Disparities in cancer survival in patients with multiple myeloma: A community-based cancer center experience.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20530-e20530
Author(s):  
Jessica M. Stempel ◽  
Vinicius Machado Jorge ◽  
Djeneba Audrey Djibo ◽  
Claudia M. Dourado
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Household Income ◽  
Statistical Significance ◽  
Determinants Of Health ◽  
Cancer Center ◽  
Community Based ◽  
Increased Risk

e20530 Background: Multiple myeloma (MM) accounts for nearly 17% of all hematological malignancies and 2% of all cancer-related deaths in 2018. Despite new treatment options, survival disparities among African Americans (AA) and other ethnic minorities still exist. Although cytogenetics and advanced age are high-risk features, equal healthcare access may also impact outcomes. We aim to investigate the social and biological factors which affect overall survival in patients with MM in a community setting with a predominantly AA population. Methods: We retrospectively identified MM cases diagnosed from January 1, 2013 and March 30, 2019, from our tumor registry. We collected demographic, clinical, histopathologic and treatment variables. Our primary endpoint was overall survival (OS). Overall and median survival with 95% confidence intervals were obtained using Kaplan Meier estimates. Results: We identified 73 patients with MM. Median age was 70 years (range, 42-88 years), 31 were female (42%) and 58 were AA (79%). Median household income in the AA group was $37,832 and $50,810 in the non-AA group ( p< 0.05). AA had a median overall survival (OS) of 15.9 months (95% CI, 8.2-23.7) compared to non-AA, 21.9 months (95% CI, 2.1-41.7). After a median follow-up of 20 months, the HR for death in AA was 1.32 (95% CI, 0.71-2.5); p= 0.37. None of the variables investigated were independently associated with an increased risk of mortality. Conclusions: Social determinants of health play a major role in community-based cancer centers, including access to care, income and social support. A difference in household income was found between both groups but was not independently associated with a survival advantage. Although, our results show AA patients with MM have a shorter OS compared to non-AA, this failed to reach statistical significance. The size of our sample limited the discovery of potential discrepancies in social determinants of health between both groups and their effect on outcomes. Larger-scale community-based studies are indispensable to investigate these differences further. [Table: see text]

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=&lt; 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=&lt; 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 Integrating Social Determinants of Health and Laboratory Data: A Pilot Study To Evaluate Co-Use of Opioids and Benzodiazepines

2019 ◽  
Vol 6 ◽  
pp. 237428951988487 ◽  
Author(s):  
Jill S. Warrington ◽  
Nick Lovejoy ◽  
Jamie Brandon ◽  
Keith Lavoie ◽  
Chris Powell
Keyword(s):  
Pilot Study ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Clinical Care ◽  
Laboratory Finding ◽  
Laboratory Data ◽  
Determinants Of Health ◽  
Opioid Use ◽  
Opioid Crisis ◽  
Increased Risk

As the opioid crisis continues to have devastating consequences for our communities, families, and patients, innovative approaches are necessary to augment clinical care and the management of patients with opioid use disorders. As stewards of health analytic data, laboratories are uniquely poised to approach the opioid crisis differently. With this pilot study, we aimed to bridge laboratory data with social determinants of health data, which are known to influence morbidity and mortality of patients with substance use disorders. For the purpose of this pilot study, we focused on the co-use of opioids and benzodiazepines, which can lead to an increased risk of fatal opioid-related overdoses and increased utilization of acute care. Using the laboratory finding of the copresence of benzodiazepines and opioids as the primary outcome measure, we examined social determinants of health attributes that predict co-use. We found that the provider practice that ordered the laboratory result is the primary predictor of co-use. Increasing age was also predictive of co-use. Further, co-use is highly prevalent in specific geographic areas or “hotspots.” The prominent geographic distribution of co-use suggests that targeted educational initiatives may benefit the communities in which co-use is prevalent. This study exemplifies the Clinical Lab 2.0 approach by leveraging laboratory data to gain insights into the overall health of the patient.

scholarly journals Social Determinants of Health in the lives of urinary catheter users

2018 ◽  
Vol 71 (4) ◽  
pp. 1928-1933
Author(s):  
Beatriz Maria Jorge ◽  
Laís Fumincelli ◽  
Valtuir Duarte de Souza-Junior ◽  
Rodrigo Guimarães dos Santos Almeida ◽  
Alessandra Mazzo ◽  
...  
Keyword(s):  
Elementary Education ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Household Income ◽  
Urinary Catheter ◽  
Determinants Of Health ◽  
Rehabilitation Center ◽  
Urinary Catheters ◽  
Life Conditions ◽  
The Social

