scholarly journals U.S. county-level characteristics to inform equitable COVID-19 response

2020 ◽  
Author(s):  
Taylor Chin ◽  
Rebecca Kahn ◽  
Ruoran Li ◽  
Jarvis T. Chen ◽  
Nancy Krieger ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Risk Factors ◽  
At Risk ◽  
Health Insurance ◽  
Socioeconomic Factors ◽  
Premature Death ◽  
The United States ◽  
County Level ◽  
Online Tool

AbstractBackgroundThe spread of Coronavirus Disease 2019 (COVID-19) across the United States confirms that not all Americans are equally at risk of infection, severe disease, or mortality. A range of intersecting biological, demographic, and socioeconomic factors are likely to determine an individual’s susceptibility to COVID-19. These factors vary significantly across counties in the United States, and often reflect the structural inequities in our society. Recognizing this vast inter-county variation in risks will be critical to mounting an adequate response strategy.Methods and FindingsUsing publicly available county-specific data we identified key biological, demographic, and socioeconomic factors influencing susceptibility to COVID-19, guided by international experiences and consideration of epidemiological parameters of importance. We created bivariate county-level maps to summarize examples of key relationships across these categories, grouping age and poverty; comorbidities and lack of health insurance; proximity, density and bed capacity; and race and ethnicity, and premature death. We have also made available an interactive online tool that allows public health officials to query risk factors most relevant to their local context.Our data demonstrate significant inter-county variation in key epidemiological risk factors, with a clustering of counties in certain states, which will result in an increased demand on their public health system. While the East and West coast cities are particularly vulnerable owing to their densities (and travel routes), a large number of counties in the Southeastern states have a high proportion of at-risk populations, with high levels of poverty, comorbidities, and premature death at baseline, and low levels of health insurance coverage.The list of variables we have examined is by no means comprehensive, and several of them are interrelated and magnify underlying vulnerabilities. The online tool allows readers to explore additional combinations of risk factors, set categorical thresholds for each covariate, and filter counties above different population thresholds.ConclusionCOVID-19 responses and decision making in the United States remain decentralized. Both the federal and state governments will benefit from recognizing high intra-state, inter-county variation in population risks and response capacity. Many of the factors that are likely to exacerbate the burden of COVID-19 and the demand on healthcare systems are the compounded result of long-standing structural inequalities in US society. Strategies to protect those in the most vulnerable counties will require urgent measures to better support communities’ attempts at social distancing and to accelerate cooperation across jurisdictions to supply personnel and equipment to counties that will experience high demand.

Cardiovascular Disease Risk Factors Among Immigrant and US-Born Adults in New York City

2021 ◽  
pp. 003335492110075
Author(s):  
Claudia Chernov ◽  
Lisa Wang ◽  
Lorna E. Thorpe ◽  
Nadia Islam ◽  
Amy Freeman ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
New York ◽  
New York City ◽  
Health Insurance ◽  
York City ◽  
The United States ◽  
Nutrition Examination Survey ◽  
Health And Nutrition

Objectives Immigrant adults tend to have better health than native-born adults despite lower incomes, but the health advantage decreases with length of residence. To determine whether immigrant adults have a health advantage over US-born adults in New York City, we compared cardiovascular disease (CVD) risk factors among both groups. Methods Using data from the New York City Health and Nutrition Examination Survey 2013-2014, we assessed health insurance coverage, health behaviors, and health conditions, comparing adults ages ≥20 born in the 50 states or the District of Columbia (US-born) with adults born in a US territory or outside the United States (immigrants, following the National Health and Nutrition Examination Survey) and comparing US-born adults with (1) adults who immigrated recently (≤10 years) and (2) adults who immigrated earlier (>10 years). Results For immigrant adults, the mean time since arrival in the United States was 21.8 years. Immigrant adults were significantly more likely than US-born adults to lack health insurance (22% vs 12%), report fair or poor health (26% vs 17%), have hypertension (30% vs 23%), and have diabetes (20% vs 11%) but significantly less likely to smoke (18% vs 27%) (all P < .05). Comparable proportions of immigrant adults and US-born adults were overweight or obese (67% vs 63%) and reported CVD (both 7%). Immigrant adults who arrived recently were less likely than immigrant adults who arrived earlier to have diabetes or high cholesterol but did not differ overall from US-born adults. Conclusions Our findings may help guide prevention programs and policy efforts to ensure that immigrant adults remain healthy.

