scholarly journals Health care experiences during the COVID-19 pandemic by race and social determinants of health among adults age ≥ 58 years in the REGARDS study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emily B. Levitan ◽  
Virginia J. Howard ◽  
Mary Cushman ◽  
Suzanne E. Judd ◽  
Stephanie E. Tison ◽  
...  
Keyword(s):  
Health Care ◽  
Social Determinants Of Health ◽  
Racial Differences ◽  
Social Determinants ◽  
Determinants Of Health ◽  
National Study ◽  
Black And White ◽  
Health Care Experiences ◽  
Public Health Infrastructure ◽  
Regards Study

Abstract Background Understanding health care experiences during the COVID-19 pandemic may provide insights into patient needs and inform policy. The objective of this study was to describe health care experiences by race and social determinants of health. Methods We conducted a telephone survey (July 6, 2020-September 4, 2021) among 9492 Black and White participants in the longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, age 58–105 years, from the continental United States. Among participants with symptoms of COVID-19, outcomes were: 1. Sought care or advice for the illness; 2. Received a SARS-CoV-2 test for the illness; and 3. Tested positive. Among participants without symptoms of COVID-19, outcomes were: 1. Wanted a test; 2. Wanted and received a test; 3. Did not want but received a test; and 4. Tested positive. We examined these outcomes overall and in subgroups defined by race, household income, marital status, education, area-level poverty, rural residence, Medicaid expansion, public health infrastructure ranking, and residential segregation. Results The average age of participants was 76.8 years, 36% were Black, and 57% were female. Among participants with COVID-19 symptoms (n = 697), 74% sought care or advice for the illness, 50% received a SARS-CoV-2 test, and 25% had a positive test (50% of those tested). Among participants without potential COVID-19 symptoms (n = 8795), 29% wanted a SARS-CoV-2 test, 22% wanted and received a test, 8% did not want but received a test, and 1% tested positive; a greater percentage of participants who were Black compared to White wanted (38% vs 23%, p < 0.001) and received tests (30% vs 18%, p < 0.001) and tested positive (1.4% vs 0.8%, p = 0.005). Conclusions In this national study of older US adults, many participants with potential COVID-19 symptoms and asymptomatic participants who desired testing did not receive COVID-19 testing.

Abstract P554: Multiple Social Determinants of Health and Incident Stroke in the Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Evgeniya Reshetnyak ◽  
Laura C. Pinheiro ◽  
Monika M. Safford ◽  
Mariella Ntamatungiro ◽  
April P. Carson ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Racial Differences ◽  
Social Determinants ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Determinants Of Health ◽  
Cox Models ◽  
Black And White ◽  
Cox Proportional Hazards Models ◽  
Stroke Study

Introduction: Although social determinants of health (SDOH) were shown to be individually associated with incident stroke, few studies explored the effect of multiple SDOH within the same individuals on incident stroke. To address this limitation, we operationalized SDOH as a count and examined its association with incident stroke. This approach is practically appealing in clinical settings - it is easy to calculate and interpret. Hypothesis: We hypothesized that a greater number of SDOH within individuals would be significantly associated with a higher risk of incident stroke. Methods: REGARDS is a prospective cohort of 30,239 black and white adults aged > 45 years recruited in 2003-2007. Sociodemographic, medical history, and stroke risk factors were collected at baseline. To define exposure, we followed the Healthy People 2020 framework, and initially used 10 SDOH to represent 5 domains: education, health, social, economic and neighborhood factors. We selected SDOH that were significantly associated with incident stroke: race, education, income, zip code poverty, health insurance, social isolation, and residence in states with poor public health infrastructure. We then created a primary exposure - a count of SDOH for each individual. The outcome was expert adjudicated incident strokes. Cox proportional hazards models examined associations between a count of SDOH (0, 1, 2, 3+) and incident stroke, adjusting for confounders. Results: This study included 27,813 individuals free from stroke at baseline. We observed 1470 incident strokes during the follow-up. A significant interaction between SDOH count and age resulted in stratification at 75 years. In fully adjusted Cox models, among individuals <75 years, risk of stroke amplified with each increase in number of SDOH. This pattern was not observed among those 75+ years (Table 1). Conclusions: Individuals <75 years with a greater number of SDOH had higher risk of stroke. Targeting individuals with multiple SDOH, especially those <75 years, may help reduce risk of stroke.

scholarly journals Impact of COVID-19 on social determinants of health for adults with cystic fibrosis

2021 ◽  
Vol 15 ◽  
pp. 175346662110374
Author(s):  
Dana Albon ◽  
Heather Bruschwein ◽  
Morgan Soper ◽  
Rhonda List ◽  
Deirdre Jennings ◽  
...  
Keyword(s):  
Health Care ◽  
Cystic Fibrosis ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Issues ◽  
Determinants Of Health ◽  
Care Utilization ◽  
Health Questionnaire ◽  
Improvement Project ◽  
The Impact

