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- (-) Social Determinants of Health (27)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 27 Research Studies DisplayedNeerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes
Hogg-Graham R, Benitez JA, Lacy ME
Association between community social vulnerability and preventable hospitalizations.
The purpose of this study was to explore the relationship between variations in social vulnerability and preventable hospitalization rates. The researchers analyzed county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). The study found that preventable hospitalizations were 40% greater in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations.
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Benitez JA, Lacy ME .
Association between community social vulnerability and preventable hospitalizations.
Med Care Res Rev 2024 Feb; 81(1):31-38. doi: 10.1177/10775587231197248..
Keywords: Hospitalization, Social Determinants of Health
Carroll AR, Hall M, Noelke C
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
This study examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. Exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children, which measures at 21.02 hospitalizations per 1000. Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased, from 26.56 per 1000 in very low COI areas to 14.76 per 1000 in very high COI areas (incidence rate ratio 1.8). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in the study.
AHRQ-funded; HS026122.
Citation: Carroll AR, Hall M, Noelke C .
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
J Hosp Med 2024 Feb; 19(2):120-25. doi: 10.1002/jhm.13252..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitalization, Social Determinants of Health
Fleming MD, Safaeinili N, Knox M
Organizational and community resilience for COVID-19 and beyond: leveraging a system for health and social services integration.
This case study paper examined how a preexisting initiative to align health care, public health, and social services influenced COVID-19 pandemic response. In-depth interviews were conducted with administrators and frontline staff in health care, public health, and social services in Contra Costa County, California from October 2020 to May 2021. The authors interviewed 31 informants including 14 managers in public health, health care, or social services and 17 social needs case managers who coordinated services across these sectors on behalf of patients. They identified four distinct components of the county's system alignment capabilities that supported COVID-19 response, including (1) an organizational culture of adaptability fostered through earlier system alignment efforts, which included the ability and willingness to rapidly implement new organizational processes, (2) trusting relationships among organizations based on prior, positive experiences of cross-sector collaboration, (3) capacity to monitor population health of historically marginalized community members, including information infrastructures, data analytics, and population monitoring and outreach, and (4) frontline staff with flexible skills to support health and social care who had built relationships with the highest risk community members.
AHRQ-funded; HS027648.
Citation: Fleming MD, Safaeinili N, Knox M .
Organizational and community resilience for COVID-19 and beyond: leveraging a system for health and social services integration.
Health Serv Res 2024 Feb; 59(suppl 1):e14250. doi: 10.1111/1475-6773.14250..
Keywords: COVID-19, Social Determinants of Health
Danielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L .
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Cai L, Wu Y, Cheskin LI
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
This study, the first systematic, quantitative study of childhood obesity prevention programs on blood lipids in high-income countries found that most interventions (70 percent) showed similar significant or no effects on adiposity- and lipid outcomes; 15 percent of interventions improved both adiposity- and lipids outcomes; 55 percent had no significant effects on either. These programs had a significant desirable effect on LDL-C and HDL-C.
AHRQ-funded; 290200710061I
Citation: Cai L, Wu Y, Cheskin LI .
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
Obes Rev. 2014 Dec;15(12):933-44. doi: 10.1111/obr.12227..
Keywords: Children/Adolescents, Obesity, Prevention, Outcomes, Social Determinants of Health
Rokicki S, Montana L, Fink G
Impact of migration on fertility and abortion: evidence from the household and welfare study of Accra.
The researchers used detailed pregnancy and migration histories collected as part of the Household and Welfare Study of Accra (HAWS) to examine the association between migration and pregnancy outcomes among women residing in the urban slums of Accra, Ghana. They found that the completed fertility patterns of lifetime Accra residents are remarkably similar to those of residents who migrated.
AHRQ-funded; HS000055.
Citation: Rokicki S, Montana L, Fink G .
Impact of migration on fertility and abortion: evidence from the household and welfare study of Accra.
Demography 2014 Dec;51(6):2229-54. doi: 10.1007/s13524-014-0339-0..
Keywords: Pregnancy, Urban Health, Social Determinants of Health, Labor and Delivery
Pignone MP, Crutchfield TM, Brown PM
Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina.
This study used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs. It found that follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47 percent); followed by test reward/copayment (33 percent).
AHRQ-funded; HS019468.
Citation: Pignone MP, Crutchfield TM, Brown PM .
Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina.
BMC Health Serv Res 2014 Nov 30;14:611. doi: 10.1186/s12913-014-0611-4..
Keywords: Cancer: Colorectal Cancer, Health Promotion, Rural Health, Screening, Social Determinants of Health
Angier H, Gregg J, Gold R
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
The researchers explored low-income parents’ perspectives on accessing health care. Interviews with 29 Oregon parents revealed that affordability and limited availability were seen as barriers to care; while a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children.
AHRQ-funded; HS018569.
Citation: Angier H, Gregg J, Gold R .
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
BMC Health Serv Res 2014 Nov 19;14:585. doi: 10.1186/s12913-014-0585-2..
Keywords: Access to Care, Children/Adolescents, Low-Income, Social Determinants of Health, Healthcare Costs
Heisler M, Choi H, Palmisano G
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
This study compared outcomes between community health worker (CHW) use of a tailored, interactive, Web-based, tablet computer-delivered tool specifically developed for the study and use of printed educational materials. In a population of low-income Latino and African American adults with diabetes and relatively low levels of formal education, participants in both CHW-led interventions reported mostly similar improvements in outcomes over 3 months.
AHRQ-funded; HS019256
Citation: Heisler M, Choi H, Palmisano G .
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
Ann Intern Med. 2014 Nov 18;161(10 Suppl):S13-22. doi: 10.7326/m13-3012..
Keywords: Health Information Technology (HIT), Diabetes, Shared Decision Making, Outcomes, Social Determinants of Health
Malhotra K, Baltrus P P, Zhang S
Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states.
Using 2007 Medicaid claims data from 556 counties in 14 southern states, the researchers described the local area variation in 1-year asthma prevalence rates, emergency department visit rates, and racial disparity rate ratios. They found much local area variation in asthma prevalence and asthma ED visit rates among Medicaid-enrolled children. Between black and white children, more counties had higher prevalence of asthma and higher ED visit rates among blacks.
AHRQ-funded; HS022444; HS019470
Citation: Malhotra K, Baltrus P P, Zhang S .
Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states.
J Asthma. 2014 Nov;51(9):913-21. doi: 10.3109/02770903.2014.930479..
Keywords: Asthma, Medicaid, Social Determinants of Health, Emergency Department, Emergency Medical Services (EMS)
Lyles CR, Schafer AL, Seligman HK
Income, food insecurity, and osteoporosis among older adults in the 2007-2008 National Health and Nutrition Examination Survey (NHANES).
The researchers investigated osteoporosis and low socioeconomic status (SES). They concluded that income and food insecurity may have significant implications not just for immediate nutritional outcomes, but also for conditions such as osteoporosis that develop over the lifespan.
AHRQ-funded; HS022408.
Citation: Lyles CR, Schafer AL, Seligman HK .
Income, food insecurity, and osteoporosis among older adults in the 2007-2008 National Health and Nutrition Examination Survey (NHANES).
J Health Care Poor Underserved 2014 Nov;25(4):1530-41. doi: 10.1353/hpu.2014.0174.
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Keywords: Elderly, Nutrition, Osteoporosis, Social Determinants of Health, Low-Income
Kaiboriboon K, Schiltz NK, Bakaki PM
Premature mortality in poor health and low income adults with epilepsy.
This research study’s objective was to examine mortality and causes of death in socioeconomically disadvantaged persons with epilepsy in the United States. While death from epilepsy-related causes was about 10%, comorbidities like cardiovascular disease, cancer, and unintentional injuries caused 18.4% of deaths. Socioeconomically deprived and Medicaid-insured patients died 17 years prematurely.
Epilepsia. 2014 Nov;55(11):1781-8. doi: 10.1111/epi.12789.
Citation: Kaiboriboon K, Schiltz NK, Bakaki PM .
Premature mortality in poor health and low income adults with epilepsy.
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Keywords: Low-Income, Mortality, Neurological Disorders, Social Determinants of Health
Diaz OV, Guendelman S, Kuppermann M
Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems.
The investigators sought to examine the effect of community and national subjective social status (SSS) on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions. They found that low perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions.
AHRQ-funded; HS011657.
Citation: Diaz OV, Guendelman S, Kuppermann M .
Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems.
Womens Health Issues 2014 Nov-Dec;24(6):649-55. doi: 10.1016/j.whi.2014.07.003.