scholarly journals 4536 Identification of the most salient risk factors of preterm birth in the US using geospatial mapping

2020 ◽  
Vol 4 (s1) ◽  
pp. 31-32
Author(s):  
Alexander J Layden ◽  
Janet Catov
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Health Insurance ◽  
Preterm Birth ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
County Level ◽  
Obesity Prevalence ◽  
The Us ◽  
Geospatial Mapping

OBJECTIVES/GOALS: Preterm birth is the most common birth complication in the United States. To date, there are no effective public health strategies to reduce the burden of prematurity. Using geospatial information system (GIS) mapping, we identified the most salient risk factors of preterm birth across US counties targetable for future interventions. METHODS/STUDY POPULATION: Risk factors of preterm birth were identified from the perinatal health nonprofit organization, March of Dimes, and included factors such as obesity, smoking, insurance coverage and poverty. US 2013 county-level data on sociodemographic characteristics, behavioral risk factors and preterm birth were extracted and combined from the American Census, Center for Disease Control, and US Health Resources and Services Administration. Spatial autocorrelation and multivariate spatial regression were used to determine the risk factors most strongly associated with preterm birth. These models were adjusted for race, given well-documented race disparities for preterm birth. As a case-study comparison, we mapped risk factors in the two states with the highest and lowest proportion of preterm births in 2013. RESULTS/ANTICIPATED RESULTS: In our preliminary analysis, obesity was the factor most strongly associated with preterm birth (ß = 7.32, SE: 1.13, p<0.001) at the US county-level. Surprisingly, smoking was not found to be significantly associated with preterm birth. In 2013, Vermont had the lowest prevalence of preterm birth at 7.6% and Mississippi had the highest prevalence of preterm birth at 13.1%. Health insurance coverage and obesity were the two risk factors that differed between Vermont and Mississippi. The median proportion of uninsured individuals in Mississippi counties was four times higher than that of Vermont counties (26.3% vs 10.9%, p<0.01). Similarly, the median obesity prevalence in Mississippi counties was significantly higher than the median obesity prevalence in Vermont counties (38.8% vs. 25.2%). DISCUSSION/SIGNIFICANCE OF IMPACT: Public health efforts aimed at reducing obesity and increasing health insurance coverage may have the greatest impact at addressing the US burden of preterm birth. Further, geospatial mapping is a powerful analytic tool to identify regions in the US where preterm birth interventions would be most beneficial.

scholarly journals Plague and Pregnancy: Why Special Considerations Are Needed

2020 ◽  
Vol 70 (Supplement_1) ◽  
pp. S27-S29
Author(s):  
Dana Meaney-Delman ◽  
Nadia L Oussayef ◽  
Margaret A Honein ◽  
Christina A Nelson
Keyword(s):  
Public Health ◽  
United States ◽  
At Risk ◽  
Pregnant Women ◽  
Yersinia Pestis ◽  
The United States ◽  
Highly Pathogenic ◽  
Pathogenic Organism ◽  
Public Health Emergencies ◽  
Life Threatening

Abstract Pregnant women are an important at-risk population to consider during public health emergencies. These women, like nonpregnant adults, may be faced with the risk of acquiring life-threatening infections during outbreaks or bioterrorism (BT) events and, in some cases, can experience increased severity of infection and higher morbidity compared with nonpregnant adults. Yersinia pestis, the bacterium that causes plague, is a highly pathogenic organism. There are 4 million births annually in the United States, and thus the unique needs of pregnant women and their infants should be considered in pre-event planning for a plague outbreak or BT event.

