Race and “Hotspots” of Preventable Hospitalizations

Abstract Preventable hospitalizations (PHs) are those for ambulatory care-sensitive conditions that indicate insufficiencies in local primary healthcare. PH rates tend to be higher among African Americans, in urban centers, rural areas and areas with more African American residents. The objective of this study is to determine geographic clusters of high PH rates (“spatial clusters”) by race. Data from Maryland hospitals were utilized to determine the rates of PHs in zip code tabulation areas (ZCTAs) by race in 2010. Geographic clusters of ZCTAs with higher than expected PH rates were identified using Scan Statistic and Anselin’s Local Moran’s I. 10 PH spatial clusters were observed among the total population with an average PH rate of 3,046.6 per 100,000 population. Among whites, the average PH rate was 3,339.9 per 100,000 in 11 PH spatial clusters. Only five PH spatial clusters were observed among African Americans with a higher average PH rate (3,710.8 per 100,000). The locations and other characteristics of PH spatial clusters differed by race. These results can be used to target resources to areas with high PH rates. Because PH spatial clusters are observed in differing locations for African Americans, approaches that include cultural tailoring may need to be specifically targeted

Addressing health inequalities in the United States: Key data trends and policy action

Health inequalities, which have been well documented for decades, have recently become policy targets in the United States. This report summarizes current patterns and trends in health inequalities, commitments to reduce health inequalities, and progress made to eliminate health inequalities. Time trend data indicate improvements in health status and major risk factors but increases in morbidity, with black and lower-education individuals experiencing a disproportionate burden of disease. A common policy response has been priority setting in the form of national objectives or goals to address health inequalities. More research and better methods are needed to precisely measure relationships between stated policy goals and observed trends in health inequalities. Despite these challenges, the United States has made commitments to advancing research and policy to eliminate health inequalities. There remain considerable opportunities for local public health systems and practioners to develop innovative solutions to address the problem of health inequalities, particularly related to action steps, and for researchers to address knowledge gaps in the scientific literature related to the evaluation and measurement of progress aimed at addressing health inequalities

Religious Coping and Types and Sources of Information Used in Making Prostate Cancer Treatment Decisions.

Treatment experiences for prostate cancer survivors can be challenging and dependent on many clinical and psychosocial factors. One area that is less understood is the information needs and sources men utilize. Among these is the influence of religion as a valid typology and the value it may have on treatment decisions. The objective of this study was to assess the relationship between race, religion, and cancer treatment decisions in African American men compared with White men. Data were from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 877 African American and White men. The main dependent variables sought respondents’ use of resources or advisors when making treatment decisions. Questions also assessed men perceptions of prostate cancer from the perspective of religious coping. After adjusting for age, marital status, education, and insurance status, race differences in the number of sources utilized were partially mediated by cancer was a punishment from God (β = −0.46, SE = 0.012, p \u3c .001), cancer was a test of faith (β = −0.49, SE = 0.013, p \u3c .001), and cancer can be cured with enough prayer (β = −0.47, SE = 0.013, p \u3c .001). Similarly, race differences in the number of advisors utilized in making the treatment decision were partially mediated by cancer was a punishment from God (β = −0.39, SE = 0.014, p = .006), and cancer was a test of faith (β = −0.39, SE = 0.014, p = .006). Religious views on prostate cancer may play an important role in explaining race differences in information used and the number of advisors utilized for treatment decision making for prostate cancer

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

“HOTSPOTS” OF PREVENTABLE HOSPITALIZATIONS: THE ROLE OF RACE, RACIAL RESIDENTIAL SEGREGATION, AND THE LOCAL HEALTH RESOURCES ENVIRONMENT

