Race/Ethnicity and County-Level Social Vulnerability Impact Hospice Utilization Among Patients Undergoing Cancer Surgery

2020 ◽  
Author(s):  
Alizeh Abbas ◽  
J. Madison Hyer ◽  
Timothy M. Pawlik
Keyword(s):  
Social Vulnerability ◽  
Cancer Surgery ◽  
County Level ◽  
Race Ethnicity

County-level USA: No Robust Relationship between Geoclimatic Variables and Cognitive Ability

2020 ◽  
Author(s):  
Bryan J Pesta ◽  
John Fuerst ◽  
Emil O. W. Kirkegaard
Keyword(s):  
Cognitive Ability ◽  
Climate Models ◽  
Cold Weather ◽  
Regression Equations ◽  
County Level ◽  
Spatial Lag ◽  
Average Temperature ◽  
Wrong Direction ◽  
Race Ethnicity ◽  
Demographic Covariates

Using a sample of ~3,100 U.S. counties, we tested geoclimatic explanations for why cognitive ability varies across geography. These models posit that geoclimatic factors will strongly predict cognitive ability across geography, even when a variety of common controls appear in the regression equations. Our results generally do not support UV radiation (UVR) based or other geoclimatic models. Specifically, although UVR alone predicted cognitive ability at the U.S. county-level (β = -.33), its validity was markedly reduced in the presence of climatic and demographic covariates (β = -.16), and was reduced even further with a spatial lag (β = -.10). For climate models, average temperature remained a significant predictor in the regression equation containing a spatial lag (β = .35). However, the effect was in the wrong direction relative to typical cold weather hypotheses. Moreover, when we ran the analyses separately by race/ethnicity, no consistent pattern appeared in the models containing the spatial lag. Analyses of gap sizes across counties were also generally inconsistent with predictions from the UVR model. Instead, results seemed to provide support for compositional models.

Association of social vulnerability with the use of high-volume and Magnet recognition hospitals for hepatopancreatic cancer surgery

Surgery ◽  
2021 ◽  
Author(s):  
Adrian Diaz ◽  
J. Madison Hyer ◽  
Rosevine Azap ◽  
Diamantis Tsilimigras ◽  
Timothy M. Pawlik
Keyword(s):  
Social Vulnerability ◽  
High Volume ◽  
Cancer Surgery ◽  
Magnet Recognition

Social vulnerability and clinical trial access for older adults with myeloma in North Carolina.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18540-e18540
Author(s):  
Shakira Jeanene Grant ◽  
Matthew Jansen ◽  
Sascha Tuchman ◽  
Samuel M. Rubinstein ◽  
Eben I. Lichtman ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Socioeconomic Status ◽  
North Carolina ◽  
Social Vulnerability ◽  
Household Composition ◽  
Comprehensive Cancer Center ◽  
County Level ◽  
Phase 2 ◽  
Financial Barriers ◽  
Trial Site

e18540 Background: Multiple myeloma (MM) is a disease of aging, associated with one of the greatest black-white disparities in incidence and mortality among all US cancer types. Clinical trials provide the critical evidence-base to inform clinical management in all cancers, including MM. However, clinical trial participants are often younger (age < 65 years) and white, limiting the generalizability of published data to real-world MM care. Although geographical and financial barriers to clinical trial participation are well recognized, less is known about the association of county-level social vulnerability with MM trial availability. We examined county-level variation in the number of registered myeloma trials per 10,000 North Carolina (NC) residents age ≥ 65 years as a function of social vulnerability and the presence of a National Cancer Institute Comprehensive Cancer Center (CCC). Methods: We conducted a cross-sectional study using data from ClinicalTrials.gov to identify all registered interventional myeloma trials involving adults age ≥ 65 years with sites in NC. Records were downloaded on January 24th, 2021. This strategy yielded 456 non-unique NC sites for 223 trials. We obtained county locations for all trial sites by matching city, zip code, or institution name. We obtained NC population data for residents age ≥ 65 years (in 2019) from the American Community Survey. The four themes (socioeconomic status, household composition, ethnic and racial minority status/language, housing/transportation) within the Centers for Disease Control Social Vulnerability Index (CDC SVI) (composite score: 0-1, with a higher number indicating more vulnerability) were used to characterize county-level social vulnerability. We performed negative binomial regression and tabulations using R, version 3.6.1. A p-value < 0.05 was considered statistically significant. Results: Across 100 counties in NC, trial site counts by county per 10,000 residents age ≥ 65 years ranged from 0 to 23.2 (mean: 1.5, median: 0; IQR, 0-0.7). Controlling for the 4 SVI themes, counties with CCCs (Durham, Forsyth, Orange) had 77% more trials than those without CCCs [Incidence Rate Ratio (IRR): 7.74; p = 0.05]. We observed a 3.3% reduction in trial counts with each percentile increase in socioeconomic vulnerability (IRR: 0.97; p = 0.008). Counties with higher representation by racial and ethnic minorities had similar trial site counts to counties with lower minority populations (IRR: 1.01; p = 0.08). Sub-group analyses of early-stage studies (phase 1/2 and phase 2; n = 268) and late-stage studies (phase 2/3 and phase 3; n = 168) were similar. Conclusions: Our preliminary results suggest county-level socioeconomic status is associated with the distribution of MM clinical trial sites across NC. Further work is planned to explore whether additional variances in trial distribution could be explained by site- and study-specific characteristics.

