Abstract MP01: Multiple Social Determinants of Health Disparities Increase the Risk of Diabetes and Mortality in the Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Joanna B Ringel ◽  
April P Carson ◽  
Doyle M Cummings ◽  
Jessica Pena ◽  
Christopher Gamboa ◽  
...  
Keyword(s):  
Relative Risk ◽  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Racial Differences ◽  
Social Determinants ◽  
Multinomial Logistic Regression ◽  
Determinants Of Health ◽  
Incident Diabetes ◽  
Annual Household Income

Introduction: The Healthy People 2020 initiative proposed that social determinants contribute to disparities in health outcomes. While studies have documented the influence of individual social determinants of health (SDOH) on health outcomes, few studies have examined how the aggregation of multiple SDOH within the same person affect health. Hypothesis: We hypothesized that as the number of individual-level and neighborhood-level SDOH increased, the relative risk of incident diabetes and mortality also increased. Methods: This study included 15,310 black and white adults aged > 45 years at baseline (2003-2007) who did not have prevalent diabetes and who completed the 10 year follow-up exam (2014-2016) or died prior to follow-up in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Exposures included 6 SDOH which have been associated with increased health risks: annual household income <$35,000, black race, < high school education, lack of health insurance, residing in a zip code with ≥ 25% poverty, and living in a state with poor public health infrastructure for 10 years prior to 2003. Outcomes were all-cause mortality or incident diabetes, defined as fasting glucose >126 mg/dL, random blood glucose >200 mg/dL, or taking diabetes medication or insulin. Multinomial logistic regression models examined associations of number of SDOH with death and incident diabetes, adjusting for other demographics, health behaviors, and medical conditions. Results: At follow-up, 1,170 (8.7%) had developed diabetes, and 3,790 (26.8%) had died. As the number of SDOH increased, the relative risk of both diabetes and death increased significantly (p for trend <0.001) in both crude and adjusted models (Figure). Conclusions: Counting the aggregate number of SDOH that an individual is exposed to may be a simple way to identify those at greater risk of developing incident diabetes or dying over 10 years. This approach has potential for application in both clinical practice and population health management.

Social determinants of health affecting treatment of pediatric brain tumors

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Brain Tumors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Cns Tumor ◽  
Initial Symptoms ◽  
Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

scholarly journals Frameworks and inequalities in healthcare: some applications

2021 ◽  
pp. 115-120
Author(s):  
Pietro Renzi ◽  
Alberto Franci
Keyword(s):  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Inequalities ◽  
Economic Status ◽  
Determinants Of Health ◽  
Health Determinants ◽  
Quadrant Analysis ◽  
Inequality Measures ◽  
Health Objectives

Background Social determinants of health (SDOH) have increasingly entered health policy conversations as a growing body of researches, reveal the direct relationship between social determinants and health outcome. In fact, the recent literature is moving from the traditional model that focus on how health affects economic status, to a new view that economic status affects health. Objectives To investigate the principal conceptual frameworks for action on social determinants of health. Another aim is to contribute on the ongoing discourse on feasible measures which could be used to alert regions to inequalities in the distribution of health. Methodology, Italian data are used as a demonstration. Quadrant charts illustrate associations between how much regions spend on health and how effectively health system functions. The relevant inequality measures are used to rank health inequalities. Main results Frameworks have been presented to help communities, health professionals and others begin to better understand and address a variety of factors that affects health. Quadrant analysis technique shows the extent to which spending more on health, translates into better health outcomes, higher quality of care and improve access to care across the Italian regions, whilst also recognition the importance of major risk factors. Conclusions The social inequalities in health and what this means for how we understand and reduce them, as not to date been compressively examined empirically. There is an urgent need to expand our knowledge with comparable data on health determinants and more refined health outcomes. Furthermore, there is a need for feasible inequality measures in the health information systems. The measures used in this study, provide a step to inform and guide the uptake of equity-sensitive policies.

scholarly journals Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association

Circulation ◽  
2020 ◽  
Vol 141 (10) ◽  
Author(s):  
Robert A. Harrington ◽  
Robert M. Califf ◽  
Appathurai Balamurugan ◽  
Nancy Brown ◽  
Regina M. Benjamin ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Rural Health ◽  
Social Determinants ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Determinants Of Health ◽  
Rural Populations ◽  
Call To Action

Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association’s pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association’s commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.

