Association of race/ethnicity and socioeconomic status with COVID-19 30-day mortality at a Philadelphia medical center using a retrospective cohort study.
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SUBMITTER: Cheney-Peters DR
PROVIDER: S-EPMC8662195 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundReducing the high patient and economic burden of early readmissions after hospitalisation for heart failure (HF) has become a health policy priority of recent years.MethodsAn observational study linking Hospital Episode Statistics to socioeconomic and death data in England (2002-2018). All first hospitalisations with a primary discharge code for HF were identified. Quasi-poisson models were used to investigate trends in 30-day readmissions by age, sex, socioeconomic status and ethnicity.FindingsThere were 698,983 HF admissions, median age 81 years [IQR 14].In-hospital deaths reduced by 0.7% per annum (pa), whilst additional deaths at 30-days remained stable at 5%. Age adjusted 30-day readmissions (21% overall), increased by 1.4% pa (95% CI 1.3-1.5). Readmissions for HF (6%) and 'other cardiovascular disease (CVD)' (3%) remained stable, but readmissions for non-CVD causes (12%) increased at a rate of 2.6% (2.4-2.7) pa. Proportions were similar by sex but trends diverged by ethnicity. Black groups experienced an increase in readmissions for HF (1.8% pa, interaction-p 0.03) and South Asian groups had more rapidly increasing readmission rates for non-CVD causes (interaction-p 0.04). Non-CVD readmissions were also more prominent in the least (15%; 15-15) compared to the most affluent group (12%; 12-12). Strongest predictors for HF readmission were Black ethnicity and chronic kidney disease, whilst cardiac procedures were protective. For non-CVD readmissions, strongest predictors were non-CVD comorbidities, whilst cardiologist care was protective.InterpretationIn HF, despite readmission reduction policies, 30-day readmissions have increased, impacting the least affluent and ethnic minority groups the most.FundingNIHR.
| S-EPMC8283308 | biostudies-literature
Project description:BACKGROUND:Very few studies with nationally representative samples have investigated the combined effects of race/ethnicity and socioeconomic position (SEP) on polypharmacy (PP) among older Americans. For instance, we do not know if prevalence of PP differs between African Americans (AA) and white older adults, whether this difference is due to a racial gap in SEP, or whether racial and ethnic differences exist in the effects of SEP indicators on PP. Aims: We investigated joint effects of race/ethnicity and SEP on PP in a national household sample of American older adults. Methods: The first wave of the University of Michigan National Poll on Healthy Aging included a total of 906 older adults who were 65 years or older (80 AA and 826 white). Race/ethnicity, SEP (income, education attainment, marital status, and employment), age, gender, and PP (using 5+ medications) were measured. Logistic regression was applied for data analysis. Results: Race/ethnicity, age, marital status, and employment did not correlate with PP; however, female gender, low education attainment, and low income were associated with higher odds of PP among participants. Race/ethnicity interacted with low income on odds of PP, suggesting that low income might be more strongly associated with PP in AA than white older adults. Conclusions: While SEP indicators influence the risk of PP, such effects may not be identical across diverse racial and ethnic groups. That is, race/ethnicity and SEP have combined/interdependent rather than separate/independent effects on PP. Low-income AA older adults particularly need to be evaluated for PP. Given that race and SEP have intertwined effects on PP, racially and ethnically tailored interventions that address PP among low-income AA older adults may be superior to universal interventions and programs that ignore the specific needs of diverse populations. The results are preliminary and require replication in larger sample sizes, with PP measured directly without relying on individuals' self-reports, and with joint data collected on chronic disease.
| S-EPMC6631748 | biostudies-literature
Project description:IntroductionThe hippocampus has a significant role in memory, learning, and cognition. Although hippocampal size is highly susceptible to family socioeconomic status (SES) and associated stress, very little is known on racial and ethnic group differences in the effects of SES indicators on hippocampus volume among American children.PurposeThis study explored the multiplicative effects of race, ethnicity, and family SES on hippocampus volume among American children.MethodsUsing data from the Adolescent Brain Cognitive Development (ABCD), we analyzed the functional Magnetic Resonance Imaging (fMRI) data of 9390 9-10 years old children. The main outcome was hippocampus volume. The predictor was parental education. Subjective family SES was the independent variable. Age, sex, and marital status were the covariates. Racial and ethnic group membership were the moderators. To analyze the data, we used regression models.ResultsHigh subjective family SES was associated with larger hippocampus volume. This effect was significantly larger for Whites than Black families.ConclusionsThe effect of subjective family SES on children's hippocampus volume is weaker in Black than White families.
