scholarly journals Social determinants of health impacting adherence to diabetic retinopathy examinations

2021 ◽  
Vol 9 (1) ◽  
pp. e002374
Author(s):  
Cindy X Cai ◽  
Yixuan Li ◽  
Scott L Zeger ◽  
Melissa L McCarthy
Keyword(s):  
Diabetic Retinopathy ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Subgroup Analysis ◽  
Determinants Of Health ◽  
Eye Disease ◽  
Housing Conditions ◽  
Study Enrollment ◽  
History Of ◽  
Post Hoc

IntroductionThis study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations.Research design and methodsThis was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in the Washington, DC Medicaid program. At study enrollment, participants were given a comprehensive SDoH survey based on the WHO SDoH model. Adherence to recommended dilated diabetic retinopathy examinations, as determined by qualifying Current Procedural Terminology codes in the insurance claims, was defined as having at least one eye examination in the 2-year period following study enrollment.ResultsOf the 8943 participants enrolled in the prospective study, 1492 (64% female, 91% non-Hispanic Black) were included in this post-hoc subgroup analysis. 47.7% (n=712) were adherent to the recommended biennial diabetic eye examinations. Not having a regular provider (eg, a primary care physician) and having poor housing conditions (eg, overcrowded, inadequate heating) were associated with decreased odds of adherence to diabetic eye examinations (0.45 (95% CI 0.31 to 0.64) and 0.70 (95% CI 0.53 to 0.94), respectively) in the multivariate logistic regression analysis controlling for age, sex, race/ethnicity, overall health status using the Chronic Disability Payment System, diabetes severity using the Diabetes Complications Severity Index, history of eye disease, and history of diabetic eye disease treatment.ConclusionsA multidimensional evaluation of SDoH revealed barriers that impact adherence to diabetic retinopathy examinations. Having poor housing conditions and not having a regular provider were associated with poor adherence. A brief SDoH assessment could be incorporated into routine clinical care to identify social risks and connect patients with the necessary resources to improve adherence to diabetic retinopathy examinations.

Health Disparities and the Social Determinants of Health: Ethical and Social Justice Issues

2019 ◽  
pp. 265-276
Author(s):  
Sridhar Venkatapuram
Keyword(s):  
Health Disparities ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Global Justice ◽  
Social Epidemiology ◽  
Social Groups ◽  
Determinants Of Health ◽  
Housing Conditions ◽  
Early Infant ◽  
The Social

The term health disparities (also called health inequalities) refers to the differences in health outcomes and related events across individuals and social groups. Social determinants of health, meanwhile, refers to certain types of causes of ill health in individuals, including lack of early infant care and stimulation, lack of safe and secure employment, poor housing conditions, discrimination, lack of self-respect, poor personal relationships, low community cohesion, and income inequality. These social determinants stand in contrast to others, such as individual biology, behaviors, and proximate exposures to harmful agents. This chapter presents some of the revolutionary findings of social epidemiology and the science of social determinants of health, and shows how health disparities and social determinants raise profound questions in public health ethics and social/global justice philosophy.

600 Social Determinants and Their Impact on Burn Surgery Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Luis H Quiroga ◽  
Tomer Lagziel ◽  
Mohammed Asif ◽  
Raymond Fang ◽  
Grace F Rozycki ◽  
...  
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Social Determinants Of Health ◽  
Population Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Hospital Charges ◽  
Burn Patients ◽  
Increased Risk ◽  
History Of

