Dual-eligible, dual-risk? A brief review on the impact of dual-eligible status on health disparities and peripheral artery disease.

Peripheral artery disease (PAD) has been associated with poorer outcomes based on particular social determinants of health, including insurance status. A unique population to study treatment outcomes related to PAD is those with dual-eligible status-those who qualify for both Medicare and Medicaid-comprising more than 12 million people. We performed a systematic review of the literature surrounding dual-eligible patients and impact on PAD, with final inclusion of six articles. Dual eligibility has been associated with higher rates of comorbidities; more severe symptoms at initial presentation for PAD; and poorer treatment outcomes, including mortality. Further studies are needed to specifically look at the association between PAD and dual-eligible status, but what is clear is that patients in this population would benefit from early identification to prevent disease progression and improve equity.

Liver Cancer Disparities in New York City: A Neighborhood View of Risk and Harm Reduction Factors.

INTRODUCTION: Liver cancer is the fastest increasing cancer in the United States and is one of the leading causes of cancer-related death in New York City (NYC), with wide disparities among neighborhoods. The purpose of this cross-sectional study was to describe liver cancer incidence by neighborhood and examine its association with risk factors. This information can inform preventive and treatment interventions. MATERIALS AND METHODS: Publicly available data were collected on adult NYC residents (n = 6,407,022). Age-adjusted data on liver and intrahepatic bile duct cancer came from the New York State Cancer Registry (1) (2007-2011 average annual incidence); and the NYC Vital Statistics Bureau (2015, mortality). Data on liver cancer risk factors (2012-2015) were sourced from the New York City Department of Health and Mental Hygiene: (1) Community Health Survey, (2) A1C registry, and (3) NYC Health Department Hepatitis surveillance data. They included prevalence of obesity, diabetes, diabetic control, alcohol-related hospitalizations or emergency department visits, hepatitis B and C rates, hepatitis B vaccine coverage, and injecting drug use. RESULTS: Liver cancer incidence in NYC was strongly associated with neighborhood poverty after adjusting for race/ethnicity (ß = 0.0217, p = 0.013); and with infection risk scores (ß = 0.0389, 95% CI = 0.0088-0.069, p = 0.011), particularly in the poorest neighborhoods (ß = 0.1207, 95% CI = 0.0147-0.2267, p = 0.026). Some neighborhoods with high hepatitis rates do not have a proportionate number of hepatitis prevention services. CONCLUSION: High liver cancer incidence is strongly associated with infection risk factors in NYC. There are gaps in hepatitis prevention services like syringe exchange and vaccination that should be addressed. The role of alcohol and metabolic risk factors on liver cancer in NYC warrants further study.