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1.
Health Aff (Millwood) ; 41(5): 671-679, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35500193

RESUMO

Concerns have been raised over wide variation in rates of unplanned (emergency or urgent) surgery for access-sensitive surgical conditions-diagnoses requiring surgery that preferably is planned (elective) but, when access is limited, may be delayed until worsening symptoms require riskier and costlier unplanned surgery. Yet little is known about geographic and community-level factors that may increase the likelihood of unplanned surgery with adverse outcomes. We examined the relationship between community-level social vulnerability and rates of unplanned surgery for three access-sensitive conditions in 2014-18 among fee-for-service Medicare beneficiaries ages 65-99. Compared with patients from communities with the lowest social vulnerability, those from communities with the highest vulnerability were more likely, overall, to undergo unplanned surgery (36.2 percent versus 33.5 percent). They were also more likely to experience worse outcomes largely attributable to differential rates of unplanned surgery, including higher rates of mortality (5.4 percent versus 5.0 percent) and additional surgery within thirty days (19.6 percent versus 18.1 percent). Our findings suggest that policy addressing community-level social vulnerability may mitigate the observed differences in surgical procedures and outcomes for access-sensitive conditions.


Assuntos
Medicare , Vulnerabilidade Social , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos , Planos de Pagamento por Serviço Prestado , Humanos , Estados Unidos
2.
Rev Soc Bras Med Trop ; 55: e04452021, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35416871

RESUMO

BACKGROUND: Social conditions are related to the impact of epidemics on human populations. This study aimed to investigate the spatial distribution of cases, hospitalizations, and deaths from COVID-19 and its association with social vulnerability. METHODS: An ecological study was conducted in 81 urban regions (UR) of Juiz de Fora from March to November 2020. Exposure was measured using the Health Vulnerability Index (HVI), a synthetic indicator that combines socioeconomic and environmental variables from the Demographic Census 2010. Regression models were estimated for counting data with overdispersion (negative binomial generalized linear model) using Bayesian methods, with observed frequencies as the outcome, expected frequencies as the offset variable, and HVI as the explanatory variable. Unstructured random-effects (to capture the effect of unmeasured factors) and spatially structured effects (to capture the spatial correlation between observations) were included in the models. The models were estimated for the entire period and quarter. RESULTS: There were 30,071 suspected cases, 8,063 confirmed cases, 1,186 hospitalizations, and 376 COVID-19 deaths. In the second quarter of the epidemic, compared to the low vulnerability URs, the high vulnerability URs had a lower risk of confirmed cases (RR=0.61; CI95% 0.49-0.76) and a higher risk of hospitalizations (RR=1.65; CI95% 1.23-2.22) and deaths (RR=1.73; CI95% 1.08-2.75). CONCLUSIONS: The lower risk of confirmed cases in the most vulnerable UR probably reflected lower access to confirmatory tests, while the higher risk of hospitalizations and deaths must have been related to the greater severity of the epidemic in the city's poorest regions.


Assuntos
COVID-19 , Teorema de Bayes , Cidades/epidemiologia , Humanos , Vulnerabilidade Social , Fatores Socioeconômicos
3.
J Trauma Acute Care Surg ; 92(5): 821-830, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35468113

