Abstract 1122‐000159: Area Deprivation Index and Transfer Likelihood Offer Insight into Improving Stroke Care Access Equity

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Naoum Fares Marayati ◽  
Jacob Morey ◽  
Xiangnan Zhang ◽  
Christina P Rossitto ◽  
Kevin Weiss ◽  
...  
Keyword(s):  
Stroke Care ◽  
Housing Quality ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Transfer Time ◽  
Care Access ◽  
Lower Socioeconomic ◽  
Triage Protocol ◽  
Unit Increase ◽  
Timely Access

Introduction : Time is brain for stroke care. Socioeconomic disparities may have an impact on timely access to stroke care. A well known factor that affects access to thrombectomy is the necessity for transfer from a non‐thrombectomy capable center to a thrombectomy capable center (TSC). The Area Deprivation Index (ADI) is a validated, neighborhood‐level composite measure (scored 1–100) which uses income, education, employment, housing quality, and other factors to identify geographic areas with increased need. We analyzed the association between ADI and requirement of transfer prior to thrombectomy to further understand how establishment of TSCs in areas with higher ADI and severity score bypass protocols can increase access to stroke care across all ranges of socioeconomic need. Methods : We obtained transfer status and the duration of the transfer time for all thrombectomy patients treated between 2016 and 2021 in a large, urban multi‐hospital health system and matched them with their respective census‐tract level ADI scores from Neighborhood Atlas, with a higher ADI score signifying lower socioeconomic status. Preliminary analysis utilized logistic regression to compare the ADI between transfer and non‐transfer cases. Further exploration observed temporal changes to the percentage of patients requiring transfer across 4 ADI ranges. Results : Among 513 cases for which we had a pick up address for between 2016–2021, the average ADI of pick‐up locations was 10.3 (range: 1 ‐ 70.5). ADI was significantly predictive of transfer status (p = 0.0004), with a 1 unit increase in ADI increasing the odds of being transferred by 1.035. Patients requiring transfer took an average of 2.7 hours longer to thrombectomy compared to non‐transfer patients. However, within the transfer population, a higher ADI did not correlate with increased transfer time. Across all ADI ranges, the likelihood of transfer began to decrease in 2018. This is likely due to the establishment of a new TSC in 2018 as well as the implementation of an EMS triage protocol transporting patients with a higher severity of stroke directly to TSCs. Notably, patients in the highest ADI range did not experience decreased likelihood of transfer until 2020, correlating with establishment of another TSC. Conclusions : Across urban census tracts, patients with a higher ADI had an increased likelihood of transfer, and hence delay in access to thrombectomy. Equity to access to thrombectomy improved over time. Expanding thrombectomy access as well as establishing EMS triage protocols appear to correlate with improvement in access to stroke thrombectomy care for patients with higher ADI.

scholarly journals Area Deprivation Index Contributes to the Association of Race with Severe Maternal Morbidity

2022 ◽  
Vol 226 (1) ◽  
pp. S38-S39
Author(s):  
Francis M. Hacker ◽  
Jaclyn M. Phillips ◽  
Lara S. Lemon ◽  
Aislin DeFilippo ◽  
Hyagriv Simhan
Keyword(s):  
Maternal Morbidity ◽  
Deprivation Index ◽  
Severe Maternal Morbidity ◽  
Area Deprivation

scholarly journals Area Deprivation Index and Rurality in Relation to Lung Cancer Prevalence and Mortality in a Rural State

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Kathleen M Fairfield ◽  
Adam W Black ◽  
Erika C Ziller ◽  
Kimberly Murray ◽  
F Lee Lucas ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Rate Ratio ◽  
Geographic Area ◽  
Population Based ◽  
Socioeconomic Deprivation ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Behavioral Risk ◽  
Cross Sectional ◽  
Cancer Prevalence

Abstract Background We sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality. Methods We conducted a population-based cross-sectional analysis of prevalent lung cancers from a statewide all-payer claims dataset from 2012 to 2016, lung cancer deaths in Maine from the state death registry from 2012 to 2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small and isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by the Behavioral Risk Factor Surveillance System. Results Among 1 223 006 adults aged 20 years and older during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex, and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates (prevalence rate ratio for ADI quintile 5 compared with quintile 1 = 1.41, 95% confidence interval [CI] =1.30 to 1.54) and mortality rate ratio = 1.59, 95% CI = 1.41 to 1.79). Conclusion Socioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions and to improve patient access to lung cancer prevention, screening, and treatment services.

scholarly journals Assessing the association between area deprivation index on COVID-19 prevalence: a contrast between rural and urban U.S. jurisdictions

