Health Disparities

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30440

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Now showing 1 - 7 of 7
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    Health Disparities and Risk Patterns of COVID-19 Case, Hospitalization, and Case Fatality in Texas Comparted to the United States of America
    (2021) Xavier, Christy; Rasu, Rafia
    Purpose: Explore age, sex, race, and underlying condition distribution with COVID-19-related case, hospitalization, and mortality rates. Methods: Secondary retrospective cohort analysis used CDC's and TDSHS's COVID-19 Data Tracker to obtain hospitalization, intensive care, mortality, and demographic counts of confirmed COVID-19 cases from submitted state and territorial health departments and case reports in U.S.A. and Texas (2020). Statistical analysis was conducted using SPSS. Results: In U.S., there were 12,573,876 COVID-19 cases, 688,911 hospitalizations, 74,933 ICU admissions, and 222,575 deaths compared to 1,551,250 cases and 30,741 deaths in Texas. 48% U.S. cases were male compared to 63.3% in Texas. Females had 19% and 22.5% lower risk of hospitalization and mortality compared to males(P< 0.001). Whites (54.1%) and Hispanics (21.3%) consisted of most cases. Blacks had 2.47 [RR 2.47,95%CI(2.42-2.52)] times higher risk of ICU admission and 16% higher mortality risk. Hispanics had 20% higher ICU risk but 35% [RR 0.647,95%CI(0.638-0.656)] lower risk of death compared to Whites(P< 0.001). Pediatric cases had 80% lower mortality risk; older adults with 15.3% case fatality ratio had 87.31 [RR 87.31,95%CI(84.55-90.16)] times mortality risk compared to adults 20-39 years old. Underlying conditions had 17 times higher risk of mortality compared to no health conditions(P< 0.001). Conclusions: Increasing age, male sex, underlying conditions, and Black race are associated with poorer outcomes in COVID-19. Healthcare professionals should be aware of COVID-19 health disparities and risk factors for poor outcomes to better address public health gaps and promote targeted interventions.
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    Underlying Causes of the Disproportionate Effect of COVID-19 within Minority Communities in the United States
    (2021) Nguyen, Alyssa
    The Coronavirus Disease 2019 (COVID-19) crisis has had detrimental impacts globally, but it has disproportionately affected minority groups especially in the United States. In particular, Indigenous and Black Americans have continued to have the highest proportion of COVID-19 cases as well as case fatalities. The goal of this study was to conduct a systematic literature review to understand why there are disproportionate effects within these communities in the United States. It also serves to provide methods that should be in place to protect these vulnerable communities from facing worse outcomes of this pandemic. Key information was gathered from twenty-one sources including quantitative studies related to this topic. The following causes that are supported by the results of this systematic literature review include health disparities, higher risk of comorbidities, implicit biases of health care providers, air pollution in urban settings, and genetic variations in the androgen receptor. Based on these results, there should be improved preventative plans with a health equity lens so that these communities don't face the disproportionate burden in the future.
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    Utility of Geospatial Visualization and Social Vulnerability Index to Inform the Dissemination of School-Based Asthma Initiative
    (2021) Ly, Connie; Felicitas, Arianne; Allsopp, Leslie C.; Zielke, Cameron
    Purpose: The contributors to pediatric asthma disparities are multifactorial; low-income and minority students face higher risks of school absences, hospitalization, and mortality. The CDC has recognized the Asthma 411 Model as an evidence-based program to improve asthma outcomes. In 2017, a Consortium was formed to enable Tarrant County school districts (ISDs) to adopt and implement Asthma 411. This study's objective is to determine whether ISD adoption of Asthma 411 reaches students at great risk for adverse outcomes. Methods: The independent variable is a three-level, categorical indicator of Asthma 411 adoption by ISDs: primary adopters (initiated 2017), secondary adopters (initiated 2018-2020), non-adopters. ArcGIS, a Geographic Information System (GIS) platform, was used to map the independent variable. A data layer was added with CDC's 2018 Social Vulnerability Index (SVI). The SVI includes American Community Survey census tract data organized around four distinct themes associated with disparities: Socioeconomic status, Household Composition & Disability, Minority Status and Language, and Housing Type & Transportation. Results: Visually, primary adopters appear to include communities with higher risk as defined by SVIs. Non-adopters appear to include less socially vulnerable communities but do include pockets of students at risk. Conclusion: The Asthma 411 Consortium appears to reach the majority of communities at risk but targeted expansion may be beneficial. GIS may assist public health planning by visualizing access to services. Application of spatial statistics and further investigation of the SVI as a measure of risk will strengthen the analysis and better inform dissemination.
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    A Review of Community-Based Interventions to Address Colorectal Cancer Health Disparities Among the Black Population
    (2021) Lim, Kendrick
    From 1975 to 2016, 5-year relative survival rates for colorectal cancer have increased from 50% to 65%, largely due to the advent of novel therapeutic options that aid in prevention and treatment. However, the disproportionate gap in mortality rates has continued to exist among the white and black population. These health disparities and discrepancies have been well documented over the past several decades. The 5-year relative colorectal cancer survival rate for the white population has increased from 50% to 65% while that of the black population has increased from 45% to 59%. To close the disparity gap, community-based interventions have been implemented and studied with a focus on improving screening rates. While many studies have shown promising results, these studies are sparse, and a heavier emphasis on reducing these health disparities is warranted. In this review, community-based interventions for the black population over the past two decades were systematically evaluated for efficacy and reproducibility. A literature review was conducted to investigate different community-based health care interventions to assess the effect on cancer screening rates. On average, a positive increase in colorectal cancer screening rates was observed when community-based interventions were implemented. Thus, there is evidence supporting the use of community-based interventions to increase cancer screening rates in an effort to reduce the health disparities associated with colorectal cancer among the black population.