Race, Ethnicity, and Trial Avoidance: A Multilevel Analysis

2018 ◽  
Vol 31 (3) ◽  
pp. 422-451
Author(s):  
Jacqueline G. Lee ◽  
Rebecca L. Richardson
Keyword(s):  
Racial Disparities ◽  
Multilevel Analysis ◽  
Hierarchical Linear Modeling ◽  
County Level ◽  
Racial Threat ◽  
Linear Modeling ◽  
Race Ethnicity ◽  
Black Defendants ◽  
White Defendants ◽  
Threat Theory

Minority criminal defendants are more likely than White defendants to exercise their right to trial, which is concerning given that research also consistently finds trial sentences to be harsher than those obtained via pleas. However, guilty pleas are not the only disposition available for avoiding a trial; pretrial diversions and case dismissals also serve as mechanisms for trial avoidance. Using hierarchical linear modeling, we find that Black criminal defendants are more likely than Whites to go to trial rather than receive other case disposition. Relationships for Hispanic defendants are less consistent. Fewer county-level effects emerge than expected, providing little to no support for racial threat theory. Results suggest that Black defendants are less often able or willing to avoid a trial, a finding which highlights and perhaps helps to explain racial disparities in final sentencing outcomes.

scholarly journals County‐Level Factors Associated With Cardiovascular Mortality by Race/Ethnicity

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Bongeka Z. Zuma ◽  
Justin T. Parizo ◽  
Areli Valencia ◽  
Gabriela Spencer‐Bonilla ◽  
Manuel R. Blum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Healthcare Access ◽  
Ethnic Disparities ◽  
County Level ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White ◽  
Cvd Mortality

Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity‐specific CVD mortality and county‐level factors. Methods and Results Using 2017 county‐level data, we studied the association between race/ethnicity‐specific CVD age‐adjusted mortality rate (AAMR) and county‐level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R 2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non‐Hispanic White individuals in 2698 counties; 100 475 deaths among non‐Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non‐Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation ( R 2 ) in CVD AAMR was explained by physical inactivity for non‐Hispanic White individuals (32.3%), median household income for non‐Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county‐level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non‐Hispanic White individuals (35.3%), socioeconomic factors for non‐Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity‐specific age‐adjusted CVD mortality and county‐level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.

scholarly journals Interactive, on-line visualization tools to measure and drive equity in COVID-19 vaccine administrations

2021 ◽  
Author(s):  
Amy W Shaheen ◽  
Eileen Ciesco ◽  
Kevin Johnson ◽  
Greg Kuhnen ◽  
Christopher Paolini ◽  
...  
Keyword(s):  
Data Warehouse ◽  
Social Vulnerability ◽  
Large Hospital ◽  
Equitable Distribution ◽  
Hospital System ◽  
Online Tools ◽  
On Line ◽  
Visualization Tools ◽  
Race Ethnicity ◽  
Data Elements

Abstract Equitable distribution of vaccines is necessary to ensure those at highest risk of illness are protected from COVID-19 (coronavirus disease 2019). Unfortunately, there is significant evidence that vaccines have not been reaching the most vulnerable. At our large hospital system, we created interactive online tools to measure and visualize equitability of vaccine administrations and to help stakeholders identify populations at highest risk within state-designated eligible vaccine groups. Using race, ethnicity, gender, and social vulnerability, we are able to measure and reflect our vaccine administration performance against the communities that we serve. With our visualization tools, stakeholders have been able to target interventions to improve equity in vaccine administrations, including improvements in race, ethnicity, and social vulnerability. We plan to use the data elements incorporated in our electronic health record and data warehouse due to the COVID-19 pandemic to guide further population health efforts at decreasing disparities.

scholarly journals Ecological Analysis of the Temporal Trends in the Association of Social Vulnerability and Race/Ethnicity with County-Level COVID-19 Incidence and Outcomes in the United States

2021 ◽  
Author(s):  
Shabatun Islam ◽  
Aditi Nayak ◽  
Yingtian Hu ◽  
Anurag Mehta ◽  
Katherine Dieppa ◽  
...  
Keyword(s):  
Social Vulnerability ◽  
Temporal Trends ◽  
The United States ◽  
Ethnic Composition ◽  
Racial Composition ◽  
Third Wave ◽  
County Level ◽  
Incidence And Mortality ◽  
Per Capita ◽  
The U.S

ABSTRACT Background The COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the U.S. initially, but the temporal trends during the year-long pandemic remain unknown. Objective We examined the temporal association between the county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the U.S. in the year starting in March 2020. Methods Counties (n=3091) with > 50 COVID-19 cases by March 6th, 2021 were included in the study. Associations between SVI (and its subcomponents) and county level racial composition with the incidence and death per capita were assessed by fitting a negative-binomial mixed-effects mod-el. This model was also used to examine potential time varying associations between weekly number of cases/deaths and SVI or racial composition. Data was adjusted for percentage of population aged great or equal to 65 years, state level testing rate, comorbidities using the average Hierarchical Condition Category (HCC) score, and environmental factors including average fine particulate matter (PM2.5), temperature and precipitation. Results Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio [IRR] per-10 percentile increase:1.02, (95% CI 1.02, 1.03, p<0.001), and death per capita (1.04, (95% CI 1.04, 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by the winter, a period that coincided with a sharp increase in infection rates and mortality, and when counties with higher proportion of White residents were disproportionately represented (third wave). By Spring of 2021, SVI was again a predictor of COVID-19 out-comes. Counties with greater proportion of Black residents also observed similar temporal trends COVID-19-related adverse outcomes. Counties with greater proportion of Hispanic residents had worse outcomes throughout the duration of the analysis. Conclusion Except for the winter third wave when majority White communities had the highest incidence of cases, counties with greater social vulnerability and proportionately higher minority populations, experienced worse COVID-19 outcomes.

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