RESUMO

INTRODUCTION: Social determinants of health are known to impact patient-level outcomes, but they are often difficult to measure. The Social Vulnerability Index was created by the Centers for Disease Control to identify vulnerable communities using population-based measures. However, the relationship between SVI and trauma outcomes is poorly understood. METHODS: In this retrospective study, we merged SVI data with a statewide trauma registry and used three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality: (1) an unadjusted model, (2) a claims-based model using only covariates available to claims datasets, and (3) a registry-based model incorporating robust clinical variables collected in accordance with the National Trauma Data Standard. RESULTS: We identified 83,607 adult trauma admissions from January 1, 2017, to September 30, 2020. Higher SVI was associated with worse mortality in the unadjusted model (odds ratio, 1.72 [95% confidence interval, 1.30-2.29] for highest vs. lowest SVI quintile). A weaker association between SVI and mortality was identified after adjusting for covariates common to claims data. Finally, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to robust trauma registries (adjusted odds ratio, 1.10 [95% confidence interval, 0.80-1.53] for highest vs. lowest SVI quintile). Higher SVI was also associated with a higher likelihood of presenting with penetrating injuries, a shock index of >0.9, any Abbreviated Injury Scale score of >5, or in need of a blood transfusion (p < 0.05 for all). CONCLUSION: Patients living in communities with greater social vulnerability are more likely to die after trauma admission. However, after risk adjustment with robust clinical covariates, this association was no longer significant. Our findings suggest that the inequitable burden of trauma mortality is not driven by variation in quality of treatment, but rather in the lethality of injuries. As such, improving trauma survival among high-risk communities will require interventions and policies that target social and structural inequities upstream of trauma center admission. LEVEL OF EVIDENCE: Prognostic / Epidemiologic, Level IV.


Assuntos
Vulnerabilidade Social , Ferimentos Penetrantes , Escala Resumida de Ferimentos , Adulto , Humanos , Estudos Retrospectivos , Centros de Traumatologia
4.
Sci Rep ; 12(1): 6152, 2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35413963

RESUMO

In our rapidly urbanizing world, many hazard-prone regions face significant challenges regarding risk-informed urban development. This study addresses this issue by investigating evolving spatial interactions between natural hazards, ever-increasing urban areas, and social vulnerability in Kathmandu Valley, Nepal. The methodology considers: (1) the characterization of flood hazard and liquefaction susceptibility using pre-existing global models; (2) the simulation of future urban built-up areas using the cellular-automata SLEUTH model; and (3) the assessment of social vulnerability, using a composite index tailored for the case-study area. Results show that built-up areas in Kathmandu Valley will increase to 352 km2 by 2050, effectively doubling the equivalent 2018 figure. The most socially vulnerable villages will account for 29% of built-up areas in 2050, 11% more than current levels. Built-up areas in the 100-year and 1000-year return period floodplains will respectively increase from 38 km2 and 49 km2 today to 83 km2 and 108 km2 in 2050. Additionally, built-up areas in liquefaction-susceptible zones will expand by 13 km2 to 47 km2. This study illustrates how, where, and to which extent risks from natural hazards can evolve in socially vulnerable regions. Ultimately, it emphasizes an urgent need to implement effective policy measures for reducing tomorrow's natural-hazard risks.


Assuntos
Inundações , Vulnerabilidade Social , Previsões , Nepal
5.
PLoS One ; 17(4): e0265888, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35442951

RESUMO

OBJECTIVE: During the COVID-19 pandemic, the unemployment rate in the United States peaked at 14.8% in April 2020. We examined patterns in unemployment following this peak in counties with rapid increases in COVID-19 incidence. METHOD: We used CDC aggregate county data to identify counties with rapid increases in COVID-19 incidence (rapid riser counties) during July 1-October 31, 2020. We used a linear regression model with fixed effect to calculate the change of unemployment rate difference in these counties, stratified by the county's social vulnerability (an indicator compiled by CDC) in the two months before the rapid riser index month compared to the index month plus one month after the index month. RESULTS: Among the 585 (19% of U.S. counties) rapid riser counties identified, the unemployment rate gap between the most and least socially vulnerable counties widened by 0.40 percentage point (p<0.01) after experiencing a rapid rise in COVID-19 incidence. Driving the gap were counties with lower socioeconomic status, with a higher percentage of people in racial and ethnic minority groups, and with limited English proficiency. CONCLUSION: The widened unemployment gap after COVID-19 incidence rapid rise between the most and least socially vulnerable counties suggests that it may take longer for socially and economically disadvantaged communities to recover. Loss of income and benefits due to unemployment could hinder behaviors that prevent spread of COVID-19 (e.g., seeking healthcare) and could impede response efforts including testing and vaccination. Addressing the social needs within these vulnerable communities could help support public health response measures.