Abstract Introduction To our knowledge, no studies have been conducted assessing the social determinants of health and the impact on the outcomes for burn patients. Such studies are needed considering burn injuries are associated with high costs, severe psychological impact, and a high burden placed on the healthcare systems. The burden is hypothesized to be aggravated by the increasing amount of diabetes and obesity seen in the general population which put patients at increased risk for developing chronic wounds. Studies have shown that several socioeconomic status (SES) factors are associated with increased risk of burns, but none have documented the outcomes of burn patients based on their social determinants of health. In our study, we will be comparing patients in the burn ICU (BICU) to patients in the surgical ICU (SICU). The purpose of this comparison is to evaluate whether the same social determinants of health have similar influences in both groups. Methods We performed a retrospective analysis of population group data from patients admitted to the BICU and SICU from January 1, 2016, to November 18, 2019. The primary outcomes were length-of-stay (LOS), mortality, 30-day-readmission, and hospital charges. Pearson’s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. Results We analyzed a total of 487 burn and 510 surgical patients. When comparing BICU and SICU patients, we observed significantly higher mean hospital charges and LOS in burn patients with a history of mental health (mean difference: $42,756.04, p=0.013 and 7.12 days, p=0.0085), ESRD ($57,8124.7, p=0.0047 and 78.62 days, p=0.0104), sepsis ($168,825.19, p=< 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=< 0.001 and 72.9 days, p=0.002). Also, higher mortality was observed in burn patients with ESRD, STEMI, sepsis, VTE, and diabetes mellitus. Burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus also had greater 30-day-readmissions rates. Conclusions This study sheds new knowledge on the considerable variability that exists between the different population health groups in terms of outcomes for each cohort of critically ill patients. It demonstrates the impacts of population health group on outcomes. These population groups and social determinants have different effects on BICU versus SICU patients and this study provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare. Further research to develop relevant and timely interventions that can improve these outcomes.

scholarly journals Physician Assessment of Social Determinants of Health: A Necessary Component in Improving Care of Patients

2021 ◽  
Vol 11 (S1) ◽  
Author(s):  
Emaan Chaudry
Keyword(s):  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Social History ◽  
Low Socioeconomic Status ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Sexual History ◽  
History Of ◽  
Asking Questions ◽  
The Government

The importance of building a therapeutic relationship between a physician and a patient is taught early on in a medical student's training, specifically through the practice of obtaining a patient history. This process consists of gathering information in four main categories: the history of the present illness, personal social history, past medical history, and family history. Each piece of information obtained within these categories is vital in ensuring a patient receives appropriate and effective care. Specifically, a social history consists of asking about a patient's relationship status, support system, home environment, interests, exercise, nutritional habits, substance use, and sexual history. To complete a successful and full social history, one should try to address the social determinants of health. As per the Government of Canada’s website, social determinants of health “refer to a specific group of social and economic factors within the broader determinants of health. These relate to an individual’s place in society such as income, education or employment” [1]. Consequently, a critical component of a complete social history interview should be investigating a patients socioeconomic status. Low socioeconomic status (LSES) has been found to play a role in incidence and susceptibility to a variety of health conditions. As such, I believe that screening for and asking questions pertaining to the socioeconomic status of a patient should be considered a vital and essential component of every patient assessment.

scholarly journals Evaluating Concussion Nondisclosure in College Athletes using a Health Disparities Framework and Appreciation for Social Determinants of Health

2021 ◽  
Author(s):  
Jessica Wallace ◽  
Erica Beidler ◽  
Johna K. Register-Mihalik ◽  
Tamaria Hibbler ◽  
Abigail Bretzin ◽  
...  
Keyword(s):  
High School ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
College Athletes ◽  
Healthcare Access ◽  
Determinants Of Health ◽  
Athletic Trainer ◽  
Black Athletes ◽  
Cross Sectional ◽  
History Of

