327 (54.3%) reported willingness for video-visits with the VA, while 275 (45.7%) were unwilling. Willing Veterans were younger (P<0.001), more likely to have an associate degree (P=0.002), be health literate (P<0.001), live in better neighborhoods (P<0.048), be independent in IADLs (P=0.02), and in better physical health (P=0.04) than unwilling. A higher number of those willing were able to use the Internet and email, and were enrolled in the VA’s patient portal, My HealtheVet (p<0.001). Of the willing Veterans, 248 (75.8%) had a video-capable device. Those with video-capable technology were younger (P=0.004), had higher health literacy (P=0.01), less likely to be African American (P=0.007), more independent in their ADLs (P=0.005) and IADLs (P=0.04), less likely to have transportation issues (P<0.001), more likely to live in better neighborhoods (P<0.049), more adept at using the Internet and more likely to use email, than those without the needed technology (P<0.001). CONCLUSIONS Only about half of our HNHR respondents were willing for video-visits, and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, Black/African American Veterans, those in worse physical health, and those living in worse neighborhoods. Our study highlights that HNHR Veterans have complex needs, which risk being exacerbated by the digital divide. Our findings underscore, yet again, that while technology holds vast potential to improve healthcare access, those most in need are also those least likely to engage with, or have access to, technology. Therefore, targeted interventions are needed to address this digital divide, especially among HNHR adults. CLINICALTRIAL NCT04846049

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Stopping, starting, and sustaining HIV antiretroviral therapy: a mixed-methods exploration among African American/Black and Latino long-term survivors of HIV in an urban context

BMC Public Health ◽

10.1186/s12889-021-10464-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marya Gwadz ◽

Charles M. Cleland ◽

Robert Freeman ◽

Leo Wilton ◽

Linda M. Collins ◽

...

Keyword(s):

African American ◽

Mixed Methods ◽

Antiretroviral Therapy ◽

High Risk ◽

Risk Levels ◽

Factors Associated ◽

American Black ◽

Hiv Antiretroviral Therapy ◽

Black And Latino

AbstractBackgroundAlthough periods of HIV antiretroviral therapy (ART) discontinuation have deleterious health effects, ART is not always sustained. Yet, little is known about factors that contribute to such ART non-persistence among long-term HIV survivors. The present study applied a convergent parallel mixed-methods design to explore the phenomena of stopping/starting and sustaining ART, focusing on low-socioeconomic status African American or Black and Latino persons living with HIV (PLWH) who face the greatest challenges.MethodsParticipants (N = 512) had poor engagement in HIV care and detectable HIV viral load. All received structured assessments andN = 48 were randomly selected for in-depth interviews. Quantitative analysis using negative binomial regression uncovered associations among multi-level factors and the number of times ART was stopped/started and the longest duration of sustained ART. Qualitative data were analyzed using a directed content analysis approach and results were integrated.ResultsParticipants were diagnosed 18.2 years ago on average (SD = 8.6), started ART a median five times (Q1 = 3, Q3 = 10), and the median longest duration of sustained ART was 18 months (Q1 = 6, Q3 = 36). Factors associated with higher rates of stops/starts were male sex, transgender identity, cannabis use at moderate-to-high-risk levels, and ART- and care-related stigma. Factors associated with lower rates of stops/starts were older age, more years since diagnosis, motivation for care, and lifetime injection drug use (IDU). Factors associated with longer durations of sustained ART were Latino/Hispanic ethnicity, motivation for ART and care, and recent IDU. Factors associated with a shorter duration were African American/Black race, alcohol use at moderate-to-high-risk levels, and social support. Qualitative results uncovered a convergence of intersecting risk factors for stopping/starting ART and challenges inherent in managing HIV over decades in the context of poverty. These included unstable housing, which contributed to social isolation, mental health distress, and substance use concerns, the latter prompting selling (“diverting”) ART. Primarily complementary quantitative and qualitative findings described mechanisms by which risk/protective factors operated and ways PLWH successfully restart and/or sustain ART.ConclusionsThe field focuses substantially on ART adherence, but greater attention to reducing the frequency of ART non-persistence is needed, along with creating social/structural conditions favorable for sustained ART.

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The impact of the COVID-19 pandemic on African American cancer survivors living in metropolitan Detroit.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12129 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12129-12129

Author(s):

Jennifer Lynn Beebe-Dimmer ◽

Chrissy Lusk ◽

Julie J. Ruterbusch ◽

Tara Baird ◽

Stephanie Pandolfi ◽

...

Keyword(s):

