Effect of Maternal Race, Residential Rurality, and Social Vulnerability on Critical Congenital Heart Defect Risk.

The development of a congenital heart defect (CHD) is multifactorial, with many cases having an unknown etiology. This study explored whether maternal race and lived environment were associated with an infant being born with a critical CHD. A cross-sectional, case-control design was conducted utilizing secondary data analysis. The CHD group (N = 199) consisted of infants diagnosed with a critical CHD within the first year of life identified from hospital databases. The non-CHD group (N = 548) was a random sample of infants selected from the state's vital statistics database. The primary outcome was a critical CHD diagnosis. Maternal race, residential rurality, and the Social Vulnerability Index (SVI) were assessed for associations with a critical CHD using bivariate and multilevel regression models. Bivariate findings reported significance among residential rurality (p < 0.001), SVI ranking overall (p = 0.017), and SVI by theme (theme 1 p = 0.004, theme 2 p < 0.001, theme 3 p = 0.007, and theme 4 p = 0.049) when comparing infants with and without a critical CHD diagnosis. Results of multilevel logistic regression analyses further identified living in a rural residential area compared to urban areas (OR = 7.32; p < 0.001) as a predictor for a critical CHD diagnosis. The findings of lived environmental level associations provides information needed for continued investigation as the burden of a critical CHD continues to impact families, suggesting further research efforts are needed to improve health disparities.

Knowledge Management for Fostering Biostatistical Collaboration within a Research Network: The RTRN Case Study.

Purpose: While the intellectual and scientific rationale for research collaboration has been articulated, a paucity of information is available on a strategic approach to facilitate the collaboration within a research network designed to reduce health disparities. This study aimed to (1) develop a conceptual model to facilitate collaboration among biostatisticians in a research network; (2) describe collaborative engagement performed by the Network's Data Coordinating Center (DCC); and (3) discuss potential challenges and opportunities in engaging the collaboration. Methods: Key components of the strategic approach will be developed through a systematic literature review. The Network's initiatives for the biostatistical collaboration will be described in the areas of infrastructure, expertise and knowledge management and experiential lessons will be discussed. Results: Components of the strategic approach model included three Ps (people, processes and programs) which were integrated into expert management, infrastructure management and knowledge management, respectively. Ongoing initiatives for collaboration with non-DCC biostatisticians included both web-based and face-to-face interaction approaches: Network's biostatistical capacities and needs assessment, webinar statistical seminars, mobile statistical workshop and clinics, adjunct appointment program, one-on-one consulting, and on-site workshop. The outreach program, as a face-to-face interaction approach, especially resulted in a useful tool for expertise management and needs assessment as well as knowledge exchange. Conclusions: Although fostering a partnered research culture, sustaining senior management commitment and ongoing monitoring are a challenge for this collaborative engagement, the proposed strategies centrally performed by the DCC may be useful in accelerating the pace and enhancing the quality of the scientific outcomes within a multidisciplinary clinical and translational research network.

Physical activity and obesity in African Americans: the Jackson Heart Study.

OBJECTIVES: To better understand how obesity and low levels of physical activity (PA) contribute to racial health disparities, we examined the association of PA domains (work, home life, and leisure) with indicators of socioeconomic status and markers of obesity in African Americans. METHODS: These cross sectional analyses of interview and clinical measures from the baseline visit of the Jackson Heart Study of cardiovascular disease (CVD) in African Americans of the Jackson, Mississippi metropolitan statistical area included 3,174 women and 1,830 men aged 21-95 years. The main measures were active living, sport, work, home life, and total PA scores; participation in regular moderate or vigorous intensity leisure physical activity (MVLPA); demographics, body mass index (BMI), waist circumference (WC) and CVD risk factors. RESULTS: The sample was 63% female, 81% high school or college graduates, with 51% aged 45-64 years, and mostly overweight (32%) or obese (53%). Women were less active than men in all domains except home life. Total PA was inversely associated with WC in women and men. The overweight (BMI 25-29.9) group was most active in all domains except work; active living and sport PA and prevalence of MVLPA then declined in a dose response association with increasing BMI. Work PA was associated with the lowest BMI but otherwise with indicators of less favorable socioeconomic status and health. CONCLUSIONS: Observed differences in PA in African Americans by domain and association with obesity biomarkers suggest areas for future study and intervention to reduce health disparities.