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Keywords: Depression, Health Status, Pain, Social Determinants of Health, Women
McCormick EV, Dickinson LM, Haemer MA
What can providers learn from childhood body mass index trajectories: a study of a large, safety-net clinical population.
The investigators described childhood weight gain using body mass index (BMI) z-score trajectories in a low-income urban safety-net population and identified among gender- and race/ethnicity-specific groups any trends for increased risk. They found that all gender and race/ethnicity subgroups showed increasing average BMI z-scores during childhood, with Hispanic boys and black girls showing the most significant increase during this observation period. They further found that many obese children were already overweight by age 3, and persistence of obesity after 3 years of age was high. They concluded that intervention before age 3 may be essential to curbing unhealthy weight trajectories.
AHRQ-funded; HS021138.
Citation: McCormick EV, Dickinson LM, Haemer MA .
What can providers learn from childhood body mass index trajectories: a study of a large, safety-net clinical population.
Acad Pediatr 2014 Nov-Dec;14(6):639-45. doi: 10.1016/j.acap.2014.06.009.
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Keywords: Children/Adolescents, Obesity, Racial and Ethnic Minorities, Social Determinants of Health, Obesity: Weight Management
Goldman LE, Sarkar U, Kessell E
Support from hospital to home for elders: a randomized trial.
The researchers studied a peridischarge, nurse-led intervention combined with telephone follow-up designed to reduce readmissions among patients who were 55 or older. They found that the nurse-led, in-hospital discharge support intervention did not show a reduction in readmissions or ED visits among 700 diverse, low-income older adults at a safety-net hospital.
AHRQ-funded; HS018090.
Citation: Goldman LE, Sarkar U, Kessell E .
Support from hospital to home for elders: a randomized trial.
Ann Intern Med 2014 Oct 7;161(7):472-81. doi: 10.7326/m14-0094..
Keywords: Hospital Discharge, Hospital Readmissions, Emergency Department, Elderly, Social Determinants of Health, Nursing
Richards MR, Marti J
Heterogeneity in the smoking response to health shocks by out-of-pocket spending risk.
Using longitudinal data from 11 European countries, the researchers investigated the impact of a new cardiovascular (CV) health shock on smoking decisions among older adults and examine whether personal exposure to medical spending risk influences the smoking response. They found that CV shocks impact the propensity to smoke, with relatively more impact among individuals with high financial risk exposure to medical spending.
AHRQ-funded; HS017589.
Citation: Richards MR, Marti J .
Heterogeneity in the smoking response to health shocks by out-of-pocket spending risk.
Health Econ Policy Law 2014 Oct;9(4):343-57. doi: 10.1017/s1744133114000152..
Keywords: Cardiovascular Conditions, Tobacco Use, Lifestyle Changes, Health Insurance, Social Determinants of Health
Regenstein M, Andres E
Reducing hospital readmissions among Medicaid patients: a review of the literature.
This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. It concluded that much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population.
AHRQ-funded; 290202010000301.
Citation: Regenstein M, Andres E .
Reducing hospital readmissions among Medicaid patients: a review of the literature.
Qual Manag Health Care 2014 Oct-Dec;23(4):203-25. doi: 10.1097/qmh.0000000000000043..
Keywords: Hospital Readmissions, Medicaid, Behavioral Health, Substance Abuse, Social Determinants of Health
Holzer J, Canavan M, Bradley E
County-level correlation between adult obesity rates and prevalence of dentists.
The researchers conducted a study to examine the association between the prevalence of dentists and the rates of adult obesity. They found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity. This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population.
AHRQ-funded; HS017589.
Citation: Holzer J, Canavan M, Bradley E .
County-level correlation between adult obesity rates and prevalence of dentists.
J Am Dent Assoc 2014 Sep;145(9):932-9. doi: 10.14219/jada.2014.48.
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Keywords: Dental and Oral Health, Obesity, Risk, Social Determinants of Health
Wheeler SB, Kuo TM, Goyal RK
Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population.
The researchers examined colorectal cancer (CRC) testing across regions of North Carolina by using population-based Medicare and Medicaid claims data from disabled individuals who turned 50 years of age during 2003-2008. They found that fewer than 50% of eligible individuals had evidence of CRC testing; men, African-Americans, Medicaid beneficiaries, and those living furthest away from endoscopy facilities had significantly lower odds of CRC testing, with significant regional variation.