Neighborhood Considerations for Social Determinants of Health and Risk

2017 ◽  
Author(s):  
Holley A. Wilkin
Keyword(s):  
Social Support ◽  
Social Networks ◽  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Communication Infrastructure ◽  
The Social ◽  
Action Context ◽  
Communication Infrastructure Theory

When it comes to health and risk, “place” matters. People who live in lower-income neighborhoods are disproportionately affected by obesity and obesity-related diseases like heart disease, hypertension, and diabetes; asthma; cancers; mental health issues; etc., compared to those that live in higher-income communities. Contributing to these disparities are individual-level factors (e.g., education level, health literacy, healthcare access) and neighborhood-level factors such as the socioeconomic characteristics of the neighborhood; crime, violence, and social disorder; the built environment; and the presence or absence of health-enhancing and health-compromising resources. Social determinants of health—for example, social support, social networks, and social capital—may improve or further complicate health outcomes in low-income neighborhoods. Social support is a type of transaction between two or more people intended to help the recipient in some fashion. For instance, a person can help provide someone who is grieving or dealing with a newly diagnosed health issue by providing emotional support. Informational support may be provided to someone trying to diagnose, manage, and/or treat a health problem. Instrumental support may come in the help of making meals for someone who is ill, running errands for them, or taking them to a doctor’s appointment. Unfortunately, those who may have chronic diseases and require a lot of support or who otherwise do not feel able to provide support may not seek it due to the expectation of reciprocity. Neighborhood features can enable or constrain people from developing social networks that can help provide social support when needed. There are different types of social networks: some can enhance health outcomes, while others may have a more limiting or even a detrimental effect on health. Social capital results in the creation of resources that may or may not improve health outcomes. Communication infrastructure theory offers an opportunity to create theoretically grounded health interventions that consider the social and neighborhood characteristics that influence health outcomes. The theory states that every neighborhood has a communication infrastructure that consists of a neighborhood storytelling network—which includes elements similar to the social determinants of health—embedded in a communication action context that enables or constrains neighborhood storytelling. People who are more engaged in their neighborhood storytelling networks are in a better position to reduce health disparities—for example, to fight to keep clinics open or to clean up environmental waste. The communication action context features are similar to the neighborhood characteristics that influence health outcomes. Communication infrastructure theory may be useful in interventions to address neighborhood health and risk.

scholarly journals The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sonia Voleti ◽  
Emmy Okello ◽  
Meghna Murali ◽  
Rachel Sarnacki ◽  
Albert Majwala ◽  
...  
Keyword(s):  
Heart Disease ◽  
Social Determinants Of Health ◽  
Rheumatic Heart Disease ◽  
Social Determinants ◽  
Determinants Of Health ◽  
World Health ◽  
Medical Decision ◽  
Rheumatic Heart

Abstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

scholarly journals The potential value of social determinants of health in predicting health outcomes

2018 ◽  
Vol 25 (8) ◽  
pp. 1109-1110
Author(s):  
Jessica S Ancker ◽  
Min-Hyung Kim ◽  
Yiye Zhang ◽  
Yongkang Zhang ◽  
Jyotishman Pathak
Keyword(s):  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Potential Value

Social determinants of health in male forensic patients admitted at a tertiary psychiatric hospital in South Africa

2021 ◽  
pp. 002076402110602
Author(s):  
Keabetswe Mogase ◽  
Tshepiso Moeketsi ◽  
Funeka B Sokudela
Keyword(s):  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Factors ◽  
Psychiatric Patients ◽  
Determinants Of Health ◽  
Main Stream ◽  
Multivariate Statistical ◽  
Black African ◽  
Forensic Patients

Introduction: Social factors are increasingly being used to determine health outcomes. The concept of social determinants of health has been used to shape policies that address disparities. There is a paucity of such studies in the forensic setting. This study aimed to use social determinants of health to identify social factors that are associated with being a male forensic patient. Methods: The study was a retrospective two-group (forensic and non-forensic) comparison clinical record review. Association was identified through independent and multivariate statistical analysis. Results: The study sample comprised of 296 patients, 56.4% ( n = 167) of which were non-forensic. The majority of the sample was black African, 50 years and older, single, unemployed and had attended main-stream schooling. Race ( p < .01), employment status ( p < .02), not completing high school ( p < .01), previous imprisonment ( p < .01), drug use ( p < .01) and not being on medication prior to admission ( p < .01) were significantly associated with being a forensic patient. Multivariate logistic regression analyses also confirmed these associations. Conclusion: Social determinants of health ought to be targeted to improve health outcomes of psychiatric patients. Collaborations between mental health, public health, law and policy makers as well as non-/governmental agencies may lead to change. Human rights of individuals with mental illness may thus be enhanced in the long run.

Call to Action: Addressing Social Determinants of Health in Pharmacy Practice

2021 ◽  
pp. 106002802110408
Author(s):  
Julie Kalabalik-Hoganson ◽  
Ayse Elif Ozdener-Poyraz ◽  
Denise Rizzolo
Keyword(s):  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Health Risks ◽  
Social Determinants ◽  
Pharmacy Practice ◽  
Social Needs ◽  
Determinants Of Health ◽  
Call To Action ◽  
Physician Practices ◽  
The Impact

Social determinants of health (SDOH) are conditions in which individuals are born, live, work, learn, play, and age that affect health, risks, functioning, and outcomes. SDOH are recognized barriers to care, risk factors for certain diseases, and associated with poorer health outcomes. Screening for SDOH in physician practices and hospitals is reportedly low. The accessibility of pharmacists and established relationships with patients make pharmacy settings ideal for identifying and mitigating social needs. An evaluation of the impact of SDOH on health outcomes and opportunities for pharmacists to embed screening into practice is warranted.

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