Supporting Families and Providers When Suicide Occurs

2018 ◽  
Vol 36 (3) ◽  
pp. 264-265
Author(s):  
Susan Carla Stone
Keyword(s):  
United States ◽  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Suicide Attempt ◽  
Young Woman ◽  
Complicated Grief ◽  
The United States ◽  
Major Risk Factor

Death by suicide has increased in the United States. Experts have identified risk factors that may identify those at risk. It is understood that depression is one of the major risk factor. The families and community are the secondary victims when a suicide attempt or completion is made, and they are at risk for complicated grief. Recently, our team was consulted for the case of a young woman with a catastrophic suicide attempt.

scholarly journals Childhood and Adolescent Obesity in the United States: A Public Health Concern

2019 ◽  
Vol 6 ◽  
pp. 2333794X1989130 ◽  
Author(s):  
Adekunle Sanyaolu ◽  
Chuku Okorie ◽  
Xiaohua Qi ◽  
Jennifer Locke ◽  
Saif Rehman
Keyword(s):  
Public Health ◽  
United States ◽  
Risk Factors ◽  
Secondary Prevention ◽  
Psychological Factors ◽  
The United States ◽  
Adolescent Obesity ◽  
Health Concern ◽  
Public Health Concern ◽  
Childhood And Adolescent Obesity

Childhood and adolescent obesity have reached epidemic levels in the United States. Currently, about 17% of US children are presenting with obesity. Obesity can affect all aspects of the children including their psychological as well as cardiovascular health; also, their overall physical health is affected. The association between obesity and other conditions makes it a public health concern for children and adolescents. Due to the increase in the prevalence of obesity among children, a variety of research studies have been conducted to discover what associations and risk factors increase the probability that a child will present with obesity. While a complete picture of all the risk factors associated with obesity remains elusive, the combination of diet, exercise, physiological factors, and psychological factors is important in the control and prevention of childhood obesity; thus, all researchers agree that prevention is the key strategy for controlling the current problem. Primary prevention methods are aimed at educating the child and family, as well as encouraging appropriate diet and exercise from a young age through adulthood, while secondary prevention is targeted at lessening the effect of childhood obesity to prevent the child from continuing the unhealthy habits and obesity into adulthood. A combination of both primary and secondary prevention is necessary to achieve the best results. This review article highlights the health implications including physiological and psychological factors comorbidities, as well as the epidemiology, risk factors, prevention, and control of childhood and adolescent obesity in the United States.

Assessing the Impact of Person-level Matching Algorithms to Identify Risk of Fatal Opioid Overdose Across Disparate Datasets: Retrospective Analysis (Preprint)

2020 ◽  
Author(s):  
Lindsey Ferris ◽  
Jonathan P. Weiner ◽  
Brendan Saloner ◽  
Hadi Kharrazi
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
At Risk ◽  
Area Under The Curve ◽  
The United States ◽  
Risk Indicators ◽  
Mortality Data ◽  
Opioid Overdose ◽  
Fatal Overdose ◽  
The Impact

BACKGROUND The opioid epidemic in the United States has precipitated a need for public health agencies to better understand risk factors associated with fatal overdoses. Matching person-level information stored in public health, medical, and human services datasets can enhance the understanding of opioid overdose risk factors and interventions. A major impediment to using datasets from separate agencies, has been the lack of a cross-organization unique identifier. Although different matching techniques that leverage patient demographic information can be used, the impact of using a particular matching approach is not well understood. OBJECTIVE This study compares the impact of using probabilistic versus deterministic matching algorithms to link disparate datasets together for identifying persons at risk of a fatal overdose. METHODS This study used statewide prescription drug monitoring program (PDMP), arrest, and mortality data matched at the person-level using a probabilistic and two deterministic matching algorithms. Impact of matching was assessed by comparing the prevalence of key risk indicators, the outcome, and performance of a multivariate logistic regression for fatal overdose using the combined datasets. RESULTS The probabilistically matched population had the highest degree of matching within the PDMP data and with arrest and mortality data, resulting in the highest prevalence of high-risk indicators and the outcome. Model performance using area under the curve (AUC) was comparable across the algorithms (probabilistic: 0.847; deterministic-basic: 0.854; deterministic+zip: 0.826), but demonstrated tradeoffs between sensitivity and specificity. CONCLUSIONS The probabilistic algorithm was more successful in linking patients with PDMP data with death and arrest data, resulting in a larger at-risk population. However, deterministic-basic matching may be a suitable option for understanding high-level risk based on the model’s area under the curve (0.854). The clinical use case should be considered when selecting a matching approach, as probabilistic algorithms can be more resource-intensive and costly to maintain compared with deterministic algorithms.

