Bridging the Telehealth Digital Divide With Collegiate Navigators: Mixed Methods Evaluation Study of a Service-Learning Health Disparities Course.

BACKGROUND: Limited digital literacy is a barrier for vulnerable patients accessing health care. OBJECTIVE: The Stanford Technology Access Resource Team (START), a service-learning course created to bridge the telehealth digital divide, trained undergraduate and graduate students to provide hands-on patient support to improve access to electronic medical records (EMRs) and video visits while learning about social determinants of health. METHODS: START students reached out to 1185 patients (n=711, 60% from primary care clinics of a large academic medical center and n=474, 40% from a federally qualified health center). Registries consisted of patients without an EMR account (at primary care clinics) or patients with a scheduled telehealth visit (at a federally qualified health center). Patient outcomes were evaluated by successful EMR enrollments and video visit setups. Student outcomes were assessed by reflections coded for thematic content. RESULTS: Over 6 academic quarters, 57 students reached out to 1185 registry patients. Of the 229 patients contacted, 141 desired technical support. START students successfully established EMR accounts and set up video visits for 78.7% (111/141) of patients. After program completion, we reached out to 13.5% (19/141) of patients to collect perspectives on program utility. The majority (18/19, 94.7%) reported that START students were helpful, and 73.7% (14/19) reported that they had successfully connected with their health care provider in a digital visit. Inability to establish access included a lack of Wi-Fi or device access, the absence of an interpreter, and a disability that precluded the use of video visits. Qualitative analysis of student reflections showed an impact on future career goals and improved awareness of health disparities of technology access. CONCLUSIONS: Of the patients who desired telehealth access, START improved access for 78.7% (111/141) of patients. Students found that START broadened their understanding of health disparities and social determinants of health and influenced their future career goals.

Impact of Structural Racism and Social Determinants of Health on Disparities in Breast Cancer Mortality.

The striking ethnic and racial disparities in breast cancer mortality are not explained fully by pathological or clinical features. Structural racism contributes to adverse conditions that promote cancer inequities, but the pathways by which this occurs are not fully understood. Social determinants of health (SDOH), such as economic status and access to care, account for a portion of this variability, yet interventions designed to mitigate these barriers have not consistently led to improved outcomes. Based on the current evidence from multiple disciplines, we describe a conceptual model in which structural racism and racial discrimination contribute to increased mortality risk in diverse groups of patients by promoting adverse SDOH that elevate exposure to environmental hazards and stress; these exposures in turn contribute to epigenetic and immune dysregulation, thereby altering breast cancer outcomes. Based on this model, opportunities and challenges arise for interventions to reduce racial and ethnic disparities in breast cancer mortality.

[Promoting Equity, Diversity, and Inclusion in Healthcare: An Example of the COVID-19 Pandemic].

Healthcare systems must embody equity, diversity, and inclusion (EDI) and, in the event of unfairness, appropriate policies / countermeasures should be enacted. The healthcare system response to the COVID-19 pandemic not only highlighted how socioeconomic disparities affect mortality risk but also posed significant challenges to the successful practice of EDI in healthcare. In light of this, this article was written to provide an overview of EDI, analyze the international efforts to promote it, and suggest strategies for promoting EDI in infectious disease healthcare using COVID-19 as an example. In healthcare settings, equity centers on ensuring patients receive fair treatment regardless of race, gender, age, or socioeconomic status; diversity centers on healthcare providers understanding the uniqueness of patients from different cultural backgrounds and the health barriers they face; and inclusion centers on ensuring patients are treated with respect and given the attention they deserve. During pandemics, social determinants of health (SDOH) greatly impact patient health outcomes and hinder the practice of EDI. Reflecting on the impact of COVID-19, healthcare systems can actively apply EDI in clinical practice to provide to all patients equitable access to healthcare opportunities and outcomes. Practical strategies include establishing EDI committees within healthcare systems, monitoring relevant data, conducting staff training, and continuously addressing the SDOH and needs of marginalized groups to achieve EDI in healthcare.

Racial and Ethnic Disparities in HIV Diagnosis Rates by Social Determinants of Health at the Census Tract Level among Adults in the United States and Puerto Rico, 2021.

