Browsing by Subject "Socioeconomic Factors"
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Item Decreased Emergency Department Utilization by Lower Socioeconomic Status Population as a Result of the COVID-19 Pandemic(2022-05) Plumber, Arifa; Chang, Mary; Marshall, Amanda L.; Idris, Ahamed H.BACKGROUND: The SARS-CoV-2 (virus which causes COVID-19) pandemic has resulted in lower emergency department (ED) volumes. It precipitated business and school closures along with the implementation of physical distancing measures, which culminated in a Shelter-in-Place Order (SIPO) issued for a major urban area county in March 2020. OBJECTIVE: The objective of this study was to determine the effect of the COVID-19 pandemic on access to health care by patients of different socioeconomic status by examining differences in ED volume by zip code stratified by the SocioNeeds Index, a measure of socioeconomic need correlated with poor health outcomes. Our hypothesis was that decrease in patient visits due to the SIPO was not uniform across Dallas County but was based on socioeconomic need and proximity to Parkland's ED. METHODS: This retrospective chart review examines whether there was a quantitative change in patient visits to an urban, tertiary county hospital (Parkland or PMH) ED from 2019-2020 by zip code. The inclusion criterion was any ED visit from a patient with a zip code within Dallas County, and the exclusion criterion was any blank, alphanumeric, or PO box zip codes including zip codes located outside of Dallas County. The SocioNeeds Index, which rates each zip code by demographic factors relative to others in the county, was used as a proxy for the socioeconomic status of residents of each zip code. We mapped daily patient visits by zip code for four phases: Phase 1 was the three months preceding the first COVID-19 case's announcement in Dallas, Phase 2 began with the first COVID case, Phase 3 encompassed when the SIPO was in effect for Dallas County, and Phase 4 comprised the three months following the expiration of the SIPO. We compared this data to records over the same time period from the previous year to control for seasonal variation in the absence of a pandemic. RESULTS: There were 275,756 ED patient visits included in this study. We identified a statistically significant decrease in ED visits among patients from all zip codes during the pandemic: 24% between Phase 1 and 4 (p<0.0001) in 2020. Additionally, there was a decrease in visits after the first case in Dallas: Phase 2 (-14%, p<0.0001), Phase 3 (-41%, p<0.0001) and Phase 4 (-25%, p<0.0001) when compared to 2019 but an increase in visits (36%, p< 0.0001) in 2020 once the SIPO expired. Zip codes with highest SNI ranks (highest needs communities) were found to have greater reductions in visits during the SIPO and more sluggish recoveries after the expiration of the SIPO in comparison to those zip codes with the lowest needs. An examination of the geographic distribution of self-reported zip codes indicated that most communities in Dallas County saw a reduction in patient visits over Phases 2 and 3 (especially zip codes further from the ED) and an increase in visits during Phase 4 although not to pre-pandemic values. These changes, however, were not uniform across the county and were tied to socioeconomic factors and proximity of residence to PMH. CONCLUSION: Our hypothesis was supported by the results obtained: a significant decrease in ED visits was observed during the pandemic relative to a non-pandemic year among patients in most zip codes except those with the highest socioeconomic status, suggesting that the threat of the virus and SIPO deterred patients disproportionately from the higher socioeconomic needs communities from accessing healthcare. These results could have implications for future pandemic public health messaging and targeted outreach to communities with barriers to healthcare access.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