Assuntos
COVID-19 , COVID-19/epidemiologia , Humanos , Incidência , Grupos Minoritários , Pandemias , Vulnerabilidade Social , Desemprego , Estados Unidos/epidemiologia
6.
BMC Health Serv Res ; 22(1): 511, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428257

RESUMO

BACKGROUND: Research exploring telehealth expansion during the COVID-19 pandemic has demonstrated that groups disproportionately impacted by COVID-19 also experience worse access to telehealth. However, this research has been cross-sectional or short in duration; geographically limited; has not accounted for pre-existing access disparities; and has not examined COVID-19 patients. We examined virtual primary care use by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. We also assessed use of in-person primary care to understand whether disparities in virtual access may have been offset by improved in-person access. METHODS: Using a cohort design, electronic health records, and Centers for Disease Control and Prevention Social Vulnerability Index, we compared changes in virtual and in-person primary care use by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our study population included 11,326 adult patients diagnosed with COVID-19 between March and July 2020. We estimated logistic regression models to examine likelihood of primary care use. In all regression models we computed robust standard errors; in adjusted models we controlled for demographic and health characteristics of patients. RESULTS: In a patient population of primarily Hispanic/Latino and non-Hispanic White individuals, and in which over half lived in socially vulnerable areas, likelihood of virtual primary care use increased from the year before to the year after COVID-19 diagnosis (3.6 to 10.3%); while in-person use remained stable (21.0 to 20.7%). In unadjusted and adjusted regression models, compared with White patients, Hispanic/Latino and other race/ethnicity patients were significantly less likely to use virtual care before and after COVID-19 diagnosis; Hispanic/Latino, Native Hawaiian/Pacific Islander, and other race/ethnicity patients, and patients living in socially vulnerable areas were also significantly less likely to use in-person care during these time periods. CONCLUSIONS: Newly expanded virtual primary care has not equitably benefited individuals from racialized groups diagnosed with COVID-19, and virtual access disparities have not been offset by improved in-person access. Health systems should employ evidence-based strategies to equitably provide care, including representative provider networks; targeted, empowering outreach; co-developed culturally and linguistically appropriate tools and technologies; and provision of enabling resources and services.


Assuntos
COVID-19 , Adulto , COVID-19/epidemiologia , Teste para COVID-19 , Estudos Transversais , Humanos , Pandemias , Atenção Primária à Saúde , Vulnerabilidade Social
7.
Clin Interv Aging ; 17: 447-465, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35431543

RESUMO

Background: Social vulnerability occurs when individuals have been relatively disadvantaged by the social determinants of health. Complex interventions that reduce social vulnerability have the potential to improve health in older adults but robust evidence is lacking. Objective: To identify, appraise and synthesize evidence on the effectiveness of complex interventions targeting reduction in social vulnerability for improving health related outcomes (mortality, function, cognition, subjective health and healthcare use) in older adults living in the community. Methods: A mixed methods systematic review was conducted. Five databases and targeted grey literature were searched for primary studies of all study types according to predetermined criteria. Data were extracted from each distinct intervention and quality was assessed using the Mixed Methods Appraisal Tool. Effectiveness data were synthesized using vote counting by direction of effect, combining p values and Albatross plots. Results: Across 38 included studies, there were 34 distinct interventions categorized as strengthening social supports and communities, helping older adults and their caregivers navigate health and social services, enhancing neighbourhood and built environments, promoting education and providing economic stability. There was evidence to support positive influences on function, cognition, subjective health, and reduced hospital utilization. The evidence was mixed for non-hospital healthcare utilization and insufficient to determine effect on mortality. Conclusion: Despite high heterogeneity and varying quality of studies, attention to reducing an older adult's social vulnerability assists in improving older adults' health.