BACKGROUND: To compare racial and ethnic disparities in HIV diagnosis rates among adults in census tracts with most disadvantaged vs advantaged levels of social determinants of health (SDOH). METHODS: In this ecological analysis, we used the National HIV Surveillance System data in 2021 and SDOH data from 2017-2021 American Community Survey. We measured racial and ethnic disparities stratified by sex in the most disadvantaged quartiles and advantaged quartiles for: 1) Poverty 2) Education level 3) Median household income and 4) Insurance coverage. We calculated 8 relative disparity measures (Black-to-White rate ratio [RR], Hispanic/Latino-to-White RR, Index of Disparity [ID], population-weighted ID, Mean Log Deviation, Theil Index, Population Attributable Proportion, Gini coefficient) and 4 absolute disparity measures (Black-to-White rate difference [RD], Hispanic/Latino-to-White RD, absolute ID, and population-weighted absolute ID). RESULTS: Comparing the most disadvantaged quartiles to the most advantaged quartiles, all four absolute disparity measures decreased, but 7 of the 8 relative disparity measures increased: the median percentage decrease in the absolute measures for males and females respectively was 38.1% and 47.6% for poverty, 12.4% and 42.6% for education level, 43.6% and 44.0% for median household income, and 44.2% and 45.4% for insurance coverage. The median percentage increases for the relative measures for males and females respectively were 44.3% and 61.3% for poverty, 54.9% and 95.3% for education level, 19.6% and 90.0% for median household income, and 32.8% and 46.4% for insurance coverage. CONCLUSION: Racial and ethnic disparities in the most disadvantaged and advantaged quartiles highlight the need for strategies addressing the root causes of disparities.

Striving toward health equity in the Americas

The Americas is the region where the largest socioeconomical disparities are found, as well as health inequities between countries and within countries among minority and excluded population groups. These health inequities are refl ected in diff erences in life expectancy; health at the start of life and over the life course; burden of infectious as well as noncommunicable diseases; health behaviors such as smoking, alcohol and drug use; and accidents, violence, and confl ict. Low-income groups, informal workers, lower educational level population, indigenous peoples, people of African descent, and other groups in situations of vulnerability in the Americas are at an enormous disadvantage and face considerable health inequities, reflected in higher rates of both communicable and noncommunicable diseases and maternal and infant mortality. PAHO has committed to work toward reducing health inequities, refl ected in its Policy on Ethnicity and Health, the Strategy and Plan of Action on Health Promotion within the context of the Sustainable Development Goals 2019–2030, and the Policy for Recovering Progress toward the Sustainable Development Goals with Equity through Action on the Social Determinants of Health and Intersectoral Work.

No seguir ciegos a la equidad: lecciones por aprender de la pandemia de COVID-19 en las Américas / We must not remain blind to equity: lessons to be learned from the COVID-19 pandemic in the Americas / Deixar de ignorar a equidade: lições a aprender com a pandemia de COVID-19 nas Américas

[RESUMEN]. La Región de las Américas ha experimentado históricamente desigualdades sociales enraizadas en el colonialismo, las cuales se reflejan y reproducen en el ámbito de la salud. La incursión de la pandemia de COVID-19 afectó a toda la Región, pero golpeó con mayor fuerza a los grupos socialmente más desaventajados, y agravó las inequidades en salud. Bajo la premisa que las pandemias no son fenómenos socialmente neutrales, en este informe especial se analizan los impactos desiguales de la pandemia desde distintas perspectivas –histórica, epidemiológica, política, social, económica, ambiental y poblacional. Se ofrecen aquí reflexiones críticas sobre las implicaciones negativas de las desigualdades para el bienestar, no solo de las poblaciones más afectadas, sino de la sociedad en su conjunto. Se concluye con recomendaciones estratégicas para progresar hacia la equidad en salud en el escenario pospandémico. Se destaca la importancia de avanzar en la madurez de los sistemas de información para el monitoreo de la equidad en salud, la resiliencia de los sistemas de salud, y la implementación de políticas y prácticas explícitas dirigidas a eliminar las inequidades en salud. Se espera que todo lo anterior allane el camino hacia la prosperidad y el desarrollo sostenible en la Región.

[ABSTRACT]. The Region of the Americas has historically experienced social inequalities rooted in colonialism, which are reflected and reproduced in the area of health. The COVID-19 pandemic affected the entire Region, but the most socially disadvantaged groups were hit hardest, intensifying health inequities. Under the premise that pandemics are not socially neutral phenomena, this special report analyzes the unequal impacts of the pandemic from different perspectives: historical, epidemiological, political, social, economic, environmental, and population-related. Critical reflections are offered here on the negative impacts of inequalities on well-being, not only in the most affected populations, but across society as a whole. Strategic recommendations are made for progress toward health equity in the post-pandemic context. This report highlights the importance of advancing toward mature information systems to monitor health equity, developing more resilient health systems, and implementing explicit policies and practices aimed at eliminating health inequities. All of this should pave the way for prosperity and sustainable development in the Region.

