scholarly journals Observational study protocol for evaluating control of hypertension and the effects of social determinants

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025975 ◽  
Author(s):  
Heather Angier ◽  
Nathalie Huguet ◽  
Miguel Marino ◽  
Beverly Green ◽  
Heather Holderness ◽  
...  
Keyword(s):  
Health Insurance ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Determinants Of Health ◽  
Research Network ◽  
Difference In Difference ◽  
Medicaid Eligibility

IntroductionHypertension is a common chronic health condition. Having health insurance reduces hypertension risk; health insurance coverage could improve hypertension screening, treatment and management. The Medicaid eligibility expansion of the Affordable Care Act was ruled not to be required by the US Supreme Court. Subsequently, a ‘natural experiment’ was produced with some states expanding Medicaid eligibility while others did not. This presents a unique opportunity to learn whether and to what extent Medicaid expansion can affect healthcare access and services for patients at risk for and diagnosed with hypertension, and patients with undiagnosed hypertension. Additionally, social determinants of health (SDH), at both the individual- and community-level, influence diagnosis and care for hypertension and it is important to understand how they interact with health insurance coverage changes.Methods/designWe will use electronic health record (EHR) data fromtheAccelerating Data Value Across a National Community Health Center Network clinical data research network, which has data from community health centres in 22 states, some that did and some that did not expand Medicaid. Data include information on changes in health insurance, service receipt and health outcomes from 2012 through the most recent data available. We will include patients between the ages of 19 and 64 years (n=1 524 241) with ≥1 ambulatory visit to a community health centre. We will estimate differences in outcomes using difference-in-difference and difference-in-difference-in-difference approaches. We will test three-way interactions with insurance group, time and social determinants of health factors to compare the potential effect of gaining insurance on our proposed outcomes.Ethics and disseminationThis study uses secondary data analysis and therefore approval for consent to participate was waived. The Institutional Review Board for OHSU approved this study. Approval reference number is: IRB00011858. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals.Trial registration numberNCT03545763.

Linkage to HIV Medical Care and Social Determinants of Health Among Adults With Diagnosed HIV Infection in 41 States and the District of Columbia, 2017

2021 ◽  
pp. 003335492110299
Author(s):  
Myrline Gillot ◽  
Zanetta Gant ◽  
Xiaohong Hu ◽  
Anna Satcher Johnson
Keyword(s):  
Health Insurance ◽  
Hiv Infection ◽  
Medical Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Determinants Of Health ◽  
Hiv Care ◽  
Care Outcomes

Objectives To reduce the number of new HIV infections and improve HIV health care outcomes, the social conditions in which people live and work should be assessed. The objective of this study was to describe linkage to HIV medical care by selected demographic characteristics and social determinants of health (SDH) among US adults with HIV at the county level. Methods We used National HIV Surveillance System data from 42 US jurisdictions and data from the American Community Survey to describe differences in linkage to HIV medical care among adults aged ≥18 with HIV infection diagnosed in 2017. We categorized SDH variables into higher or lower levels of poverty (where <13% or ≥13% of the population lived below the federal poverty level), education (where <13% or ≥13% of the population had <high school diploma), and health insurance coverage (where <12% or ≥12% of the population lacked health insurance). We calculated prevalence ratios (PRs) and 95% CIs. Results Of 33 204 adults with HIV infection diagnosed in 2017, 78.4% were linked to HIV medical care ≤1 month after diagnosis. Overall, rates of linkage to care were significantly lower among men and women living in counties with higher versus lower poverty (PR = 0.96; 95% CI, 0.94-0.97), with lower versus higher health insurance coverage (PR = 0.93; 95% CI, 0.92-0.94), and with lower versus higher education levels (PR = 0.97; 95% CI, 0.96-0.98). Conclusions Increasing health insurance coverage and addressing economic and educational disparities would likely lead to better HIV care outcomes in these areas.

scholarly journals Media Exposure and the Social Determinants of Health Insurance Coverage in Ethiopia 2011 - 2016

2021 ◽  
Author(s):  
Eniola Olatunji ◽  
Sanam Maredia ◽  
Allen Nguyen ◽  
Natalie Freeman ◽  
David J Washburn
Keyword(s):  
Health Insurance ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Media Exposure ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Social ◽  
Universal Health