Assuntos
Vida Independente , Vulnerabilidade Social , Idoso , Cuidadores , Escolaridade , Humanos , Apoio Social
8.
MMWR Morb Mortal Wkly Rep ; 71(10): 378-383, 2022 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-35271559

RESUMO

On October 29, 2021, the Pfizer-BioNTech pediatric COVID-19 vaccine received Emergency Use Authorization for children aged 5-11 years in the United States.† For a successful immunization program, both access to and uptake of the vaccine are needed. Fifteen million doses were initially made available to pediatric providers to ensure the broadest possible access for the estimated 28 million eligible children aged 5-11 years, especially those in high social vulnerability index (SVI)§ communities. Initial supply was strategically distributed to maximize vaccination opportunities for U.S. children aged 5-11 years. COVID-19 vaccination coverage among persons aged 12-17 years has lagged (1), and vaccine confidence has been identified as a concern among parents and caregivers (2). Therefore, COVID-19 provider access and early vaccination coverage among children aged 5-11 years in high and low SVI communities were examined during November 1, 2021-January 18, 2022. As of November 29, 2021 (4 weeks after program launch), 38,732 providers were enrolled, and 92% of U.S. children aged 5-11 years lived within 5 miles of an active provider. As of January 18, 2022 (11 weeks after program launch), 39,786 providers had administered 13.3 million doses. First dose coverage at 4 weeks after launch was 15.0% (10.5% and 17.5% in high and low SVI areas, respectively; rate ratio [RR] = 0.68; 95% CI = 0.60-0.78), and at 11 weeks was 27.7% (21.2% and 29.0% in high and low SVI areas, respectively; RR = 0.76; 95% CI = 0.68-0.84). Overall series completion at 11 weeks after launch was 19.1% (13.7% and 21.7% in high and low SVI areas, respectively; RR = 0.67; 95% CI = 0.58-0.77). Pharmacies administered 46.4% of doses to this age group, including 48.7% of doses in high SVI areas and 44.4% in low SVI areas. Although COVID-19 vaccination coverage rates were low, particularly in high SVI areas, first dose coverage improved over time. Additional outreach is critical, especially in high SVI areas, to improve vaccine confidence and increase coverage rates among children aged 5-11 years.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Programas de Imunização , Cobertura Vacinal , Criança , Pré-Escolar , Humanos , Farmácias/estatística & dados numéricos , SARS-CoV-2/imunologia , Vulnerabilidade Social
9.
J Nurs Manag ; 30(4): 1061-1068, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35266605

RESUMO

AIM: To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators. BACKGROUND: Nursing records support clinical decision-making and encourage continuity of care, hence the importance of auditing their completion in order to take corrective action where necessary. METHOD: This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID-19 hospital units during three observation periods: pre-pandemic, first wave, and second wave. RESULTS: A significant reduction in nursing record completion rates was observed between pre-pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit. CONCLUSIONS: The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions. IMPLICATIONS FOR NURSING MANAGEMENT: Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.


Assuntos
COVID-19 , Lesão por Pressão , Acidentes por Quedas , COVID-19/epidemiologia , Humanos , Registros de Enfermagem , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Lesão por Pressão/prevenção & controle , Vulnerabilidade Social
10.
Artigo em Inglês | MEDLINE | ID: mdl-35329217

RESUMO

Background-The exposome concept refers to the totality of exposures from internal and external sources, including chemical and biological agents from conception throughout the lifetime. Exposome is also made up of psychosocial components such as socio-economic status (SES), which will focus on in this review. Despite exposures to the same environmental nuisances, individuals and groups are impacted differently. According to the literature, health inequalities exist among different socioeconomic groups, and SES may influence the association between environmental nuisances and health outcomes. However, the variation of this interaction across ages has rarely been studied. There is a need to adopt a life course approach to understand the history of diseases better. Objective-The main objective of this review is to document how SES could modify the association between environmental nuisances and health outcomes, across different ages, as a first crucial step introducing the emerged concept of social exposome. Methods-The PubMed database was searched from January 2010 to August 2021 for systematic reviews published in English addressing the interaction between SES, environmental nuisances, and health outcomes. Socio-economic indicators considered include education, level of income, neighborhood environment. Environmental nuisances considered many environment nuisances, mainly air pollution and noise. Results-Among 242 literature reviews identified, 11 of them address the question of the effect modification. Overall, our work reveals that environmental nuisances were mostly associated with poorer health outcomes and that SES modified this association, increasing the health risk among the poorest. Very interestingly, our work reports the existence of this interaction across different ages, including pregnancy, childhood, and adulthood, and for various environmental nuisances. Conclusion-In conclusion, our work confirms that we are not all equal to face environmental nuisances. The poorest are more vulnerable to the health effect of environmental nuisances. Policy decisions and interventions should target this high-risk population as a priority. Further investigations are needed to formalize the concept of social exposome more precisely and then communicate about it.


