Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness

Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5% unemployed) and 181 adults with anxiety diagnoses and active anti-anxiety prescriptions (Mage = 43.45 ± 11.02, 54.4% Caucasian, 57.5% male, 66.3% uninsured, 88.9% unemployed) recruited from six homeless-serving agencies in Oklahoma City. Self-reported sociodemographic variables included: age, sex, race/ethnicity, education, monthly income, employment status, and health insurance status. Adjusted logistic regression analyses revealed that employed (OR = 4.022, CI0.95: 1.244–13.004) and insured (OR = 2.923, CI0.95: 1.225–6.973) participants had greater odds of depression medication nonadherence. For anxiety, being employed (OR = 3.573, CI0.95: 1.160–11.010) was associated with greater odds of anxiety medication nonadherence, whereas having depression and anxiety diagnostic comorbidity (OR = 0.333, CI0.95: 0.137–0.810) was associated with lower odds of anxiety medication nonadherence. Interventions aimed at facilitating accessible prescription acquisition or otherwise reducing barriers to prescription medications for employed adults, including those with health insurance, may benefit adherence, but more research is needed. Future studies would benefit from using a qualitative approach to better delineate nuanced barriers to psychiatric medication adherence.

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Race/Ethnicity and Health Insurance Status: 1987 and 1996

Medical Care Research and Review ◽

10.1177/107755800773743583 ◽

2000 ◽

Vol 57 (4) ◽

pp. 11-35 ◽

Cited By ~ 39

Author(s):

Alan C. Monheit ◽

Jessica P. Vistnes

Keyword(s):

Health Insurance ◽

Insurance Status ◽

Health Insurance Status ◽

Race Ethnicity

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Age-related Differences in Breast Cancer Mortality according to Race/Ethnicity, Insurance, and Socioeconomic Status

10.21203/rs.2.12129/v2 ◽

2019 ◽

Author(s):

Yazmin San Miguel ◽

Scarlett Lin Gomez ◽

James D. Murphy ◽

Richard B. Schwab ◽

Corinne McDaniels-Davidson ◽

...

Keyword(s):

Breast Cancer ◽

Socioeconomic Status ◽

Health Insurance ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Insurance Status ◽

Younger Patients ◽

Younger Women ◽

Health Insurance Status ◽

Race Ethnicity

Abstract Purpose We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. Methods The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (<60 years) patients separately by race/ethnicity, nSES, and health insurance status. Results Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction<0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic white (HR=1.43; 95% CI, 1.36-1.51) and Hispanic women (HR=1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic blacks (HR=1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR=1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction<0.0001), with largest mortality differences observed for privately insured women (HR=1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR=1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. Conclusion Our results provide evidence for the continued disparity in black-white breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.

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Emerging Adulthood, Emergent Health Lifestyles: Sociodemographic Determinants of Trajectories of Smoking, Binge Drinking, Obesity, and Sedentary Behavior

Journal of Health and Social Behavior ◽

10.1177/0022146517702421 ◽

2017 ◽

Vol 58 (2) ◽

pp. 181-197 ◽

Cited By ~ 23

Author(s):

Jonathan Daw ◽

Rachel Margolis ◽

Laura Wright

Keyword(s):

Health Behavior ◽

Sedentary Behavior ◽

Transition To Adulthood ◽

Parental Education ◽

Later Life ◽

Sociodemographic Factors ◽

Health Lifestyles ◽

Sociodemographic Determinants ◽

Race Ethnicity ◽

Health And Mortality

During the transition to adulthood, many unhealthy behaviors are developed that in turn shape behaviors, health, and mortality in later life. However, research on unhealthy behaviors and risky transitions has mostly focused on one health problem at a time. In this article, we examine variation in health behavior trajectories, how trajectories cluster together, and how the likelihood of experiencing different behavior trajectories varies by sociodemographic characteristics. We use the National Longitudinal Study of Adolescent Health (Add Health) Waves I to IV to chart the most common health behavior trajectories over the transition to adulthood for cigarette smoking, alcohol consumption, obesity, and sedentary behavior. We find that health behavior trajectories cluster together in seven joint classes and that sociodemographic factors (including gender, parental education, and race-ethnicity) significantly predict membership in these joint trajectories.

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Disparities in Mammography Use Among US Women Aged 40???64 Years, by Race, Ethnicity, Income, and Health Insurance Status, 1993 and 2005

Medical Care ◽

10.1097/mlr.0b013e31817893b1 ◽

2008 ◽

Vol 46 (7) ◽

pp. 692-700 ◽

Cited By ~ 85

Author(s):

Susan A. Sabatino ◽

Ralph J. Coates ◽

Robert J. Uhler ◽

Nancy Breen ◽

Florence Tangka ◽

...