| S-EPMC7581302 | biostudies-literature
Project description:Background:Higher socioeconomic status (SES) indicators such as educational attainment and income reduce the risk of chronic lung diseases (CLDs) such as Chronic Obstructive Pulmonary Disease (COPD), emphysema, chronic bronchitis, and asthma. Marginalization-related Diminished Returns (MDRs) refer to smaller health benefits of high SES for marginalized populations such as racial and ethnic minorities compared to the socially privileged groups such as non-Hispanic Whites. It is still unknown, however, if MDRs also apply to the effects of education and income on CLDs. Purpose:Using a nationally representative sample, the current study explored racial and ethnic variation in the associations between educational attainment and income and CLDs among American adults. Methods:In this study, we analyzed data (n = 25,659) from a nationally representative survey of American adults in 2013 and 2014. Wave one of the Population Assessment of Tobacco and Health (PATH)-Adult study was used. The independent variables were educational attainment (less than high school = 1, high school graduate = 2, and college graduate =3) and income (living out of poverty =1, living in poverty = 0). The dependent variable was any CLDs (i.e., COPD, emphysema, chronic bronchitis, and asthma). Age, gender, employment, and region were the covariates. Race and ethnicity were the moderators. Logistic regressions were fitted to analyze the data. Results:Individuals with higher educational attainment and those with higher income (who lived out of poverty) had lower odds of CLDs. Race and ethnicity showed statistically significant interactions with educational attainment and income, suggesting that the protective effects of high education and income on reducing odds of CLDs were smaller for Blacks and Hispanics than for non-Hispanic Whites. Conclusions:Education and income better reduce the risk of CLDs among Whites than Hispanics and Blacks. That means we should expect disproportionately higher than expected risk of CLDs in Hispanics and Blacks with high SES. Future research should test if high levels of environmental risk factors contribute to the high risk of CLDs in high income and highly educated Black and Hispanic Americans. Policy makers should not reduce health inequalities to SES gaps because disparities sustain across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.
| S-EPMC7100893 | biostudies-literature
Project description:Anatomic subsite risk factors for gastric cancer differ substantially, and subsite-specific distribution of risk factors (such as Helicobacter pylori) can vary by race and ethnicity and neighborhood socioeconomic status (nSES). We examined differences in gastric cancer incidence by subsite, stratified by race and ethnicity and nSES, using Surveillance Epidemiology and End Results Program 2000-2014 data for 77,881 incident gastric cancer cases (cardia, n = 23,651; non-cardia, n = 35,825; overlapping or unspecified, n = 18,405). Compared with non-Hispanic whites, cardia cancer multivariable-adjusted incidence rate ratios were 35%-47% lower for blacks, Hispanics, Asian or Pacific Islanders, and American Indian or Alaska Natives; conversely, non-cardia incidence rate ratios were 1.7- to 3.9-fold higher for blacks, Hispanics, Asian or Pacific Islanders, and American Indian or Alaska Natives. Higher adjusted incidence rate ratios with decreasing nSES (lowest vs highest nSES quintile) were observed for all gastric (1.3-fold) and non-cardia (1.3-fold) cancers but were borderline significant for cardia cancers (1.1-fold). In conclusion, non-cardia cancer incidence is higher in minorities and varies by nSES, but cardia cancer incidence is higher in non-Hispanic whites and does not vary substantially by nSES. Clarifying reasons for higher cardia risk in non-Hispanic whites and targeted interventions to address non-cardia cancer risk in minorities could lessen the burden of gastric cancer.