Assuntos
Poluição do Ar , Expossoma , Adulto , Criança , Exposição Ambiental/análise , Feminino , Humanos , Gravidez , Vulnerabilidade Social , Revisões Sistemáticas como Assunto
11.
Artigo em Inglês | MEDLINE | ID: mdl-35329285

RESUMO

PURPOSE: The first coronavirus disease (COVID-19) spike and subsequent pandemic in South Korea were rapid and disruptive. Government response measures for disadvantaged groups against infectious disease should be prioritized based on evidence and affordability. We investigated whether COVID-19 infection, intensive care unit (ICU) care, and mortality from COVID-19 are related to social and medical vulnerability, including tuberculosis (TB). PATIENTS AND METHODS: Using the National Health Insurance Service COVID-19 database in South Korea, we analyzed 129,128 patients, including controls, from 1 January to 30 May 2020, during the early stage of the COVID-19 epidemic. The relationship between health insurance premiums (representing socioeconomic status), the Charlson comorbidity index (CCI) score for the severity of the underlying disease, and additional TB diagnosis was analyzed using the chi-square test and logistic regression. RESULTS: For the demographics, 3244 out of 51,783 men (6.3%) and 4836 out of 77,345 women (6.3%) were infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 infection, ICU care, and mortality were related to older age (p < 0.001) and lower health insurance premium levels (p < 0.05). Regarding the CCI score, the CCI score, COVID-19 infection, and mortality increased (p < 0.0001). In terms of premium level, the highest group showed a lower risk of infection (OR 0.52, 0.48-0.57, p = 0.004), ICU care (OR 0.59, 0.46-0.75, p < 0.001), and mortality (OR 0.51, 0.32-0.78, p = 0.016) than the medical aid group. TB was related to ICU care for COVID-19 (OR 4.27, 1.27-14.38, p = 0.018). CONCLUSION: In the early epidemic, SARS-CoV-2 infection, ICU admission, and mortality from COVID-19 increased in socioeconomically and physically vulnerable groups. However, the relationship between tuberculosis, COVID-19 and mortality was not definite because of the possible under-reporting of TB cases and the relatively small number of TB patients.


Assuntos
COVID-19 , Tuberculose , COVID-19/epidemiologia , Comorbidade , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , SARS-CoV-2 , Vulnerabilidade Social , Tuberculose/epidemiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-35329165

RESUMO

Ensuring access to high-quality outpatient care is an important strategy to improve COVID-19 outcomes, reduce social inequities, and prevent potentially expensive complications of disease. This study assesses the equity of health care response to COVID-19 by examining outpatient care utilization by factors at the individual and community levels in the 12 months prior to and following COVID-19 diagnosis. Employing a retrospective, observational cohort design, we analyzed electronic health record data from a sample of 11,326 adults diagnosed with COVID-19 between March and July 2020. We used two-part models to estimate changes in use of primary and specialty care by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our findings showed that while overall probability and counts of primary and specialty care visits increased following a positive COVID-19 diagnosis, disparities in care utilization by race/ethnicity and living in a socially vulnerable community persisted in the year that followed. These findings reiterate the need for strategic approaches to improve access to and utilization of care among those diagnosed with COVID-19, especially for individuals who are traditionally undeserved by the health system. Our findings also highlight the importance of systematic approaches for addressing social inequity in health care.