[RESUMO]. Historicamente, a Região das Américas vivencia desigualdades sociais enraizadas no colonialismo, que estão refletidas e se reproduzem no campo da saúde. A pandemia de COVID-19 afetou toda a Região, mas atingiu com mais força os grupos mais desfavorecidos do ponto de vista social, agravando as iniquidades em saúde. Sob a premissa de que as pandemias não são fenômenos neutros em termos sociais, este relatório especial analisa os impactos desiguais da pandemia a partir de diferentes perspectivas: histórica, epidemiológica, política, social, econômica, ambiental e populacional. São apresentadas reflexões críticas sobre as implicações negativas das desigualdades para o bem-estar, não apenas das populações mais afetadas, mas da sociedade como um todo. Conclui-se com recomendações estratégicas para avançar em direção à equidade em saúde no cenário pós-pandemia. Destaca-se a importância de avançar na maturidade dos sistemas de informação para monitorar a equidade em saúde, a resiliência dos sistemas de saúde e a implementação de políticas e práticas explícitas voltadas para a eliminação das iniquidades em saúde. Espera-se que os pontos mencionados abram caminho para a prosperidade e o desenvolvimento sustentável na Região.

Promoção da Saúde e Vigilância de Doenças e Agravos Não Transmissíveis Integradas

O Caderno Promoção da Saúde e Vigilância de Doenças e Agravos Não Transmissíveis Integradas – Parte 1 integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outros setores e instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. Este Caderno apresenta uma análise da implementação de estratégias de vigilância das DANT nos últimos anos, à luz da promoção da saúde, dos determinantes e da equidade. A Parte 2, apresentará propostas de articulação entre a PNPS e os processos de desenvolvimento teórico, conceitual e metodológico de implementação da vigilância integrada de DANT. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.

Educação Permanente para a Promoção da Saúde

O Caderno Educação Permanente para a Promoção da Saúde integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outros setores e instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. Este Caderno apresenta uma proposta de articulação entre a PNPS e os processos de educação permanente desenvolvidos no âmbito do Sistema Único de Saúde, a partir das lentes da promoção da saúde, dos determinantes e da equidade. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.

Promoção de saúde e as cidades

O Caderno Promoção da saúde e as cidades integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outros setores e instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. Este Caderno apresenta uma proposta de articulação entre a PNPS e o contexto da vida nas cidades, a partir das lentes da promoção da saúde, dos determinantes e da equidade. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.

Monitoramento e Avaliação em Promoção da Saúde

O Caderno Monitoramento e Avaliação em Promoção da Saúde integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outras instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. A PNPS, baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais. Políticas, programas, projetos de promoção da saúde inscrevem-se no campo das intervenções complexas, que impactam o monitoramento e a avaliação pela necessidade de incluir a análise do contexto material, político, social e cultural dos determinantes da saúde e das desigualdades. O monitoramento e a avaliação em promoção da saúde devem fortalecer a capacidade de criar e sustentar processos de mudança, enriquecer a teoria e a prática, qualificar a tomada de decisões promovendo o uso de enfoques metodológicos em consonância com a natureza complexa das intervenções em promoção da saúde. Neste sentido, deve considerar os modos de vida, opiniões e percepções sobre os processos de saúde/doença produzidos nos territórios, reforçando a importância da participação social no monitoramento e avaliação das ações de promoção da saúde.

Promoção da Saúde e Objetivos de Desenvolvimento Sustentável. Trilhar a Promoção da Saúde nos Objetivos de Desenvolvimento Sustentável (ODS)

O Caderno Promoção da Saúde e Objetivos de Desenvolvimento Sustentável integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outras instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saúde e na promoção da equidade e da saúde. Este Caderno apresenta uma proposta de articulação entre a PNPS e as estratégias utilizadas para a implementação e alcance dos Objetivos de Desenvolvimento Sustentável no âmbito dos territórios, a partir das lentes da promoção da saúde, dos determinantes sociais e ambientais e da equidade. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.

Treating the whole patient: Facilitating health care for patients facing health inequity.

Social determinants of health (SDOH) are conditions in which people are born, grow, live, work, and age. Variations in these conditions are largely responsible for health inequities, the differences in health status or distribution of health resources within a population. Despite recent increases in attention to SDOH in research and clinical practice, few, if any, resources exist to describe how these complex dynamics impact patients with inborn errors of metabolism. Recognizing the role real-life narratives have as a powerful educational tool, we compiled a series of 3 original cases, published as part of this special supplement, to illustrate challenges and learnings related to SDOH within the context of urea cycle disorders and phenylketonuria.