Abstract Context: There is limited research concerning the relationship between social determinants of health, including race, healthcare access, socioeconomic status (SES), and physical environment; and, concussion nondisclosure in college-athletes. However, in high school athletes, disparities have been noted, with Black athletes attending under-resourced schools and lacking access to an athletic trainer (AT) disclosing fewer concussions. Objective: To investigate whether concussion nondisclosure disparities exist by 1) race, 2) SES, and 3) AT healthcare access prior to college; and to understand the differential reasons for concussion nondisclosure between Black and White college-athletes. Design: Cross-sectional Setting: College athletics Participants: 735 college-athletes (84.6% White, 15.4% Black) Main Outcome Measures: Participants completed a questionnaire that directly assessed concussion nondisclosure, including reasons for not reporting a suspected concussion. With the premise of investigating social determinants of health, race was the primary exposure of interest. The outcome of interest, nondisclosure, was assessed with a binary (yes/no) question, “Have you ever sustained a concussion that you did not report to your coach, athletic trainer, parent, teammate, or anyone else?” Results: Overall, among White and Black athletes 15.6% and 17.7% respectively reported a history of concussion nondisclosure. No significant differences were found by race for distributions of history of concussion nondisclosure (p=0.57). Race was not associated with concussion nondisclosure when evaluated as an effect modification measure or confounder; and, no significant associations were noted by SES or high school AT access. Differences by race for reported reasons for nondisclosure were found for: “At the time I did not think it was a concussion” (p=0.045) and “I thought my teammates would think I am weak” (p=0.03) with Black athletes reporting these more frequently than White athletes. Conclusions: These data help to contextualize race and its intersection with other social determinants of health that could influence concussion nondisclosure outcomes in college-athletes.

The foundations of health promotion.

2021 ◽  
pp. 1-40
Author(s):  
Ruth Cross ◽  
Simon Rowlands ◽  
Sally Foster
Keyword(s):  
Health Promotion ◽  
Social Determinants Of Health ◽  
Recent Work ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Threshold Concepts ◽  
The Social ◽  
Concepts Of Health ◽  
History Of

Abstract This book chapter seeks to: (i) explore concepts of 'health' held by lay people and health promoters; (ii) introduce recent work on the social determinants of health; (iii) introduce certain threshold concepts including salutogenesis, social models of health and upstream thinking; (iv) establish the value base of health promotion; (v) introduce the disciplinary foundations of health promotion; (vi) outline in more detail 'empowerment' as a key value in health promotion; and (vii) describe the key WHO conferences, which provide the milestones in the development of health promotion. This chapter has provided a foundation upon which to base further study; it has presented the key values and principles of health promotion; emphasized the need to tackle the social determinants of health; presented a history of health promotion's development through the WHO-led conferences; introduced some threshold concepts; introduced the disciplines that contribute to health promotion; outlined professional and lay concepts of health; and suggested that empowerment approaches are the essence of health promotion.

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 The Association between Social Determinants of Health and Self-Reported Diabetic Retinopathy: An Exploratory Analysis

2021 ◽  
Vol 18 (2) ◽  
pp. 792
Author(s):  
Emily L. Silverberg ◽  
Trevor W. Sterling ◽  
Tyler H. Williams ◽  
Grettel Castro ◽  
Pura Rodriguez de la Vega ◽  
...  
Keyword(s):  
High School ◽  
Health Care ◽  
Diabetic Retinopathy ◽  
Social Determinants Of Health ◽  
Health Care Providers ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Outcome Variable ◽  
Diabetic Patients ◽  
Care Providers

One-third of Americans with diabetes will develop diabetic retinopathy (DR), the leading cause of blindness in working-age Americans. Social determinants of health (SDOHs) are conditions in a person’s environment that may impact health. The objective of this study was to determine whether there is an association between SDOHs and DR in patients with type II diabetes. This cross-section study used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). This study included people with self-reported diabetes in the US in 2018 (n = 60,703). Exposure variables included homeownership, marital status, income, health care coverage, completed level of education, and urban vs. rural environment. The outcome variable was DR. Logistic regression analysis were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Alaskan Native/Native American (OR 2.11; 95% CI: 1.14–3.90), out of work (OR 2.82; 95% CI: 1.62–4.92), unable to work (OR 2.14; 95% CI: 1.57–2.91), did not graduate high school (OR 1.91; 95% CI: 1.30–2.79), only graduated high school (OR 1.43; 95% CI 1.08–1.97), or only attended college or technical school without graduating (OR 1.42; 95% CI: 1.09–1.86) were SDOHs associated with DR in patients with diabetes. Health care providers should identify these possible SDOHs affecting their diabetic patients.

Sign in / Sign up

Export Citation Format

Share Document