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1.
Anticancer Res ; 41(4): 2067-2070, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813415

RESUMEN

BACKGROUND/AIM: Melanoma incidence has increased in the United States over the past few decades, and disparities in patient treatment have been described. Although most patients with melanoma are good candidates for curative treatment, some are considered poor candidates for treatment because of comorbid conditions. We examined whether patient demographics influence treatment contraindication in melanoma. PATIENTS AND METHODS: The National Cancer Database (NCDB) was used to identify patients with melanoma from 2004 through 2015. Multivariate logistic regression was used to determine independent associations, adjusted for confounders. We excluded patients who did not receive treatment for reasons and patients with unknown treatment status. RESULTS: A total of 499,092 patients met the inclusion criteria. Of these, 525 (0.1%) had Treatment contraindicated because of comorbid conditions (TCBC) and 498,567 (99.9%) received treatment. Multivariate logistic regression showed higher odds of TCBC in patients with government insurance (OR=1.34, 95%CI=03-1.73; p=0.03) and patients without insurance (OR=2.75, 95%CI=1.76-4.29; p<0.001) than patients with private insurance. CONCLUSION: Demographic disparities affects treatment decision in oncological patients. Our study demonstrated a significantly higher likelihood of "nontreatment because of comorbid conditions" among melanoma patients with government insurance or without insurance. Greater efforts are needed to address inequalities in melanoma treatment in the United States.


Asunto(s)
Contraindicaciones , Melanoma/epidemiología , Melanoma/terapia , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Bases de Datos Factuales , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Melanoma/patología , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/patología , Estados Unidos/epidemiología
4.
BMJ Open ; 11(3): e045813, 2021 03 18.
Artículo en Inglés | MEDLINE | ID: mdl-33737441

RESUMEN

OBJECTIVE: Access to health services and adequate care is influenced by sex, ethnicity, socioeconomic position (SEP) and the burden of comorbidities. Our study aimed to assess whether the COVID-19 pandemic further deepened these already existing health inequalities. DESIGN: Cross-sectional study. SETTING: Data were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946). PARTICIPANTS: A web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants. MAIN OUTCOMES MEASURED: The survey provided data on cancelled surgical or medical appointments, and the number of care hours received in a week during the first UK COVID-19 national lockdown. INTERVENTIONS: Using binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study design, non-response weights, psychological distress, presence of children or adolescents in the household, COVID-19 infection, key worker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts, and meta-regression was used to evaluate the effect of age as a moderator. RESULTS: Women (OR 1.40, 95% CI 1.27 to 1.55) and those with a chronic illness (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SEP was not associated with cancellation or care hours. Age was not independently associated with either outcome in the meta-regression. CONCLUSION: The UK government's lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly women, ethnic minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a fourthwave.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Pandemias , Adulto , Anciano , Control de Enfermedades Transmisibles , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Reino Unido , Adulto Joven
7.
JAMA Netw Open ; 4(3): e214149, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33739434

RESUMEN

Importance: Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. Objective: To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution's resource allocation policy. Design, Setting, and Participants: This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. Exposures: Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). Main Outcomes and Measures: The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. Results: The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). Conclusions and Relevance: In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.


Asunto(s)
Asignación de Recursos para la Atención de Salud , Disparidades en Atención de Salud/etnología , Hospitalización/estadística & datos numéricos , Asignación de Recursos , Nivel de Atención/estadística & datos numéricos , /etnología , Estudios de Cohortes , Grupos Étnicos , Femenino , Florida/epidemiología , Asignación de Recursos para la Atención de Salud/métodos , Asignación de Recursos para la Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Asignación de Recursos/métodos , Asignación de Recursos/organización & administración
8.
Am J Manag Care ; 27(3): 93-95, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33720665

RESUMEN

The coronavirus disease 2019 pandemic is magnifying preexisting health disparities whereby patients with limited English proficiency receive lower-quality health care and experience poorer outcomes. To address these realities, language interventions to date have focused on interpreter services and linguistically tailored health information. But these limited solutions fail to target a more upstream, overlooked, and modifiable factor: a patient's access to improving their English proficiency and health literacy. We present recommendations for addressing language as a social determinant of health by improving access to English as a Second Language programs. This article outlines steps that health systems and policy makers can take to more directly treat upstream causes of language disparities.