Social Disparities and Critical Illness during the Coronavirus Disease 2019 Pandemic: A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic raised new considerations for social disparities in critical illness including hospital capacity and access to personal protective equipment, access to evolving therapies, vaccinations, virtual care, and restrictions on family visitation. This narrative review aims to explore evidence about racial/ethnic and socioeconomic differences in critical illness during the COVID-19 pandemic, factors driving those differences and promising solutions for mitigating inequities in the future. We apply a patient journey framework to identify social disparities at various stages before, during, and after patient interactions with critical care services and discuss recommendations for policy and practice.

[Equity and social determinants of health over the life course]. / Gerechtigkeit und soziale Determinanten der Gesundheit im Lebenslauf.

BACKGROUND: Socio-structural and socio-cultural change in Western societies is increasingly challenging healthcare institutions to take good care of people's health and dignity. Further and sustainable progress in health care is increasingly influenced by socio-cultural conditions. If these conditions are insufficiently taken into account, further medical progress is jeopardized. AIM OF THE PAPER: The aim of this paper is to elucidate the significance of social conditions of health over the life course and thus to shed more light on one of the four ethical principles in medicine, namely equity. MATERIAL: The question is addressed by a literature review, whereby the literature was reviewed from a structural theory perspective. RESULTS: If people feel discriminated against in terms of their age, gender, or migration background, this not only has an impact on their self-esteem, but also on their health and recovery from illness. Unfavorable economic living conditions have a negative impact on health behavior. Experiences of discrimination in the healthcare system can reduce satisfaction with treatment and contribute to non-compliance with treatment instructions. DISCUSSION: The socio-cultural effects mentioned above can be influenced not only by individual changes in behavior but in particular by structural and institutional change processes. There is a need for "habitus sensitivity" in both clinical and private practice, i.e., it is also part of the responsibility of doctors in the healthcare system to eliminate discrimination.

The Impact of Racism on Health: A Health Equity Training on Structural Racism for Military Residents and Fellows.

Introduction: Recognizing the need for more opportunities to learn about health equity within military graduate medical education (GME), we developed a resident-led curriculum to introduce these concepts from a military cultural competency lens. The Impact of Racism on Health module focuses on structural racism and health disparities. Methods: This 60-minute module was presented to ear, nose, and throat (ENT) and pediatrics residents and fellows. It includes a case presentation of an adolescent with an asthma exacerbation, a large-group discussion about social determinants of health and structural racism, and a small-group discussion/debrief conceptualizing the case. Results: Thirty pediatrics residents and 15 ENT residents participated in this activity with a 46% and 60% pretest response rate, respectively. A two-sample Mann-Whitney U test showed statistically significant improvement (p = .005) in knowledge related to structural racism between the pretest (M = 0.5, SD = 0.3) and posttest (M = 0.7, SD = 0.1) knowledge assessments with a small effect size (r = 0.4; Z = 2.8). Discussion: We demonstrated that interactive teaching methods can be used to educate military GME trainees on the impact of structural racism on health outcomes for military health care beneficiaries. Understanding the role of structural racism in the context of military health care using curricula that highlight military-specific health disparities is essential to understanding the role of the military physician in systemically addressing health disparities.

Baby-Friendly Hospitals, Social Determinants of Health, and Disparities in Breastfeeding Initiation in a Low-Income Population, 2017-2020.

BACKGROUND: Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. RESEARCH AIM: To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. METHOD: We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017-2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. RESULTS: Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). CONCLUSION: Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.

Sociodemographic determinants of health inequities in low back pain: a narrative review.

Background: Health equity is defined as the absence of unjust and avoidable disparities in access to healthcare, quality of care, or health outcomes. The World Health Organization (WHO) has developed a conceptual framework that outlines the main causes of health inequalities and how these contribute to health inequities within a population. Despite the WHO implementing health equity policies to ensure accessibility and quality of healthcare services, disparities persist in the management of patients suffering from low back pain (LBP). The objective of this study was to review the existing evidence on the impact of health inequities on the care trajectories and treatments provided to individuals with LBP. Methods: A narrative review was performed, which included a literature search without language and study design restrictions in MEDLINE Ovid database, from January 1, 2000, to May 15, 2023. Search terms included free-text words for the key concepts of "low back pain," "health inequities," "care pathways," and "sociodemographic factors." Results: Studies have revealed a statistically significant association between the prevalence of consultations for LBP and increasing age. Additionally, a significant association between healthcare utilization and gender was found, revealing that women were more likely to seek medical attention for LBP compared to men. Furthermore, notable disparities related to race and ethnicity were identified, more specifically in opioid prescriptions, spinal surgery recommendations, and access to complementary and alternative medical approaches for LBP. A cross-sectional analysis found that non-Hispanic White individuals with chronic LBP were more likely to be prescribed one or more pharmacological treatments. Lower socioeconomic status and level of education, as well as living in lower-income areas were also found to be associated with greater risks of receiving non-guideline concordant care, including opioid and MRI prescriptions, before undergoing any conservative treatments. Conclusion: Persistent inequalities related to sociodemographic determinants significantly influence access to care and care pathways of patients suffering from LBP, underscoring the need for additional measures to achieve equitable health outcomes. Efforts are needed to better understand the needs and expectations of patients suffering from LBP and how their individual characteristics may affect their utilization of healthcare services.