Keyword(s):

Health Insurance ◽

Insurance Status ◽

Health Insurance Status ◽

Race Ethnicity ◽

Mammography Use

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Association Between Health Insurance and Race With Mortality From Trauma: a Retrospective Study

10.21203/rs.3.rs-546029/v1 ◽

2021 ◽

Author(s):

Ibrahim Gwarzo ◽

Maria Perez-Patron ◽

Xiaohui Xu ◽

Tiffany Radcliff ◽

Jennifer Horney

Keyword(s):

Health Insurance ◽

Trauma Registry ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Registry Data ◽

Insurance Status ◽

Health Insurance Status ◽

Trauma Mortality ◽

Race Ethnicity ◽

Related Mortality

Abstract Background: The population health implications of the growing burden of trauma-related mortality may be influenced by access to health insurance coverage, and demographic characteristics such as race and ethnicity. We investigated the effects of health insurance status and race/ethnicity on the risk of mortality among trauma victims in Texas.Methods: Using Texas trauma registry data from 2014 - 2016, we categorized health insurance coverage into private, public, and uninsured, and categorized patients with serious injuries into Non-Hispanic Whites, Non-Hispanic Blacks, Hispanics Any-Race, and Others. Multivariate logistic regression was used to estimate the effects of health insurance status and race/ethnicity on mortality, controlling for age, gender, severity of the trauma, cause of trauma, presence of comorbid conditions, trauma center designation, presence of a traumatic brain injury (TBI), and severity of a TBI. Results: From January 1, 2014, to December 31, 2016, there were 415,159 trauma cases in Texas; 8,827 (2.1%) were fatal. Among patients with at least a moderate injury, 24, 606 (17.4%) were uninsured, and 98, 237 (69.4%) identified as Non-Hispanic White. In the multivariate analysis, Hispanics of any race and Non-Hispanic Blacks had higher adjusted odds of trauma mortality compared to Non-Hispanic Whites [ORHispanics= 1.25: 95% CI (1.16 – 1.36)] [ORBlacks= 2.11: 95% CI (1.87 – 2.37)]. Similarly, compared to privately insured, uninsured patients had 86% higher odds of trauma-related death [OR= 1.86: 95% CI (1.66 – 2.05)]. The effects of lack of health insurance on trauma mortality varied across race/ethnicity of the victims; uninsured Non-Hispanic Blacks had disproportionately higher adjusted odds of trauma mortality than uninsured Whites. Conclusion: Using Texas trauma registry data, we found significant disparities in trauma-related mortality risk based on race/ethnicity and health insurance coverage. The identification of trauma mortality inequalities could inform the design and implementation of future public health interventions.

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Physician Recommendation for Colorectal Cancer Screening by Race, Ethnicity, and Health Insurance Status Among Men and Women in the United States, 2000

Health Promotion Practice ◽

10.1177/1524839905278742 ◽

2005 ◽

Vol 6 (4) ◽

pp. 369-378 ◽

Cited By ~ 43

Author(s):

Steven S. Coughlin ◽

Trevor Thompson

Keyword(s):

Colorectal Cancer ◽

United States ◽

Health Insurance ◽

Cancer Screening ◽

The United States ◽

Insurance Status ◽

Physician Recommendation ◽

Men And Women ◽

Health Insurance Status ◽

Race Ethnicity

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Health Insurance Coverage Better Protects Blacks than Whites against Incident Chronic Disease

Healthcare ◽

10.3390/healthcare7010040 ◽

2019 ◽

Vol 7 (1) ◽

pp. 40 ◽

Cited By ~ 4

Author(s):

Shervin Assari ◽

Hamid Helmi ◽

Mohsen Bazargan

Keyword(s):