Introduction: Outcomes in cystic fibrosis are influenced by multiple factors, including social determinants of health. Low socioeconomic status has been shown to be associated with lung function decline, increased exacerbation rates, increased health care utilization, and decreased survival in cystic fibrosis. The COVID-19 pandemic disrupted the US economy, placing people with cystic fibrosis at risk for negative impacts due to changes in social determinants of health. Methods: To characterize the impact of COVID-19-related changes in social determinants of health in the adult cystic fibrosis population, a social determinants of health questionnaire was designed and distributed to patients as part of a quality improvement project. Results: Of 132 patients contacted, 76 (57.6%) responses were received. Of these responses, 22 (28.9%) answered yes to at least one question that indicated an undesired change in social determinants of health. Patients with stable employment prior to COVID-19 were more likely to endorse undesired change in all domains of the questionnaire, and the undesired changes were most likely to be related to employment, insurance security, and access to medications. Patients receiving disability were more likely to report hardship related to utilities and food security compared with patients previously employed or unemployed. Of patients endorsing risk of socioeconomic hardship, 21 (95.5%) were contacted by a social worker and provided resources. Conclusion: Utilizing a social determinants of health questionnaire to screen for social instability in the context of COVID-19 is feasible and beneficial for patients with cystic fibrosis. Identifying social issues early during the pandemic and implementing processes to provide resources may help patients with cystic fibrosis mitigate social hardship and maintain access to health care and medications.

scholarly journals Social determinants of health in mental health care and research: a case for greater inclusion

2019 ◽  
Vol 26 (8-9) ◽  
pp. 895-899 ◽  
Author(s):  
Joseph J Deferio ◽  
Scott Breitinger ◽  
Dhruv Khullar ◽  
Amit Sheth ◽  
Jyotishman Pathak
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Determinants Of Health ◽  
Language Processing ◽  
Social Determinants ◽  
Ad Hoc ◽  
Extraction Methods ◽  
Determinants Of Health ◽  
Independent Risk Factors

Abstract Social determinants of health (SDOH) are known to influence mental health outcomes, which are independent risk factors for poor health status and physical illness. Currently, however, existing SDOH data collection methods are ad hoc and inadequate, and SDOH data are not systematically included in clinical research or used to inform patient care. Social contextual data are rarely captured prospectively in a structured and comprehensive manner, leaving large knowledge gaps. Extraction methods are now being developed to facilitate the collection, standardization, and integration of SDOH data into electronic health records. If successful, these efforts may have implications for health equity, such as reducing disparities in access and outcomes. Broader use of surveys, natural language processing, and machine learning methods to harness SDOH may help researchers and clinical teams reduce barriers to mental health care.

scholarly journals Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health

2020 ◽  
Vol 42 (1) ◽  
Author(s):  
Matthew W. Kreuter ◽  
Tess Thompson ◽  
Amy McQueen ◽  
Rachel Garg
Keyword(s):  
Public Health ◽  
Health Care ◽  
Social Determinants Of Health ◽  
Social Services ◽  
Social Determinants ◽  
Safety Net ◽  
Social Needs ◽  
Determinants Of Health ◽  
Health Improvement ◽  
Health Care Settings

There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health. Expected final online publication date for the Annual Review of Public Health, Volume 42 is April 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Emancipatory practices of nurses in primary health care: the home visit as an instrument of health needs assessment

2014 ◽  
Vol 48 (spe) ◽  
pp. 119-125 ◽  
Author(s):  
Celia Maria Sivalli Campos ◽  
Bárbara Ribeiro Buffette Silva ◽  
Deisi Cristine Forlin ◽  
Carla Andréa Trapé ◽  
Iara de Oliveira Lopes
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Home Visit ◽  
Care Service ◽  
Health Care Service ◽  
Health Needs ◽  
Determinants Of Health ◽  
Primary Health

Objective Identify nurses’ emancipatory practices in primary care, to contribute to the improvement of health care. Method A case study type social research of qualitative nature, in which nurses of a primary health care service unit in São Paulo were interviewed. Results The home visit was identified as a nursing practice possible to be expanded in order to identify social determinants of health, triggering emancipatory practices in the service. This expansion occurred because the design of health care labour intended by the service team changed its focus from the traditional object of health services, the disease. Conclusion First, it is advocated that social policies lead projects with the purpose of improving health needs. On the other hand, the daily labour needs to provide opportunities for reflection and discussion of healthcare projects, leading workers to propose labour-processes targeted to both the social determinants of health and people’s illness.

scholarly journals The Role of Social Determinants of Health in Self-Reported Access to Health Care Among Women Undergoing Screening Mammography

2020 ◽  
Vol 29 (11) ◽  
pp. 1437-1446
Author(s):  
Louise M. Henderson ◽  
Ellen S. O'Meara ◽  
Jennifer S. Haas ◽  
Christoph I. Lee ◽  
Karla Kerlikowske ◽  
...  
Keyword(s):  
Health Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Access To Health Care ◽  
Screening Mammography ◽  
Determinants Of Health ◽  
Access To Health

scholarly journals Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
O. Pearson ◽  
◽  
K. Schwartzkopff ◽  
A. Dawson ◽  
C. Hagger ◽  
...  
Keyword(s):  
Health Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Torres Strait Islander ◽  
Determinants Of Health ◽  
Annual Reports ◽  
Aboriginal Community ◽  
Primary Health ◽  
The Social ◽  
Torres Strait

Abstract Background Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented. Methods The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed. A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings. Results Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes. Conclusions This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.

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