Asunto(s)
Disparidades en Atención de Salud/etnología , Dominio Limitado del Inglés , Educación del Paciente como Asunto , /etnología , Alfabetización en Salud , Humanos , Determinantes Sociales de la Salud/etnología
9.
Semin Vasc Surg ; 34(1): 18-28, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757631

RESUMEN

Thoracoabdominal aortic aneurysms, although rare, continue to be associated with high morbidity and mortality in the modern era of vascular surgery, and knowledge of this disease is essential for those in clinical practice. Given the clinically silent nature of the disease, it is difficult to determine disease incidence, with most epidemiologic recommendations not made based on evidence regarding those diagnosed with the disease, but extrapolated from data on surgical outcomes. It appears that although men are more likely to develop thoracoabdominal aortic aneurysms, the distribution is not as skewed as in abdominal aortic aneurysms. Current evidence suggests that Black and Hispanic patients continue to have disproportionately poor disease outcomes, mostly attributed to later presentation and undergoing interventions at lower-volume centers. Although select patients meet criteria for disease screening based on personal or family history of aneurysmal disease, general population screening has not been recommended by any professional organization to date. Vascular surgeons need to continue to be at the forefront of thoracoabdominal aortic aneurysm management, especially as care becomes centered around comprehensive "aortic care centers" and as more endovascular therapies become available.


Asunto(s)
Aneurisma de la Aorta Torácica/epidemiología , Factores de Edad , Anciano , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/terapia , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento , Estados Unidos/epidemiología
10.
Semin Vasc Surg ; 34(1): 29-37, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757632

RESUMEN

Abdominal aortic aneurysm (AAA) disease remains a major source of morbidity in developed countries and can progress to life-threatening rupture if left untreated, with exceedingly high mortality. The goal of AAA management is to identify and electively repair AAAs before rupture. AAA disease burden and outcomes have improved over time with declining tobacco use and advancements in care across patients' disease course. The introduction of endovascular AAA repair, in particular, has allowed for elective AAA repair in patients previously considered too high risk for open surgery and has contributed to lower rates of AAA rupture over time. However, these improved outcomes are not universally experienced, and disparities continue to exist in the detection, treatment, and outcomes of AAA by sex, race, and ethnicity. Mitigating these disparities requires enhanced, focused efforts at preventing disease, promoting health, and delivering appropriate care among an increasingly diverse patient population.


Asunto(s)
Aneurisma de la Aorta Abdominal/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/terapia , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento , Estados Unidos/epidemiología
11.
Semin Vasc Surg ; 34(1): 3-9, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757633

RESUMEN

Atherosclerotic carotid artery disease is a significant cause of stroke in the United States and globally. Its prevalence increases with age and it is more prevalent in men and White and Native-American populations. However, the outcomes related to carotid disease are worse in women and Black patients. Research suggests the disparities exist due to a multitude of factors, including disease pathophysiology, access to care, provider bias, and socioeconomic status. The prevalence of carotid stenosis in the general population is low (3%), and routine screening for carotid stenosis is not recommended in adults. Randomized clinical trials have shown benefits of stroke risk reduction with surgery (carotid endarterectomy or stenting) for symptomatic patients. Management is controversial in asymptomatic patients, as modern medical management has results equivalent to those of surgery and ongoing randomized clinical trials will address this important question. Carotid surgery is not appropriate in asymptomatic patients with limited life expectancy. Future work should explore comprehensive care models for care of patients with carotid disease and assessment of patient-reported outcomes to measure quality of care.


Asunto(s)
Enfermedades de las Arterias Carótidas/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/terapia , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/prevención & control , Estados Unidos/epidemiología
12.
Semin Vasc Surg ; 34(1): 38-46, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757634

RESUMEN

Peripheral artery disease (PAD) is the clinical manifestation of atherosclerosis that primarily affects peripheral arteries within the lower extremities. In this brief review, we describe the epidemiology and burden of disease of PAD within the United States, particularly among high-risk populations. Although the prevalence of PAD continues to increase and is typically higher among the elderly as well as men, women in lower socioeconomic strata are affected at rates two times that of men. Among racial/ethnic groups, Black and African-American patients both experience higher rates of disease as well as lower rates of access to preventative care. Moreover, despite an overall decrease in amputation rates among all patients with PAD, high-risk populations remain disproportionally affected. Specifically, patients in rural areas, African-American and Native-American patients, and those of low socioeconomic status carry the highest risk of amputation. Efforts to improve care among PAD patients should target these high-risk populations and offer comprehensive, evidence-based preventative care. Wide adoption and integration of these practices into comprehensive care models may help to mitigate amputation in the highest-risk populations. As our treatment pathways continue to evolve, we must place further emphasis on patient input and quality of life as we work toward continual improvement in the care of patients with PAD.