| S-EPMC6309455 | biostudies-literature
Project description:BackgroundLength of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.7 days per admission.ObjectiveTo assess differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home).MethodData were obtained from 2009-2014 Healthcare Cost and Utilization Project State Inpatient Datasets for New York, New Jersey, and Florida. Multivariate generalized linear models were used to examine trends in aALOS differences by race/ethnicity, and by high vs low SES patients (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics.ResultsFor those discharged home, racial/ethnic and SES aALOS differences remained stable from 2009 to 2014. However, among those discharged to non-home destinations, Black vs White aALOS differences increased from 0.21 days in Q1 2009, (95% confidence interval (CI): 0.13 to 0.30) to 0.32 days in Q3 2013, (95% CI: 0.23 to 0.40), and for low vs high SES patients from 0.03 days in Q1 2009 (95% CI: -0.04 to 0.1) to 0.26 days, (95% CI: 0.19 to 0.34). Notably, for patients not discharged home, racial/ethnic and SES aALOS differences increased and persisted after Q3 2011, coinciding with the introduction of the Affordable Care Act (ACA).ConclusionFurther research to understand the ACA's policy impact on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.
| S-EPMC8330458 | biostudies-literature
Project description:ObjectivesThis study sought to describe the health status of outpatients with heart failure and reduced ejection fraction (HFrEF) by sex, race/ethnicity, and socioeconomic status (SES).BackgroundAlthough a primary goal in treating patients with HFrEF is to optimize health status, whether disparities by sex, race/ethnicity, and SES exist is unknown.MethodsIn the CHAMP-HF (Change the Management of Patients with Heart Failure) registry, the associations among sex, race, and SES and health status, as measured by the Kansas City Cardiomyopathy Questionnaire-overall summary (KCCQ-os) score (range 0 to 100; higher scores indicate better health status) was compared among 3,494 patients from 140 U.S. clinics. SES was categorized by total household income. Hierarchical multivariate linear regression estimated differences in KCCQ-os score after adjusting for 31 patient characteristics and 10 medications.ResultsOverall mean KCCQ-os scores were 64.2 ± 24.0 but lower for women (29% of sample; 60.3 ± 24.0 vs. 65.9 ± 24.0, respectively; p < 0.001), for blacks (60.5 ± 25.0 vs. 64.9 ± 23.0, respectively; p < 0.001), for Hispanics (59.1 ± 21.0 vs. 64.9 ± 23.0, respectively; p < 0.001), and for those with the lowest income (<$25,000; mean: 57.1 vs. 63.1 to 74.7 for other income categories; p < 0.001). Fully adjusted KCCQ-os scores were 2.2 points lower for women (95% confidence interval [CI]: -3.8 to -0.6; p = 0.007), no different for blacks (p = 0.74), 4.0 points lower for Hispanics (95% CI: -6.6 to -1.3; p = 0.003), and lowest in the poorest patients (4.7 points lower than those with the highest income (95% CI: 0.1 to 9.2; p = 0.045; p for trend = 0.003).ConclusionsAmong outpatients with HFrEF, women, blacks, Hispanics, and poorer patients had worse health status, which remained significant for women, Hispanics, and poorer patients in fully adjusted analyses. This suggests an opportunity to further optimize treatment to reduce these observed disparities.
| S-EPMC6003698 | biostudies-literature
Project description:ObjectivesSlow afternoon cortisol decline may be a marker of aging. We hypothesize that lower socioeconomic status (SES) and African American race are associated with lower waking cortisol and slower afternoon decline.MethodSix salivary cortisol samples, collected within a 24-hr period from 566 cohort participants aged 56-78 years, were examined in random-effects models. SES measures included socioeconomic vulnerability (household income and assets <500% of poverty) and education (≥college, some college, and ≤high school). African Americans were compared with all others.ResultsAdjusting for age and sex, intermediate, but not low, education was associated with approximately 17% lower average waking cortisol and 1% slower decline, compared with high education. Socioeconomic vulnerability was not associated with waking cortisol or linear decline. Accounting for African American race/ethnicity, socioeconomic vulnerability was associated with a 3% faster decline, and education was not associated with cortisol. African Americans had 26% lower average waking cortisol and 1% slower decline than others.DiscussionAfrican American race/ethnicity, but not lower SES, was associated with lower waking cortisol and slower afternoon decline in middle-aged and older adults. This pattern is likely a marker of earlier biological aging in vulnerable groups. Race/ethnicity may compete with SES as a measure of cumulative vulnerability.