Health Insurance ◽

Protective Effect ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

The United States ◽

Relative Advantage ◽

Linear Regression Models ◽

Socioeconomic Resources ◽

Health Insurance Status ◽

Race Ethnicity

Although the protective effect of health insurance on population health is well established, this effect may vary based on race/ethnicity. This study had two aims: (1) to test whether having health insurance at baseline protects individuals over a 10-year period against incident chronic medical conditions (CMC) and (2) to explore the race/ethnic variation in this effect. Midlife in the United States (MIDUS) is a national longitudinal study among 25–75 year-old American adults. The current study included 3572 Whites and 133 Blacks who were followed for 10 years from 1995 to 2004. Race, demographic characteristics (age and gender), socioeconomic status (educational attainment and personal income), and health insurance status were measured at baseline. Number of CMC was measured in 1995 and 2005. Linear regression models were used for data analysis. In the overall sample, having health insurance at baseline was inversely associated with an increase in CMC over the follow up period, net of covariates. Blacks and Whites differed in the magnitude of the effect of health insurance on CMC incidence, with a stronger protective effect for Blacks than Whites. In the U.S., health insurance protects individuals against incident CMC; however, the health return of health insurance may depend on race/ethnicity. This finding suggests that health insurance may better protect Blacks than Whites against developing more chronic diseases. Increasing Blacks’ access to health insurance may be a solution to eliminate health disparities, given they are at a relative advantage for gaining health from insurance. These findings are discussed in the context of Blacks’ diminished returns of socioeconomic resources. Future attempts should test replicability of these findings.

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THE EPIDEMIOLOGY OF BACK PAIN IN CHILDREN AND ADOLESCENTS: A CROSS-SECTIONAL STUDY OF 2,001 AMERICAN YOUTH

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00062 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0006

Author(s):

Jonathan M. Schachne ◽

Colleen Wixted ◽

Daniel W. Green ◽

Roger F. Widmann ◽

Peter D. Fabricant

Keyword(s):

Physical Activity ◽

Health Insurance ◽

Back Pain ◽

Children And Adolescents ◽

Insurance Status ◽

Cross Sectional ◽

Health Insurance Status ◽

The Mean ◽

Race Ethnicity ◽

American Children

Background: Back pain is a common condition that affects millions of Americans each year, including both adult and pediatric populations. To our knowledge, there has been no study that has epidemiologically studied back pain in a representative cohort of American children and adolescents. The purpose of this study was to establish the prevalence of back pain in American children and adolescents 10-18 years old and investigate for any demographic or physical activity predictors of increased risk. Methods: A cross-sectional survey-based investigation was performed in 2,001 children and adolescents, equally split by age and sex, and representing census-weighted distributions of state of residence, race/ethnicity, and health insurance status. Overall prevalence of back pain (at present and any time in past year) was calculated, and comparative analyses were performed to investigate any relationship between back pain and age, sex, backpack use, race/ethnicity, BMI, insurance status, and level of activity. Results: Two thousand and one subjects completed the survey of which 1,000 were male (50%) and 1,001 were female (50%). The mean age of the respondents was 14.0±2.6 years and the mean BMI was 22.4±8.1. A majority of subjects (1,633; 81.6%) stated that they participated in a sport or physical activity, with basketball being the most common sport followed by soccer, baseball, dance, and football. In total, 743 subjects (37.1%) stated that they had back pain within the last year, most commonly in the lumbar region (64.9%). The mean age of the subjects with back pain was significantly higher than those who did not experience back pain in the previous year (14.76±2.4 vs. 13.6±2.6 years old, P<0.001). Regression analysis demonstrated that the proportion of subjects who experienced back pain within the previous year increased linearly by age from 10 to 16 years old before plateauing just under 50% from age 16 to 18 (Figure 1). Age accounted for 94% of the variation of the response data for back pain in the past year, and 84% for those currently experiencing back pain (P<0.001 for both). Subjects with back pain had greater BMI than those without back pain (23.5±9.5 vs. 21.8±7.0, P<0.001). Subjects that used backpacks with two straps were least likely to have back pain (33.0%), while those who used rolling backpacks (57.1%), backpacks with two straps and the waistband fastened (55.9%), and backpacks with one strap (46.9%) were more likely to have back pain (P<0.05 for all). Females were more likely to have had back pain than males in the previous year (41.5% vs. 32.8%, P<0.001). Varsity and national/internationally competitive athletes demonstrated the highest rate of back pain in the previous year (51.0% and 49.2%, respectively). This was significantly higher than the prevalence of back pain in recreational, local/community, and junior varsity athletes (33.5%, 29.7%, 44.4%, respectively, P<0.05 for all pairwise comparisons). No associations were found between subjects’ health insurance status or race/ethnicity and occurrence of back pain. Conclusions/Significance: The current study quantifies the prevalence of back pain in an epidemiologic, census-derived sample of 2,001 American children and adolescents. There was a statistically significant linear increase by age from 10 to 16 years old before plateauing just under 50% from age 16 to 18. Additional statistically significant associations between presence of back pain in the previous year and BMI, backpack use, sex, and level of athletic participation were discovered. No association between insurance status or race and back pain was reported. These results will aid in future research and clinical care by demonstrating the epidemiology of back pain within the 10-18 year old American pediatric population. Figure Legend: [Figure: see text]

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