Background: In a push for universal health coverage, Ethiopia introduced two insurance schemes in 2010. Yet coverage rates remain very low. To encourage greater adoption, policymakers require a better understanding of who chooses to enroll and which promotional efforts are most effective in encouraging enrollment. Objective: Using nationally representative Demographic and Health Surveys, this research assessed the social determinants of health insurance coverage, including media exposure, in Ethiopia from 2011-2016. Methods: This research analyzed health insurance coverage and other sociodemographic and media exposure variables using multivariable logistic regression model. Results: Health insurance coverage increased 3.30 times from 1.48% in 2011 to 4.89% in 2016. In both years, coverage was associated with higher education, older age, higher wealth levels, and exposure to newspaper and television. Compared to those with no exposure to newspaper, those with newspaper exposure at least once a week were 1.80 times (2011) and 1.86 times (2016) more likely to be insured. Similar results were obtained for television exposure. Conclusion: Initiatives that target the poor and less educated will be necessary if Ethiopia is to achieve universal health coverage. This research suggests that, to date, newspaper and television mediums have been effective promotion mechanisms for growing enrollment.

scholarly journals Epidemiology of chronic kidney disease in Peru and its relation to social determinants of health

2019 ◽  
Vol 12 (4) ◽  
pp. 264-271
Author(s):  
Noé Atamari-Anahui ◽  
Maycol Suker Ccorahua-Rios ◽  
Mirian Condori-Huaraka ◽  
Yerika Huamanvilca-Yepez ◽  
Elard Amaya ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Insurance Coverage ◽  
Secondary Analysis ◽  
Public Health Problem ◽  
Education Level ◽  
Determinants Of Health ◽  
Health Coverage

Abstract Background Chronic kidney disease (CKD) is a growing public health problem and an important cause of morbidity and mortality. Disparities in CKD may be related to social determinants and health inequalities in low- and middle-income countries. This study determined how social determinants of health influence trends in the prevalence and mortality of CKD in Peru. Methods This was an ecological study based on a secondary analysis of health care and death records obtained from the Ministry of Health of Peru for the period 2010–2016. The standardized prevalence and mortality rates of CKD were descriptively reported using geospatial exploratory analysis. We also determined the association with social determinants of health according to the domains suggested by Healthy People 2020. Results In the studied period, CKD prevalence increased by 300% and was associated with the health insurance coverage rate (β=5.9 [95% CI 0.82 to 10.92]), proportion of people with a secondary education level (β=11.4 [95% CI 1.94 to 20.93]), mean age (β=−10.7 [95% CI −19.33 to −2.12]), monetary poverty rate (β=−2.2 [95% CI −3.88 to −0.60]) and gross domestic product per capita (β=−63.2 [95% CI −117.81 to −8.52]). The standardized mortality decreased by 10% and was associated with mean age (β=−0.6 [95% CI −1.22 to −0.06]) and the proportion of people with a primary education level (β=−0.5 [95% CI −0.9 to −0.05]). Conclusions During the period 2010–2016, the prevalence of CKD increased and the mortality associated with CKD decreased. The observed changes were associated with some social determinants of health, such as increased health coverage and education. The health system of Peru must be prepared to take on the challenge.

Barriers to Teaching Social Determinants of Health: Nursing Study-Abroad Programs in a Digital Age

2016 ◽  
Vol 22 (4) ◽  
pp. 254-258 ◽  
Author(s):  
Hans-Peter de Ruiter
Keyword(s):  
Study Abroad ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
World Health ◽  
Health Study ◽  
Study Abroad Programs ◽  
The Social ◽  
Barriers To Teaching

The social determinants of health are the conditions in which humans are born, grow up, live, work, and age (World Health Organization [WHO], 2012). In nursing programs, this content is typically taught in community health courses. Another strategy for teaching students how to understand the social determinants of health is study-abroad courses. Budding nurses can learn how to assess conditions that influence the health of a community. Conducting this assessment in a culture that differs from the student’s own can help highlight what factors impact one’s own health. For the past eight years, the author has been teaching the social and cultural determinants of health to nursing students by taking them on 3-week cultural immersion/community health study-abroad programs. Destinations have included Ghana, Austria, the Netherlands, and Thailand. This article presents observations on how the teaching of social determinants of health has changed during the period 2008–2016.

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