Browsing by Subject "Socioeconomic Factors"
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Item Investigating the Impacts of Area Deprivation Index in Rheumatoid Arthritis(2023-01-31) Kim, Joseph; Xie, Donglu; Zhang, Song; Solow, E. BlairBACKGROUND/PURPOSE: Rheumatoid arthritis (RA) is associated with increased morbidity and mortality, particularly if RA is poorly controlled. The effects of socioeconomic deprivation have not been well studied in the context of RA. We analyzed the impact of the Area Deprivation Index (ADI) on disease activity in RA. METHODS: We conducted a retrospective analysis of RA patients, defined by ICD-10 codes, seen at the UTSW and Parkland clinics in the past 5 years and are 18-89 years old. We collected age, ethnicity, race, gender, insurance plan, primary language, address, RA medications, MyChart engagement, primary care physician presence, ED/Inpatient visits over 5 years, RA disease activity and functional scores (RAPID3, HAQ), Charlson comorbidity index (CCI), and CVD presence. ADI was used as a proxy for socioeconomic deprivation and was assigned using 9-digit zip codes. Patients were divided by the upper ADI quartile vs lower ADI quartiles and matched by gender, race/ethnicity, age and CCI for propensity score analysis. Two-sample t test and Chi-square test were conducted for final group comparisons. RESULTS: 862 patients from UTSW and 1320 patients from Parkland were assessed in the final analysis. The median national ADI score was 45 and 72 for UTSW and Parkland respectively (range 1-100). In the UTSW cohort, those with high ADI scores (more deprived) had significantly higher RA disease activity (RAPID3: 11.9±7.1 vs 13.8±7.1, p<0.0001) and RA functional impairment (HAQ: 0.77±0.7 vs 0.94±0.7 p<0.001), were more likely to have cardiovascular disease (p<0.05), had lower MyChart utilization (p<.0001), more emergency department visits (p<0.05) and had lower jakinib use (p<.0001) compared to those with low ADI scores (less deprived). There were also statistically significant differences in insurance type (p<.05) and smoking status (p<.01). In the Parkland cohort, there were no significant differences between high ADI and low ADI groups in any of the measured variables. CONCLUSION: We found significant differences in RA disease activity and function in patients from more socioeconomically deprived areas only in the UTSW system. The absence of these differences in Parkland patients raises important questions as to whether certain hospital specific factors influence the role ADI plays in various health outcomes. Identifying the discrepancies between the two hospital systems may elucidate areas of improvement for patient care.Item Leptospirosis Risk Perception and Associated Behavior in a Region of High Seroprevalence in Iquitos, Peru(2016-04-01) Gutierrez, Carolina Paola; Higashi, Robin T.; Niwagaba, Lilian; Southern, PaulBACKGROUND: Iquitos has an ideal environment for Leptospira transmission leading up to endemic leptospirosis. Studies in Belen, an urban slum in Iquitos, indicate seroprevalence as high as 28% with rates higher in flooding and non-flooding areas, and pathogenic Leptospira in floodwater. Public health education efforts to date have failed to reduce prevalence and transmission rates. OBJECTIVE: Assess the community environment, residents' beliefs and behaviors, and social networks for information exchange to identify opportunities for enhancing public health strategies. METHODS: The primary researcher collected qualitative data from site observation (approximately 12 hours), 51 interviews, and 4 focus group interviews (n=27). All audio recordings were transcribed verbatim, translated to English, then analyzed and interpreted using NVivo 9.0 (QSR Australia). RESULTS: Roughly half (47%) of participants were familiar with the term "Leptospirosis" or "la enfermedad de la rata" (the rat's disease), but few could report on disease presentation or prevention. Although limited knowledge uptake has hampered prevention efforts, results also demonstrate that high-risk behaviors are closely aligned with environmental conditions, daily living practices, and cultural values, beliefs, and priorities. CONCLUSION: Complex and interconnected social, economical, and cultural conditions make Belen an ideal environment for transmission of leptospirosis. Public health strategies and funding to reduce transmission should target community trash disposal techniques, knowledge of water-borne illness, and modification of education modalities and distribution to leverage community-oriented values and priorities.Item [UT Southwestern Medical Center News](2008-02-06) Stafford, Erin Prather