ABSTRACT Objective: To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. Method: This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. Results: Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. Conclusion: The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.

scholarly journals Social Determinants of Myocardial Infarction Risk and Survival: A Systematic Review

2020 ◽  
pp. 1-12
Author(s):  
Steven S. Coughlin ◽  
Steven S. Coughlin ◽  
Lufei Young
Keyword(s):  
Myocardial Infarction ◽  
Social Support ◽  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Low Socioeconomic Status ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Access To Health Services ◽  
Immigration Status ◽  
Increased Risk

Social determinants of health that have been examined in relation to myocardial infarction incidence and survival include socioeconomic status (income, education), neighbourhood disadvantage, immigration status, social support, and social network. Other social determinants of health include geographic factors such as neighbourhood access to health services. Socioeconomic factors influence risk of myocardial infarction. Myocardial infarction incidence rates tend to be inversely associated with socioeconomic status. In addition, studies have shown that low socioeconomic status is associated with increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by socioeconomic status, race, education, and census-tract-level poverty. The results of this review indicate that social determinants such as neighbourhood disadvantage, immigration status, lack of social support, and social isolation also play an important role in myocardial infarction risk and survival. To address these social determinants and eliminate disparities, effective interventions are needed that account for the social and environmental contexts in which heart attack patients live and are treated.

scholarly journals A rapid qualitative assessment of the impact of the COVID-19 pandemic on a racially/ethnically diverse sample of gay, bisexual, and other men who have sex with men living with HIV in the US South

2020 ◽  
Author(s):  
Scott D. Rhodes ◽  
Lilli Mann-Jackson ◽  
Jorge Alonzo ◽  
Manuel Garcia ◽  
Amanda E. Tanner ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Ethnically Diverse ◽  
Determinants Of Health ◽  
Qualitative Assessment ◽  
Increased Risk ◽  
Persons Living With Hiv ◽  
Sex With Men ◽  
Living With Hiv ◽  
The Impact

Abstract Persons living with HIV (PLWH) may be at increased risk for severe COVID-19-related illness. Our community-based participatory research partnership collected and analyzed semi-structured interview data to understand the early impact of the COVID-19 pandemic on a sample of racially/ethnically diverse gay, bisexual, and other men who have sex with men living with HIV. Fifteen cisgender men participated; their mean age was 28. Six participants were Black/African American, five were Spanish-speaking Latinx, and four were White. Seventeen themes emerged that were categorized into six domains: knowledge and perceptions of COVID-19; COVID-19 information sources and perceptions of trustworthiness; impact of COVID-19 on behaviors, health, and social determinants of health; and general COVID-19-related concerns. Interventions are needed to ensure that PLWH have updated information and adhere to medication regimens, and to reduce the impact of COVID-19 on social isolation, economic stability, healthcare access, and other social determinants of health within this vulnerable population.

scholarly journals Students’ understanding of social determinants of health in a community-based curriculum: a general inductive approach for qualitative data analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sachiko Ozone ◽  
Junji Haruta ◽  
Ayumi Takayashiki ◽  
Takami Maeno ◽  
Tetsuhiro Maeno
Keyword(s):  
Data Analysis ◽  
Medical Students ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Rural Areas ◽  
Qualitative Data ◽  
Determinants Of Health ◽  
Qualitative Data Analysis ◽  
Community Based ◽  
Inductive Approach

Abstract Background A community-based medical education (CBME) curriculum may provide opportunities to learn about the social determinants of health (SDH) by encouraging reflection on context, but the categories that students can learn about and their level of reflection are unclear. We aimed to analyze medical students’ understanding and level of reflection about SDH in a CBME curriculum. Methods Study design: General inductive approach for qualitative data analysis. Education Program: All 5th-year and 6th-year medical students at the University of Tsukuba School of Medicine in Japan who completed a mandatory 4-week clinical clerkship in general medicine and primary care during October 2018 and May 2019 were included. The curriculum included 3 weeks of rotations in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. On the first day, students learned about SDH through a lecture and a group activity. As an SDH assignment, they were instructed to prepare a structural case description using the Solid Facts framework based on encounters during the curriculum. On the final day, they submitted the structural reflection report. Analysis: Content analysis was based on the Solid Facts framework. Levels of reflection were categorized as reflective, analytical, or descriptive. Results We analyzed 113 SDH case descriptions and 118 reports. On the SDH assignments, the students frequently reported on social support (85%), stress (75%), and food (58%), but less frequently on early life (15%), unemployment (14%), and social gradient (6%). Of the 118 reports, 2 were reflective, 9 were analytical, and 36 were descriptive. The others were not evaluable. Conclusions The CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

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