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    Racial Differences in Treatment and Outcomes of Chronic Low Back Pain
    (2021) Timmer, Benjamin; Licciardone, John C.
    Purpose: Chronic low back pain (CLBP) is the leading cause of patient visits to primary care physicians in the United States. Black patients with chronic pain are at higher risk of progressing to disability due to lack of access to healthcare, yet limited studies have addressed the epidemiology of CLBP treatment and outcomes in the Black population. Methods: This cross-sectional study utilized the Pain Registry for Epidemiologic, Clinical, and Interventional Studies and Innovation (PRECISION) to study racial differences in selected patient-reported treatment and clinical outcomes, including a numerical rating scale (NRS) for pain, Roland-Morris Disability Questionnaire, Pain Sensitivity Questionnaire, and Pain Catastrophizing Scale. Results: A total of 848 patients with CLBP participated, including 184 (22%) who were Black. The percentage (95% CI) of Black patients who used non-pharmacological treatments was 70%(63%-77%) vs. 87%(84%-89%) of White patients (p=< 0.001). Black patients were also less likely to use nonsteroidal anti-inflammatory drugs for pain, 72%(65%-78%) vs 86%(83%-89%) (p=< 0.001). However, opioid use was not different between races. Black patients experienced greater pain than White patients based on reported mean (95% CI) NRS values of 7.2(6.9-7.4) vs. 5.8(5.7-5.9) (p=< 0.001). Additionally, Black patients experienced greater disability, pain sensitivity, and pain catastrophizing than White patients (p=< 0.001 for each contrast). Conclusions: These findings suggest that racial health disparities exist among patients with CLBP. Greater efforts to increase awareness of and access to non-pharmacological treatments for Black patients with CLBP may improve their outcomes.
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    The Effect of Polysubstance Use on Menstrual Cycle Length among Women in a Substance Abuse Recovery Program
    (2021) Sahu, Shweta; Felini, Martha
    Purpose: Previous studies have found chronic conditions such as anemia are prevalent among marginalized women with co-occurring substance use disorders. We hypothesized that illegal drugs (including opioids) alter physiologic processes that impact menstrual cycles and tested whether polydrug use has a significant effect on menstrual cycle length among women in substance abuse treatment. Methods: A cross-sectional analysis was performed on data abstracted from data collected through the cancer prevention project Sound Mind, Sound Body project (2012-2016). The dependent variable was polydrug use which was assessed as both a continuous (number of drugs used) and categorical measure (yes/no). The main independent variable was self-reported average menstrual cycle length (days). Potential confounding variables assessed included age, race/ethnicity, trauma history, and BMI. Chi-square p values and odds ratios (95% CI) were calculated using stratified analysis and logistic regression. Results: A total of 856 women of reproductive age reported a history of polydrug use (66%) and complex trauma (58%). The average cycle length was 5.15 days for polydrug users, and 5.10 days for single drug users. The association between polydrug use and abnormal cycle length was not statistically significant (OR = 1.30, 95% CI: 0.91-1.87, chi-square p value = 0.15). Conclusion: Our study found that while polydrug use is common, it did not significantly alter cycle length compared to single drug users. Patterns of substance use and more robust study design may better shed light on whether abnormal menstrual cycle length stems from polysubstance use.
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    Covid-19 Case and Mortality Trends across Incarcerated Populations in the U.S.
    (2021) Jodray, Megan; Xavier, Christy; Rasu, Rafia
    Purpose: Explore case and mortality rate differences across county, state, and federal facilities to identify places most vulnerable to coronavirus disease 19 (COVID-19). Methods: Secondary retrospective cohort analysis utilizing the UCLA's comprehensive COVID-19 research data on cases and mortality trends collected until January 29th, 2021. This data set is collected by UCLA volunteers directly from facility websites. Statistical analysis was conducted using SPSS. Results: Since March 2020, it is reported the total U.S. population of incarcerated residents has had 370,042 cases and 2,185 deaths nationally. County facilities have reported 19,099 (5.16%) cases and 43 (1.97%) deaths. State facilities have reported 305,616 cases and 1,913 deaths and have the highest case fatality ratio compared to all facilities. Federal facilities have reported 45,327 cases and 229 deaths. Out of total incarcerated resident population, Texas had 9.42% and 11.53% of cases and deaths, respectively. Moreover, there is a higher chance of dying from COVID-19 [RR: 5.55, 95%CI (3.36-9.17)] in a county prison compared to a federal prison in Texas. Conclusion: Limited information exists on the incarcerated population effected by COVID-19, especially amid an ongoing pandemic. There appears to be a higher risk of mortality in COVID-19 cases in state facilities compared to federal and in Texas we observed a 5 times higher risk of dying in county versus federal prisons. Identifying at-risk incarcerated populations can help control spread and reduce health gaps.