scholarly journals To what extent are social determinants of health, including household overcrowding, air pollution and housing quality deprivation, modulators of presentation, ITU admission and outcomes among patients with SARS-COV-2 infection in an urban catchment area in Birmingham, United Kingdom?

2020 ◽  
Author(s):  
Marina Soltan ◽  
LE Crowley ◽  
CR Melville ◽  
Justin Varney ◽  
Sam Cassidy ◽  
...  
Keyword(s):  
Air Pollution ◽  
Intensive Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Housing Quality ◽  
Determinants Of Health ◽  
Lobar Pneumonia ◽  
Risk Of Death ◽  
Increased Risk ◽  
Deprivation Indices

Abstract Background: Internationally, researchers have called for evidence to support tackling health inequalities during the Severe acute respiratory syndrome coronavirus 2(COVID19) pandemic. UK Office for National Statistics data suggests that patients in regions of most deprived overall, generic Index of Multiple Deprivation Score(IMDS) are twice as likely to die of COVID19 than other causes. The Intensive Care National Audit and Research Centre (ICNARC) report that BAME patients account for 34% of critically ill COVID19 patients nationally despite constituting 14% of the population. This paper is the first to explore the roles of social determinants of health, including specific IMDS sub-indices with indicators for household quality deprivation, household overcrowding deprivation and air pollution deprivation, as modulators of presentation, Intensive Care Unit(ITU) admission and outcomes among COVID19 patients of all ethnicities. Methods: An in-depth retrospective cohort study of 408 hospitalised COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including two-step cluster analyses were applied. Results: Patients admitted from highest living environment(LE) deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services(BHS) deprivation indices were at increased risk of ITU admission. Admission to ITU significantly increased the risk of death. Black, Asian and Minority Ethnic(BAME) patients were more likely, than white patients, to present with multi-lobar pneumonia, be admitted to ITU and be admitted from highest BHS and LE deprivation indices. Comorbidities and frailty significantly increased the risk of death among COVID19 patients irrespective of deprivation.Conclusions: Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Patents of BAME ethnicity are more likely to be admitted from regions of highest air pollution, housing quality and household overcrowding deprivation; this is likely to contribute an explanation towards the higher ITU admissions reported among COVID19 BAME patients. These findings have urgent implications for supporting front line clinical decisions, disseminating practical advice around applying social distancing messages at the household level and informing wider pandemic strategy.

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=< 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=< 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 Medical and Social Determinants of Health Associated with Intensive Care Admission for Asthma in Children

2016 ◽  
Vol 13 (7) ◽  
pp. 1081-1088 ◽  
Author(s):  
Karen M. McDowell ◽  
Carolyn M. Kercsmar ◽  
Bin Huang ◽  
Theresa W. Guilbert ◽  
Robert S. Kahn
Keyword(s):  
Intensive Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Intensive Care Admission ◽  
Asthma In Children

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.

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