Health Promotion and Disease Prevention in the Primary Health Care Setting: Setting the Scene

1994 ◽  
Vol 11 (3) ◽  
pp. 129-131 ◽  
Author(s):  
Brian Oldenburg
Keyword(s):  
Public Health ◽  
Mental Health ◽  
United States ◽  
Premature Death ◽  
The United States ◽  
United States Department ◽  
The Past ◽  
Department Of Health ◽  
Related Risk ◽  
National Public Health

Last (1983) defines public health as: the efforts organised by society to protect, promote and restore the public's health. It is the combination of sciences, skills and beliefs that are directed to the maintenance and improvement of the health of all people through collective or social actions. The programs, services and institutions involved emphasise the prevention of disease and the health needs of the population as a whole. Public health activities change with changing technology and values, but the goals remain the same: to reduce the amount of disease, premature death and disability in the population. (p.45)Recommended goals and targets for addressing national public health problems and directed at reducing the amount of death and premature death have been proposed in many countries over the past 10 years, including the United States of America (United States Department of Health and Human Services, 1990), the United Kingdom (Department of Health, 1992), Canada (Ontario Premiers' Council on Health, 1987) and Australia (Nutbeam, Wise, Bauman, Harris, & Leeder, 1993). In Australia for example, over the past 2 years, much attention has been directed at health outcomes related to cardiovascular disease, cancers, accidents and injuries and mental health. All of these reports have emphasised the importance of changing those lifestyle and related risk factors associated with preventable causes of death. Priority lifestyle areas that have been identified include physical inactivity, diet and nutrition, smoking, alcohol and other drug use, safety behaviours, sun protective behaviours, appropriate use of medicines, immunisation, sexuality and reproductive health, oral hygiene, and mental health. Priority populations and appropriate settings for intervening in these areas have also been identified.

scholarly journals Vaping Restrictions: Is Priority to the Young Justified?

2020 ◽  
Author(s):  
Monica Magalhaes
Keyword(s):  
Public Health ◽  
United States ◽  
At Risk ◽  
Young People ◽  
Harm Reduction ◽  
Ethical Dilemma ◽  
The United States ◽  
Youth Smoking ◽  
Health Authorities ◽  
Public Health Authorities

Abstract The vast majority of smokers become dependent on nicotine in youth. Preventing dependence has therefore been crucial to the recent decline in youth smoking. The advent of vaping creates an opportunity for harm reduction to existing smokers (mostly adults) but simultaneously also undermines prevention efforts by becoming a new vehicle for young people to become dependent on nicotine, creating an ethical dilemma. Restrictions to access to some vaping products enacted in response to the increase in vaping among youth observed in the United States since 2018 have arguably prioritized prevention of new cases of dependence—protecting the young—over harm reduction to already dependent adults. Can this prioritization of the young be justified? This article surveys the main bioethical arguments for prioritizing giving health benefits to the young and finds that none can justify prioritizing dependence prevention over harm reduction: any reasons for prioritizing the current cohort of young people at risk from vaping will equally apply to current adult smokers, who are overwhelmingly likely to have become nicotine-dependent in their own youth. Public health authorities’ current tendency to prioritize the young, therefore, does not seem to be ethically justified. Implications This article argues that commonsense reasons for prioritizing the young do not apply to the ethical dilemma surrounding restricting access to vaping products.

scholarly journals On the history of medicine in the United States, theory, health insurance, and psychiatry: an interview with Charles Rosenberg

2016 ◽  
Vol 23 (1) ◽  
pp. 211-220
Author(s):  
Charles Rosenberg ◽  
Rafael Mantovani
Keyword(s):  
Public Health ◽  
United States ◽  
Health Policy ◽  
Health Insurance ◽  
The United States ◽  
Historical Research ◽  
Current Debate ◽  
Behavior Control ◽  
History Of ◽  
And Behavior

Abstract An interview with Charles Rosenberg conducted by Rafael Mantovani in November 2013 that addressed four topics. It first focused on the way in which Rosenberg perceived trends and directions in historical research on medicine in the United States during the second half of the twentieth century. The second focus was on his experience with other important historians who wrote about public health. Thirdly, he discussed his impressions about the current debate on health policy in his country. Finally, the last part explores some themes related to psychiatry and behavior control that have appeared in a number of his articles.

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