Identifying Potential Factors Associated With Racial Disparities in COVID-19 Outcomes: Retrospective Cohort Study Using Machine Learning on Real-World Data.

BACKGROUND: Racial disparities in COVID-19 incidence and outcomes have been widely reported. Non-Hispanic Black patients endured worse outcomes disproportionately compared with non-Hispanic White patients, but the epidemiological basis for these observations was complex and multifaceted. OBJECTIVE: This study aimed to elucidate the potential reasons behind the worse outcomes of COVID-19 experienced by non-Hispanic Black patients compared with non-Hispanic White patients and how these variables interact using an explainable machine learning approach. METHODS: In this retrospective cohort study, we examined 28,943 laboratory-confirmed COVID-19 cases from the OneFlorida Research Consortium's data trust of health care recipients in Florida through April 28, 2021. We assessed the prevalence of pre-existing comorbid conditions, geo-socioeconomic factors, and health outcomes in the structured electronic health records of COVID-19 cases. The primary outcome was a composite of hospitalization, intensive care unit admission, and mortality at index admission. We developed and validated a machine learning model using Extreme Gradient Boosting to evaluate predictors of worse outcomes of COVID-19 and rank them by importance. RESULTS: Compared to non-Hispanic White patients, non-Hispanic Blacks patients were younger, more likely to be uninsured, had a higher prevalence of emergency department and inpatient visits, and were in regions with higher area deprivation index rankings and pollutant concentrations. Non-Hispanic Black patients had the highest burden of comorbidities and rates of the primary outcome. Age was a key predictor in all models, ranking highest in non-Hispanic White patients. However, for non-Hispanic Black patients, congestive heart failure was a primary predictor. Other variables, such as food environment measures and air pollution indicators, also ranked high. By consolidating comorbidities into the Elixhauser Comorbidity Index, this became the top predictor, providing a comprehensive risk measure. CONCLUSIONS: The study reveals that individual and geo-socioeconomic factors significantly influence the outcomes of COVID-19. It also highlights varying risk profiles among different racial groups. While these findings suggest potential disparities, further causal inference and statistical testing are needed to fully substantiate these observations. Recognizing these relationships is vital for creating effective, tailored interventions that reduce disparities and enhance health outcomes across all racial and socioeconomic groups.

Public health and system approach in eliminating disparities in hypertensive disorders and cardiovascular outcomes in non-Hispanic Black women across the pregnancy life course.

Hypertension is one of the leading risk factors for cardiovascular disease. The ACC/AHA/Multisociety hypertension guideline covered all aspects of the recommendations for optimal blood pressure diagnosis and management to improve cardiovascular outcomes. Despite this, there remains a growing prevalence of hypertension within the United States, largely in non-Hispanic Black women at earlier stages of their life course. This highlights the evident racial disparities, but offers a targeted opportunity for improved outcomes. With hypertension increasingly seen in the antenatal and immediate postpartum period, and obstetrics societies weighing in on the need to alter pharmacotherapy initiation goals, national initiatives have purposefully targeted pregnant and postpartum women in an effort to improve outcomes. This same energy must also re-focus health care efforts across the entire health continuum. Public health and system strategies are in place to do so, with the strongest enforcing initiatives as early as childhood with a greater focus on primordial prevention.

Partnering for Vaccine Equity: A Public Health-Community Action Model to Advance Delivery of Essential Health Services.

As part of CDC's Partnering for Vaccine Equity Program, the Association of State and Territorial Health Officials worked with the National Community Action Partnership and five community action agencies (CAAs) to address disparities in adult immunization among racial and ethnic minority populations. CAAs leveraged partnerships with public health, healthcare, and other local entities to increase uptake of COVID-19 and other vaccines, while simultaneously addressing related social determinants of health. With over 1000 agencies across the United States, including state associations, CAAs are accessible partners to nearly all state and local health departments. Collaboration between public health and community action is a promising model that can be used to cultivate trust, build and support resiliency, and address systemic disparities to advance health equity within communities.