2021 ◽  
Vol 8 (3) ◽  
pp. 519-530
Author(s):  
Christopher Kitchen ◽  
◽  
Elham Hatef ◽  
Hsien Yen Chang ◽  
Jonathan P Weiner ◽  
...  
Keyword(s):  
Rural Communities ◽  
Family Income ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Minority Populations ◽  
Property Value ◽  
Rural And Urban ◽  
Level Data ◽  
The Relationship ◽  
The U.S

<abstract><sec> <title>Background</title> <p>The COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S.</p> </sec><sec> <title>Objectives</title> <p>To understand the spread and impact of COVID-19 across the U.S., county level data for confirmed cases of COVID-19 were examined by Area Deprivation Index (ADI) and Metropolitan vs. Nonmetropolitan designations from the National Center for Health Statistics (NCHS). These designations were the basis for making comparisons between Urban and Rural jurisdictions.</p> </sec><sec> <title>Method</title> <p>Kendall's Tau-B was used to compare effect sizes between jurisdictions on select ADI composites and well researched social determinants of health (SDH). Spearman coefficients and stratified Poisson modeling was used to explore the association between ADI and COVID-19 prevalence in the context of county designation.</p> </sec><sec> <title>Results</title> <p>Results show that the relationship between area deprivation and COVID-19 prevalence was positive and higher for rural counties, when compared to urban ones. Family income, property value and educational attainment were among the ADI component measures most correlated with prevalence, but this too differed between county type.</p> </sec><sec> <title>Conclusions</title> <p>Though most Americans live in Metropolitan Areas, rural communities were found to be associated with a stronger relationship between deprivation and COVID-19 prevalence. Models predicting COVID-19 prevalence by ADI and county type reinforced this observation and may inform health policy decisions.</p> </sec></abstract>

scholarly journals The Association Between Area Deprivation Index and Patient-Reported Outcomes in Patients with Advanced Cancer

Health Equity ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 8-16
Author(s):  
Margaret Quinn Rosenzweig ◽  
Andrew D. Althouse ◽  
Lindsay Sabik ◽  
Robert Arnold ◽  
Edward Chu ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Patient Reported

scholarly journals The effect of area deprivation on COVID-19 risk in Louisiana

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243028
Author(s):  
Madhav K. C. ◽  
Evrim Oral ◽  
Susanne Straif-Bourgeois ◽  
Ariane L. Rung ◽  
Edward S. Peters
Keyword(s):  
Census Tract ◽  
The United States ◽  
Neighborhood Environment ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Neighborhood Deprivation ◽  
Department Of Health ◽  
High Deprivation ◽  
Case Count ◽  
Deprived Neighborhoods

Background Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana. Methods The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed. Results Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and –33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods. Conclusion While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation.

scholarly journals Rationing of Civilian Coronavirus Disease 2019 Vaccines While Supplies Are Limited

2020 ◽  
Vol 222 (11) ◽  
pp. 1776-1779
Author(s):  
Richard K Zimmerman ◽  
Jeannette E South-Paul ◽  
Gregory A Poland
Keyword(s):  
Racial Disparities ◽  
Critical Infrastructure ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Medical Benefit

Allocation of the initial doses of coronavirus disease 2019 vaccines should account for epidemiology, vaccinology, bioethics, and racial disparities. Our priority tiers for vaccination are critical infrastructure, those at highest medical benefit, and those chosen by a weighted Area-Deprivation Index lottery.

scholarly journals Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study

Thorax ◽  
2019 ◽  
Vol 74 (9) ◽  
pp. 849-857 ◽  
Author(s):  
Tristram Ingham ◽  
Michael Keall ◽  
Bernadette Jones ◽  
Daniel R T Aldridge ◽  
Anthony C Dowell ◽  
...  
Keyword(s):  
Dose Response ◽  
Acute Respiratory Infection ◽  
Case Control Study ◽  
Quality Measures ◽  
Case Control ◽  
Housing Quality ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Unit Increase ◽  
Control Study

IntroductionA gap exists in the literature regarding dose–response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children.MethodsA prospective, unmatched case–control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011–2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp–mould subscale. The main outcome was case–control status. Adjusted ORs (aORs) of the association of housing quality measures with case–control status were estimated, along with the population attributable risk of eliminating dampness–mould on hospitalisation for ARI among New Zealand children.Results188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp–mould index had a significant, adjusted dose–response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually.ConclusionsA dose–response relationship exists between housing quality measures, particularly dampness–mould, and young children’s ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness–mould would have a large impact on ARI hospitalisation.

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