African American ◽

High Risk ◽

Health Behaviors ◽

Cancer Survivors ◽

Medical Care ◽

Patient Population ◽

High Risk Patient ◽

Direct Result ◽

The Impact

12129 Background: COVID-19 has had profound direct and indirect effects on population health to date and long-term effects are anticipated. Vulnerabilities to the most serious consequences of infection include older age, obesity, African American race and the presence of comorbid conditions. African American cancer survivors represent a particularly high-risk group, therefore understanding the impact of the virus and our strategies to prevent its spread on this patient population is important. Methods: The Detroit Research on Cancer Survivors (ROCS) cohort is a unique effort to understand the determinants of poor outcomes in African American cancer survivors. Eligible participants were diagnosed with breast, prostate, colorectal, or lung cancer on or after 1/1/2013, or with endometrial or any other cancer before age 50 on or after 01/01/2016 and were identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. To date, we have enrolled 4173 survivors. Full participation includes completion of a baseline survey, and collection of biospecimens, medical records and tumor tissue, if available. Participants are also followed annually for outcomes and changes in history. A supplemental survey focused on the impact of COVID-19 was offered to enrolled participants beginning in the spring of 2020. The results presented here include data from 890 survivors who also completed the ROCS COVID survey. Results: Nearly all ( > 99%) survivors reported some change in their daily activities in an effort to reduce the risk of infection. At the time of survey, just over 1/3 of participants reported being tested for the virus and among those, 12% reported positive results. More than 40% of survivors reported some disruption in their access to medical care. A substantial ( > 40%) proportion of survivors reported feeling anxious, depressed and/or isolated during the COVID-19 pandemic. Approximately 40% of patients reported changes in health behaviors as a direct result of the pandemic that are known to negatively affect survivorship outcomes (physical inactivity, smoking, alcohol use). Notably, 30% of survivors reported declines in physical activity and these declines were significantly associated with increased anxiety (p = 0.008), depression (p = 0.005) and poorer health-related quality of life (p < 0.001). Conclusions: The influence of the COVID-19 pandemic on African American cancer survivors has been substantial, affecting both their physical and mental health and access to needed medical care. Coupled with changes in health behaviors as a direct result of the pandemic, these factors will likely affect outcomes in this high-risk patient population making further study and interventions necessary to mitigate the long-term impact of the pandemic on cancer outcomes.

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Presentation Characteristics, Risk Profiles and Long-Term Outcomes in a Public Health System, Minority Patient Population with Chronic Lymphocytic Leukemia.

Blood ◽

10.1182/blood.v108.11.4956.4956 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4956-4956

Author(s):

Sunita Nathan ◽

Olusola Ogundipe ◽

Perry Menini ◽

Anshul Bamrolia ◽

Decebal S. Griza ◽

...

Keyword(s):

Public Health ◽

African American ◽

High Risk ◽

Chronic Lymphocytic Leukemia ◽

Health System ◽

Public Health System ◽

Lymphocytic Leukemia ◽

Minority Population ◽

Medical Comorbidity

Abstract BACKGROUND: Chronic lymphocytic leukemia (CLL) is noted to exhibit male predominance, median age of 65 years at diagnosis and variable survival. Little data exist however regarding the characteristics of CLL in the U.S. minority population. METHODS: Data from 72 patients (pts) with CLL were collected from the primarily minority population served by Cook County Hospital, Chicago, Illinois over a 6 year period, and analyzed for clinical, presentation and prognostic characteristics and long-term survival. Continuous data were analyzed via Student’s T test and categorical data via Fisher’s Exact test. Survival was ascertained via Social Security Death Index query and analyzed using Kaplan Meier life-table analyses. RESULTS: 72 pts [age at diagnosis 58.4 ± 12.1 yrs, range 31–94 yrs, 45 (62.5%) males, 27 (37.5%) females] were identified and analyzed as a retrospective cohort. 16 pts (22.2%) were < 50 yrs of age and the majority of pts (53, 73.6%) had ≥ 1 major medical comorbidity at presentation. 40 (55.5%) were African American (AA), 18 (25%) Caucasian, 6 (8.3%) Hispanic, 4 (5.5%) Middle Eastern, and 4 (5.5%) Asian. Distribution by Rai stage at diagnosis was as follows: 16 (22.2%) pts Stage 0, 17 (23.6%) Stage 1, 6 (8.3%) Stage 2, 16 (22.2%) Stage 3, 16 (22.2%) Stage 4 and 1(1.4%) Richter transformation. 17 pts (23.6%) were low risk, 24 (33.3%) were intermediate risk and 31 (43.1%) were high risk (HR). Of 65 pts in whom prognostic data were available 46 (70.8%) pts had 1 or more HR features of which 25 (54.3%) were AA. Poor prognosticators included clinical stage 3 and 4 (43.1%), beta2m > 5.0 (4%), diffuse involvement of BM (36.4%), ZAP-70 positivity (20%), CD38 positivity (15.7%) and poor cytogenetic profile (del 11q / del 17q, 23.7%). CLL-associated complications included AIHA in 8 (11.1%) pts, (3/8 Coomb’s positive), ITP in 1(1.4%) pt, hypogammaglobinemia in.20/27 (74.1%) tested pts, CLL transformation to DLBCL (Richter) in 1(1.4%) pt, and second malignancies in 6 (8.3%) pts. AA pts, comprising the largest ethnic subgroup, were significantly older than non-AA pts (60.9 ± 12.9 yrs vs 55.3 ± 10.5 yrs, p<0.0478) and were more likely to have >1 medical comorbidity than non- AA pts (55.6% vs 25.0%, p=0.014). Both advanced stage at presentation (Rai 3 and 4, AA:42.5% vs non-AA:46.9%, p=0.812) and high-risk profile (AA:67.5% vs non-AA:55.9%, p=0.34) were comparably distributed between AA and non-AA pts. A modest difference was noted between AA and non-AA pts in the likelihood of receiving treatment (52.5% vs 68.8%, p=0.23) however survival at mean follow-up of 26.5 ± 20.7 months was similar (90% vs 87.5%, p=1.0). CONCLUSIONS: The primarily minority-based, public health system patient cohort analyzed in this observational study were somewhat younger than published historical control populations at the time of CLL diagnosis. African American pts while generally older and noted to have more comorbidities, had comparable disease stage and risk profiles at presentation as non-African American pts. The numerical disparity between proportions of AA vs non-AA pts treated did not appear to impact survival in this analysis. Further investigations of diagnostic, prognostic and healthcare disparities in the underserved minority population, are warranted.

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