Utilization of the emergency room: impact of geographic distance.

The aim of this study was to estimate the distance Mississippi patients must travel to access hospital-based emergency rooms (ERs) and to determine whether an association exists between geographic distance and ER utilization. To that end, great circle distances between Census Block Group Centroid Points and 89 hospitals with emergency departments were calculated for the State of Mississippi. Data on the socio-demographic characteristics of each block group came from the 2000 US Census data. Logistic regression analyses were conducted to test if there was any association between ER utilization and travel distance. Compared to the national benchmark of 35.7%, more than one in two (56.7%), or 1,612,762 Mississippians visited ERs in 2003 with an estimated 6.1 miles per person annual travel for this purpose. The majority of the target population (54.9%) was found to live within 5 miles of hospitals with ERs. Logistic analyses revealed that block groups associated with less miles traveled to hospitals with ERs had a higher proportion of African Americans, impoverished people, female householders, people with more than 12 years education, people older than 65 years, people with high median house values, and people without employment. Twenty-nine of the 89 hospitals (33%) providing ER care in Mississippi were found to be in areas with above-average ER utilization rates. These hospitals served a smaller geographical area (28% of the total) but had a greater proportion of visitors (57%) and served a higher percentage (37%) of the state population. People in areas served by the less utilized ERs traveled more miles to be cared for (7.1 miles vs 5.4 miles; p<0.0001). Logistic regression analysis revealed that shorter distances were associated with increased use of the ERs, even after controlling for socio-demographic factors. The conclusion is that Mississippi ERs are typically located in block groups with higher percentages of disadvantaged residents and that people in these areas are more likely to utilize ER services. Our data suggest that the geographical distance has an impact on ER utilization, especially by reducing utilization in disadvantaged block group areas. Disadvantaged persons living near ER hospitals (<5 miles) were found to be more likely to utilize the ER services. Geographic distance should therefore be considered when planning state-wide ER programmes for disadvantaged populations.

Health-related quality of life of cataract patients: cross-cultural comparisons of utility and psychometric measures.

BACKGROUND: This study was conducted to assess the presence and/or absence of cross-cultural differences or similarities between Korean and United States cataract patients. A systematic assessment was performed using utility and psychometric measures in the study population. RESEARCH DESIGN: A cross-sectional study design was used to examine the comparison of preoperative outcomes measures in cataract patients in Korea and the United States. Study subjects were selected using non-probabilistic methods and included 132 patients scheduled for cataract surgery in one eye. PARTICIPANTS: Subjects were adult cataract patients at Samsung and Kunyang General Hospital in Seoul, Korea, and Tulane University Hospital and Clinics in New Orleans, Louisiana. MEASUREMENTS: Preoperative utility was assessed using the verbal rating scale and standard reference gamble techniques. Current preoperative health status was assessed using the SF-36 and VF-14 surveys. Current preoperative Snellen visual acuity was used as a clinical measure of vision status. RESULTS: Korean patients were more likely to be younger (p = 0.001), less educated (p = 0.001), and to have worse Snellen visual acuity (p = 0.002) than United States patients. Multivariate analysis of variance (MANOVA) revealed that in contrast to Korean patients, United States patients were assessed to have higher scoring in general health, vitality, VF-14, and verbal rating for visual health. This higher scoring trend persisted after controlling for age, gender, education and Snellen visual acuity. The difference in health-related quality of life (HRQOL) between the two countries was quite clear, especially in the older age and highly educated group. CONCLUSIONS: Subjects in Korea and the United States were significantly different in quality of life, functional status and clinical outcomes. Subjects in the United States had more favorable health outcomes than those in Korea. These differences may be caused by multiple factors, including country-specific differences in economic status, health care system, cultural value system, and health policy. Cross-cultural differences should be considered when making international comparisons of quality of life.