Assuntos
COVID-19 , Adulto , COVID-19/epidemiologia , Teste para COVID-19 , Disparidades em Assistência à Saúde , Humanos , Pacientes Ambulatoriais , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Vulnerabilidade Social
14.
Multimedia | Recursos Multimídia | ID: multimedia-9622

RESUMO

O evento integra a agenda de trabalho do Brasil para o Ano Internacional das Frutas, Legumes e Verduras (FLV) e tem como objetivo impulsionar as discussões sobre Promoção da Alimentação Adequada e Saudável, com base no Guia Alimentar da População Brasileira, por meio do fomento às iniciativas de incentivo à produção, à disponibilidade, ao acesso e ao consumo de frutas, legumes e verduras. As experiências inscritas no Laboratório de Inovação – Incentivo à produção, à disponibilidade, ao acesso e ao consumo de frutas, legumes e verduras foram apresentadas no evento.


Assuntos
Guias Alimentares , Segurança Alimentar , Dieta Saudável/economia , Desnutrição/prevenção & controle , Sobrepeso/prevenção & controle , Obesidade/prevenção & controle , Vulnerabilidade Social , Política Nutricional , Indústria Alimentícia , Agricultura Sustentável ,
15.
Multimedia | Recursos Multimídia | ID: multimedia-9623

RESUMO

O evento integra a agenda de trabalho do Brasil para o Ano Internacional das Frutas, Legumes e Verduras (FLV) e tem como objetivo impulsionar as discussões sobre Promoção da Alimentação Adequada e Saudável, com base no Guia Alimentar da População Brasileira, por meio do fomento às iniciativas de incentivo à produção, à disponibilidade, ao acesso e ao consumo de frutas, legumes e verduras. As experiências inscritas no Laboratório de Inovação – Incentivo à produção, à disponibilidade, ao acesso e ao consumo de frutas, legumes e verduras foram apresentadas no evento.


Assuntos
Política Nutricional , Segurança Alimentar , Dieta Saudável/economia , Guias Alimentares , Vulnerabilidade Social , Sobrepeso/prevenção & controle , Obesidade/prevenção & controle , Desnutrição/prevenção & controle , Indústria Alimentícia , Agricultura Sustentável
16.
J Allergy Clin Immunol Pract ; 10(4): 994-1002, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35123099

RESUMO

BACKGROUND: Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing. OBJECTIVE: We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care. METHODS: A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization. RESULTS: Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. CONCLUSIONS: Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.


Assuntos
Asma , Infecções Respiratórias , Asma/diagnóstico , Criança , Pré-Escolar , Humanos , Qualidade de Vida , Sons Respiratórios , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Vulnerabilidade Social
17.
J Surg Res ; 275: 35-42, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35219249

RESUMO

INTRODUCTION: Multiple factors signifying higher social vulnerability, including lower socioeconomic status and minority race, have been associated with presentation with complicated appendicitis (CA). In this study, we compared the Social Vulnerability Index (SVI) of our population by appendicitis severity (uncomplicated appendicitis [UA] versus CA). We hypothesized that SVI would be similar between patients with UA and CA presenting to our institution, a safety-net hospital in a state with high healthcare insurance coverage. METHODS: We included all patients at our hospital aged 18 y and older who underwent appendectomy for acute appendicitis between 2012 and 2016. SVI values were determined based on the 2010 census data using ArcMap software. We used nonparametric univariate statistics to compare the SVI of patients with CA versus UA and multivariable regression to model the likelihood of operative CA. RESULTS: A total of 997 patients met inclusion criteria, of which 177 had CA. The median composite SVI score for patients with CA was lower than for patients with UA (80% versus 83%, P = 0.004). UA was associated with higher socioeconomic (83% versus 80%, P = 0.007), household/disability (68% versus 55%, P = 0.037), and minority/language SVI scores (91% versus 89%, P = 0.037). On multivariable analysis controlling for age, sex, ethnicity, insurance status, relevant comorbidities, and chronicity of symptoms, there was an inverse association between SVI and the likelihood of CA (odds ratio 0.59, 95% confidence interval 0.4-0.87, P = 0.008). CONCLUSIONS: In the setting of high healthcare insurance and a medical center experienced in caring for vulnerable populations, patients presenting with UA have a higher composite SVI, and thus greater social vulnerability, than patients presenting with CA.