Statement of the problem: Hospitalizations for ambulatory care sensitive conditions are preventable because they can be treated in the primary care system. There have been consistent associations between race and location-based characteristics like segregation. Because of this, a study of “hotspots” of PHs is warranted, and the role of race, segregation and a possible mechanism, local health resources, was performed. Methods: This study analyzed Maryland hospital discharge data to determine the presence of hotspots (i.e. areas with higher PH rates). The adjusted rate of PHs was determined through multi-variate regression on the zip code tabulation area (ZCTA)-level. Segregation was assessed by the Dissimilarity Index (DI score) and racial composition. The association between segregation and PH hotspots was assessed. The effect of local health resources on PH hotspots was assessed. The mediating effects of local health resources on the association between PH rates and segregation were assessed using comparative regression analyses. Results: There were 10 geographic clusters (or hotspots) of ZCTAs with higher than expected PH rates in the State of Maryland. The location and characteristics of PH hotspots varied by race/ethnicity, but varied little when comparing by PH type. Accounting for segregation reduced the number of PH hotspots. Three of the local health resources were associated with PH rates and hotspots, and, in general, the number of PH hotspots was decreased after adjustment. The association between PH rates and DI scores was reduced after adjusting for associated local health resources, suggesting that these local health resources partially mediated the association between segregation and PH rates. Conclusions: The results of this study do find PH hotspots in Maryland, and significant inter-relationships between race, segregation, local health resources and PHs in Maryland. PH hotspots can be directly targeted by public health practitioners and policy makers with attention to PH hotspots among African Americans compared to whites, and PH hotspots for acute versus chronic and CVD-related PHs. The presence of local health resources was found to be a mediator of the relationship between segregation and PH rates. Policy makers should consider the potential role of various local health resources on PH. Committee members: Janice V. Bowie, David M. Levine, Roland J. Thorpe, Jr., C. Debra Furr-Holden, Karin Tobin (alternate), Sara N. Bleich (alternate) Reader: Frank C. Currier

Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition

Obesity rates in the U.S. are associated with area-level, food-related characteristics. Studies have previously examined the role of structural racism (policies/practices that advantaged White Americans and deprived other racial/ethnic minority groups), but racial inequalities in socioeconomic status (SES) is a novel indicator. The aim of this study is to determine the associations between racial inequalities in SES with obesity and obesogenic environments. Data from 2007–2014 County Health Rankings and 2012–2016 County Business Patterns were combined to assess the associations between relative SES comparing Blacks to Whites with obesity, and number of grocery stores and fast food restaurants in U.S. counties. Random effects linear and Poisson regressions were used and stratified by county racial composition. Racial inequality in poverty, unemployment, and homeownership were associated with higher obesity rates. Racial inequality in median income, college graduates, and unemployment were associated with fewer grocery stores and more fast food restaurants. Associations varied by county racial composition. The results demonstrate that a novel indicator of structural racism on the county-level is associated with obesity and obesogenic environments. Associations vary by SES measure and county racial composition, suggesting the ability for targeted interventions to improve obesogenic environments and policies to eliminate racial inequalities in SES

Difference in All-Cause Mortality between Unemployed and Employed Black Men: Analysis Using the National Health and Nutrition Examination Survey (NHANES) III

The Black-White racial employment disparity and its link to mortality have demonstrated the health benefits obtained from employment. Further, racial/ethnic mortality disparities existing among men with different employment statuses have been previously documented. The purpose of this study was to examine the association between employment status and all-cause mortality among Black men. Data for the study was obtained from the National Health and Nutrition Examination Survey (NHANES) III 1988–1994 linked to the NHANES III Linked Mortality File. Cox proportional hazard models were specified to examine the association between health behaviors and mortality in Black men by employment status. Among those who were assumed alive (n = 1354), 41.9% were unemployed. In the fully adjusted model, unemployed Black men had an increased risk of all-cause mortality (Hazard Ratio [HR] 1.60, 95% confidence interval or CI [1.33, 1.92]) compared to Black men who were employed. These results highlight the impact of employment on all-cause mortality among unemployed Black men and underscore the need to address employment inequalities to reduce the mortality disparities among Black men