Asunto(s)
Enfermedad Arterial Periférica/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Amputación , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/terapia , Prevalencia , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento , Estados Unidos/epidemiología
13.
Semin Vasc Surg ; 34(1): 47-53, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757635

RESUMEN

Diabetic foot ulcers (DFUs) are a common but highly morbid complication of long-standing diabetes, carrying high rates of associated major amputation and mortality. As the global incidence of diabetes has increased, along with the lifespan of the diabetic patient, the worldwide burden of DFUs has grown steadily. Outcomes in diabetes and DFUs are known to depend strongly on social determinants of health, with worse outcomes noted in minority and socioeconomically disadvantaged populations. Effective treatment of DFUs is complex, requiring considerable expenditure of resources and significant cost to the health care system. Comprehensive care models with multidisciplinary teams have proven effective in the treatment of DFUs by decreasing barriers to care and increasing access to the multiple specialists required to provide timely and effective DFU procedural intervention, surveillance, and preventative care. Vascular surgeons are an integral part throughout the cycle of care for DFUs and should be involved early in the course of such patients to maximize their contributions to a multidisciplinary care model.


Asunto(s)
Pie Diabético/epidemiología , Pie Diabético/terapia , Grupo de Atención al Paciente , Factores de Edad , Terapia Combinada , Pie Diabético/diagnóstico , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Comunicación Interdisciplinaria , Masculino , Prevalencia , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares
14.
Semin Vasc Surg ; 34(1): 59-64, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757637

RESUMEN

Chronic venous insufficiency (CVI) affects more than 25 million adults in the United States alone, and more 6 million with advanced stages of venous disease. The high incidence of CVI and the increasing costs of care, place a heavy financial burden on the US health care system. Recent studies estimate the total cost of care at more than $3 billion per year. These staggering numbers highlight the importance of timely diagnosis, treatment, and prevention of CVI. In this article, we review the epidemiology and prevalence of CVI, and its financial impact on national health care budget. Racial disparities in CVI and the impact of socioeconomic status on access to care are also discussed. Finally, we discuss CVI-related screening programs and the importance of preventative measures in venous disease.


Asunto(s)
Costos de la Atención en Salud , Insuficiencia Venosa , Factores de Edad , Presupuestos , Enfermedad Crónica , Costo de Enfermedad , Femenino , Disparidades en Atención de Salud/economía , Humanos , Incidencia , Masculino , Prevalencia , Pronóstico , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Determinantes Sociales de la Salud , Factores Socioeconómicos , Estados Unidos/epidemiología , Insuficiencia Venosa/diagnóstico , Insuficiencia Venosa/economía , Insuficiencia Venosa/epidemiología , Insuficiencia Venosa/terapia
15.
Semin Vasc Surg ; 34(1): 79-88, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757640

RESUMEN

Patients with syndromic and nonsyndromic heritable aortopathies (also known as genetic aortic disease) are a heterogeneous group of patients who present at younger ages with more rapid growth of aortic aneurysms and/or increased frequency of dissections compared with patients with atherosclerotic aortopathies. In this review, we describe the etiology, epidemiology, and appropriate care delivery for these conditions at each stage of management. Within each section, we discuss sex, gender, and race differences and highlight disparities in care and knowledge. We then discuss the role of the vascular team throughout the cycle of care and the evolving inclusion of patient input in research. This understanding is essential to the creation of effective health care policies that support equitable, appropriate, and patient-centered clinical practices.


Asunto(s)
Enfermedades de la Aorta , Disparidades en Atención de Salud , Factores de Edad , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/epidemiología , Enfermedades de la Aorta/genética , Enfermedades de la Aorta/terapia , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento , Estados Unidos/epidemiología
18.
J Nurs Adm ; 51(4): 182-184, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33734176

RESUMEN

To meet the growing demands in the US healthcare system caused by multiculturalism and the expansion of health inequities, due diligence must be given to testing the efficacy of tools used in teaching nurses to provide culturally competent care. This project assessed the utility of a free US government-developed training module. The team found an improved trend in nurse-patient communication scores and improved willingness to ask for help with cultural issues for the intervention unit. The use of no-cost, publicly available resources may be a cost-effective option for training materials.


Asunto(s)
Competencia Cultural/educación , Asistencia Sanitaria Culturalmente Competente/organización & administración , Personal de Salud/educación , Disparidades en Atención de Salud/organización & administración , Competencia Cultural/organización & administración , Diversidad Cultural , Asistencia Sanitaria Culturalmente Competente/economía , Personal de Salud/economía , Disparidades en Atención de Salud/economía , Humanos
20.
Int J Equity Health ; 20(1): 76, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33706774

RESUMEN

BACKGROUND: Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic. METHODS: Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis. RESULTS: Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines. CONCLUSIONS: Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.


Asunto(s)
/epidemiología , Cuidadores/psicología , Demencia/psicología , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud , Servicio Social , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
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