Assuntos
Apendicite , Seguro , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Humanos , Estudos Retrospectivos , Vulnerabilidade Social , Populações Vulneráveis
18.
PLoS One ; 17(2): e0264336, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35196332

RESUMO

The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 µm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.


Assuntos
Poluição do Ar/análise , Asma/epidemiologia , COVID-19/epidemiologia , Vulnerabilidade Social , COVID-19/virologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Louisiana/epidemiologia , Ozônio/análise , Pandemias , Material Particulado/análise , Fatores de Risco , SARS-CoV-2/isolamento & purificação
19.
Artigo em Inglês | MEDLINE | ID: mdl-35206386

RESUMO

Cardiometabolic diseases are a group of interrelated diseases that pose greater burden among socially vulnerable communities. The social vulnerability index (SVI) identifies communities vulnerable to emergencies and may also help determine communities at risk of adverse chronic health outcomes. However, no studies have examined the relationship between the SVI and cardiometabolic health outcomes in Colorado or focused on rural settings. The aim of this ecological study was to determine whether the county-level SVI is associated with county-level cardiometabolic health indicators with a particular focus on rurality and racial/ethnic diversity. We obtained 2014 SVI scores from the Centers for Disease Control and Prevention (scored 0-1; higher = more vulnerable) and 2013-2015 cardiometabolic health estimates from the Colorado Department of Public Health and Environment. The distribution of social determinants of health was spatially evaluated. Bivariate relationships between the SVI and cardiometabolic indicators were estimated using simple linear regression models. The highest SVI scores were observed in rural areas, including the San Luis Valley (mean: 0.78, median: 0.91), Southeast (mean: 0.72, median: 0.73), and Northeast (mean: 0.66, median: 0.76) regions. Across Colorado, the SVI accounted for 41% of the variability in overweight and obesity prevalence (p < 0.001), 17% of the variability in diabetes prevalence (p = 0.001), and 58% of the age-adjusted myocardial infarction hospitalization rate (p < 0.001). SVI values may be useful in determining a community's burden of cardiometabolic diseases.


Assuntos
Doenças Cardiovasculares , Vulnerabilidade Social , Doenças Cardiovasculares/epidemiologia , Colorado/epidemiologia , Humanos
20.
MMWR Morb Mortal Wkly Rep ; 71(5): 167-170, 2022 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-35113849

RESUMO

During 2018, Black or African American (Black) persons accounted for 43% of all new diagnoses of HIV infection in the United States (1). The annual diagnosis rate (39.2 per 100,000 persons) among Black persons was four times the rate among all other racial/ethnic groups combined, indicating a profound disparity in HIV diagnoses (1,2). Community-level social and structural factors, such as social vulnerability, might help explain the higher rate of HIV diagnoses among Black persons. Social vulnerability refers to the potential negative health effects on communities caused by external stresses (3). CDC used National HIV Surveillance System (NHSS)* and Social Vulnerability Index (SVI)† data to examine the association between diagnosed HIV infections and social vulnerability among Black adults aged ≥18 years. Black adults in communities in the highest quartile of SVI were 1.5 times (rate ratio [RR] = 1.5; 95% CI = 1.4-1.6) as likely to receive a diagnosis of HIV infection as were those in communities in the lowest quartile. Because of a history of racial discrimination and residential segregation, some Black persons in the United States reside in communities with the highest social vulnerability (4,5), and this finding is associated with experiencing increased risk for HIV infection. The development and prioritization of interventions that address social determinants of health (i.e., the conditions in which persons are born, grow, live, work, and age), are critical to address the higher risk for HIV infection among Black adults living in communities with high levels of social vulnerability. Such interventions might help prevent HIV transmission and reduce disparities among Black adults.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/epidemiologia , Vulnerabilidade Social , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência , Determinantes Sociais da Saúde , Estados Unidos/epidemiologia , Estados Unidos/etnologia
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