| S-EPMC5926996 | biostudies-literature
Project description:Study objectivesGrowing evidence indicates sleep is a major public health issue. Race/ethnicity and socioeconomics may contribute to sleep problems. This study assessed whether sleep symptoms were more prevalent among minorities and/or the socioeconomically disadvantaged.DesignCross-sectional.SettingEpidemiologic survey.Patients or participants2007-2008 National Health and Nutrition Examination Survey (N = 4,081).InterventionsNone.Measurements and resultsSociodemographics included age, sex, race/ethnicity, marital status, and immigration. Socioeconomics included poverty, education, private insurance, and food insecurity. Sleep symptoms assessed were sleep latency > 30 min, difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, non-restorative sleep, daytime sleepiness, snorting/gasping, and snoring. Decreased reported problems for most symptoms were found among minorities, immigrants, and lower education levels. In general, in fully adjusted models, long sleep latency was associated with female gender, being black/African American, lower education attainment, no private insurance, and food insecurity. Difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, and non-restorative sleep were also associated with female gender and food insecurity. Daytime sleepiness was seen in female and divorced respondents. Snorting/gasping was more prevalent among male, other-Hispanic/Latino, and 9(th)- to 11(th)-grade-level respondents. Snoring was prevalent among male, other-Hispanic/Latino, less-educated, and food-insecure respondents.ConclusionsSleep symptoms were associated with multiple sociodemographic and economic factors, though these relationships differed by predictor and sleep outcome. Also, reports depended on question wording.
| S-EPMC3746717 | biostudies-literature
Project description:ImportanceSocioeconomic status may help delineate racial and ethnic inequities in mortality.ObjectiveTo investigate the joint associations of race, ethnicity, and neighborhood and individual socioeconomic status with mortality.Design, setting, and participantsThis prospective analysis used data from the Multiethnic Cohort Study. A population-based sample of participants recruited from California (mainly Los Angeles County) and Hawaii from 1993 to 1996 was followed up until 2013. African American, European American, Japanese American, Latino American, and Native Hawaiian men and women were included. Participants with baseline residential addresses that could not be geocoded or who were missing information on education or adjustment variables were excluded. Data analyses were conducted from January 2018 to December 2020.ExposuresNeighborhood socioeconomic status (nSES) was derived using US Census block group data on education, occupation, unemployment, household income, poverty, rent, and house values. Participants self-reported their highest education attainment. Five racial and ethnic groups, 2 states of residence, 2 nSES, and 2 education categories were combined to create a joint exposure variable. Low and high nSES were defined as quintiles 1 to 3 and 4 to 5, respectively. Low and high education levels were defined as high school or less and greater than high school graduate, respectively.Main outcomes and measuresAll-cause, cardiovascular disease (CVD), cancer, and non-CVD and noncancer deaths were ascertained through 2013 via linkage to death certificates and the US National Death Index. Multivariable Cox proportional hazards regression analyses were conducted.ResultsAmong 182 912 participants (100 785 [55.1%] women and 82 127 [44.9%] men; mean [SD] age, 60.0 [8.9] years; 31 138 African American, 45 796 European American, 52 993 Japanese American, 39 844 Latino American, and 13 141 Native Hawaiian participants) with a mean (SD) follow-up of 17 (5) years, there were 63 799 total deaths, including 23 191 CVD deaths, 19 008 cancer deaths, and 21 235 non-CVD and noncancer deaths. The lowest all-cause mortality was found among 15 104 Japanese American participants in Hawaii with high nSES and high education (eg, 2870 all-cause deaths [19.0%]), and this population served as the reference group for all regression analyses. Native Hawaiian participants in Hawaii with low nSES and low education had the highest all-cause mortality HR (2.38; 95% CI, 2.21-2.57). African American and European American participants in California with low nSES and low education had the next highest all-cause mortality HRs (2.01; 95% CI, 1.91-2.11 and 1.98; 95% CI, 1.85-2.12, respectively). Latino American participants in California with low nSES had equivalent all-cause mortality HRs regardless of education level (high education: 1.57; 95% CI, 1.48-1.66; low education: 1.57; 95% CI, 1.50-1.65). Patterns for cause-specific mortality were similar to those for all-cause mortality. For example, Native Hawaiian participants in Hawaii with low nSES and low education had highest CVD mortality HR (2.92; 95% CI, 2.60-3.27) and cancer mortality HR (2.01; 95% CI, 1.77-2.29).Conclusions and relevanceThese results suggest that joint associations of nSES and education may further delineate racial and ethnic inequities in mortality and that future investigations of racial and ethnic inequities in mortality should consider differences by measures of socioeconomic status, especially for underserved populations.
| S-EPMC9002338 | biostudies-literature