Unique health needs and characteristics of homeless women in Iowa City, Iowa

Context: Homeless individuals have comparatively poorer health, however few gender specific assessments exist. Purpose: This cross-sectional survey of homeless individuals assesses gender-specific health needs. Procedure: 68 Homeless adults were surveyed at a shelter from March to April, 2015 in Iowa City, IA. Descriptive statistics were computed to compare gender-subgroup responses. Main Findings: The study population was predominately male (45, 67.2%), white (37, 54.4%), and averaged 42.35 years old (range 21-74). Males were more likely to be veterans (13, 28.9% vs. 1, 4.5%, p=0.025). Women were more likely to have dependents (9, 47.4% vs. 1, 4%, p=0.001) and access to dental coverage (16, 80% vs. 12, 30.8%, p=0.001). Similar rates of chronic disease, primary care access, and unmet health needs were noted. Conclusions: Homeless women and men have unique needs and would benefit from gender-specific health interventions. Resources for child-care may be important for women who are homeless, while dental health care may be particularly beneficial for men

Redlining−associated methylation in breast tumors: the impact of contemporary structural racism on the tumor epigenome

PurposePlace-based measures of structural racism have been associated with breast cancer mortality, which may be driven, in part, by epigenetic perturbations. We examined the association between contemporary redlining, a measure of structural racism at the neighborhood level, and DNA methylation in breast tumor tissue.MethodsWe identified 80 Black and White women diagnosed and treated for a first-primary breast cancer at Emory University Hospitals (2008–2017). Contemporary redlining was derived for census tracts using the Home Mortgage Disclosure Act database. Linear regression models were used to calculate the association between contemporary redlining and methylation in breast tumor tissue. We also examined epigenetic age acceleration for two different metrics, regressing β values for each cytosine-phosphate-guanine dinucleotide (CpG) site on redlining while adjusting for covariates. We employed multivariable Cox-proportional hazards models and 95% confidence intervals (CI) to estimate the association between aberrant methylation and mortality.ResultsContemporary redlining was associated with 5 CpG sites after adjustment for multiple comparisons (FDR<0.10). All genes were implicated in breast carcinogenesis, including genes related to inflammation, immune function and stress response (ANGPT1, PRG4 and PRG4). Further exploration of the top 25 CpG sites, identified interaction of 2 sites (MRPS28 and cg11092048) by ER status and 1 site (GDP1) was associated with all-cause mortality. Contemporary redlining was associated with epigenetic age acceleration by the Hannum metric (β=5.35; CI 95%=0.30,10.4) and showed positive but non-significant correlation with the other clock.ConclusionWe identified novel associations between neighborhood contemporary redlining and the breast tumor DNA methylome, suggesting that racist policies leading to inequitable social and environmental exposures, may impact the breast tumor epigenome. Additional research on the potential implications for prognosis is needed

How Socioeconomic Status Affects Patient Perceptions of Health Care: A Qualitative Study

Introduction: Clinician perceptions of patients with low socioeconomic status (SES) have been shown to affect clinical decision making and health care delivery in this group. However, it is unknown how and if low SES patients perceive clinician bias might affect their health care. Methods: In-depth interviews with 80 enrollees in a state Medicaid program were analyzed to identify recurrent themes in their perceptions of care. Results: Most subjects perceived that their SES affected their health care. Common themes included treatment provided, access to care, and patient-provider interaction. Discussion: This study highlights complex perceptions patients have around how SES affects their health care. These results offer opportunities to reduce health care disparities through better understanding of their impact on the individual patient-provider relationship. This work may inform interventions that promote health equity via a multifaceted approach, which targets both providers and the health care system as a whole