AHRQ-funded; HS019468.
Citation: Wheeler SB, Kuo TM, Goyal RK .
Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population.
Health Place 2014 Sep;29:114-23. doi: 10.1016/j.healthplace.2014.07.001.
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Keywords: Access to Care, Cancer: Colorectal Cancer, Disparities, Screening, Social Determinants of Health
Kenik J, Jean-Jacques M, Feinglass J
Explaining racial and ethnic disparities in cholesterol screening.
This study examining the impact of low socioeconomic status, access to care, and language on racial and ethnic disparities in cholesterol screening found that these factors explained most of those disparities. After adjusting for these factors, disparities between whites and Blacks and Hispanics but not Asians and Pacific Islanders were eliminated.
AHRQ-funded; HS021141
Citation: Kenik J, Jean-Jacques M, Feinglass J .
Explaining racial and ethnic disparities in cholesterol screening.
Prev Med. 2014 Aug;65:65-9. doi: 10.1016/j.ypmed.2014.04.026..
Keywords: Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Screening, Access to Care
Gomez SL, Lichtensztajn DY, Parikh P
Hospital practices in the collection of patient race, ethnicity, and language data: a statewide survey, California, 2011.
The authors reported on a sruvey of general acute care hospitals in California to elucidate practices regarding collection and auditing of patient race, ethnicity, and primary spoken language (REL). They found that the majority of hospitals used standardized forms for collection, and 75% audited patient information for completeness. They concluded that California hospitals are collecting information on patient REL as mandated, but variation in data collection exists, and hospitals may benefit from standardized data collection and auditing practices.
AHRQ-funded; HS019963.
Citation: Gomez SL, Lichtensztajn DY, Parikh P .
Hospital practices in the collection of patient race, ethnicity, and language data: a statewide survey, California, 2011.
J Health Care Poor Underserved 2014 Aug;25(3):1384-96. doi: 10.1353/hpu.2014.0126.
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Keywords: Data, Hospitals, Racial and Ethnic Minorities, Social Determinants of Health
Chambers C, Chiu S, Scott AN
Factors associated with poor mental health status among homeless women with and without dependent children.
The researchers estimated the prevalence of mental health problems among homeless women as well as the effects of risk factors on those problems. They found that, in a group of 522 homeless women in Toronto, Canada, poor mental health was associated with low perceived access to social support, physical/sexual assault in the past 12 months, presence of a chronic health condition, and presence of a drug use problem.
AHRQ-funded; HS014129
Citation: Chambers C, Chiu S, Scott AN .
Factors associated with poor mental health status among homeless women with and without dependent children.
Community Ment Health J. 2014 Jul;50(5):553-9. doi: 10.1007/s10597-013-9605-7..
Keywords: Behavioral Health, Chronic Conditions, Social Determinants of Health, Risk
Singh JA
The impact of gout on patient's lives: a study of African-American and Caucasian men and women with gout.
The objectives of this study were to assess the impact of gout on patients’ quality of life (QOL) and explore gender and race differences in the impact of gout on patients’ QOL. Some frequently cited high-ranked concerns among the ten nominal race- and sex-stratified groups were: (1) effect of gout flare on daily activities (n = 10 groups); (2) work disability (n = 8 groups);and (3) severe pain (n = 8 groups).
AHRQ-funded; HS021110.
Citation: Singh JA .
The impact of gout on patient's lives: a study of African-American and Caucasian men and women with gout.
Arthritis Res Ther 2014 Jun 24;16(3):R132. doi: 10.1186/ar4589..
Keywords: Quality of Life, Social Determinants of Health, Racial and Ethnic Minorities
Bettger JP, Zhao X, Bushnell C
The association between socioeconomic status and disability after stroke: findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry.
The authors examined the association of three indicators of SES--educational attainment, working status, and perceived adequacy of household income--with disability 3-months following an acute ischemic stroke. They found that 58% of the Adherence eValuation After Ischemic stroke--Longitudinal study patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. They concluded that, in this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke.
AHRQ-funded; HS019479; HS016964.
Citation: Bettger JP, Zhao X, Bushnell C .
The association between socioeconomic status and disability after stroke: findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry.
BMC Public Health 2014 Mar 26;14:281. doi: 10.1186/1471-2458-14-281.
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Keywords: Disabilities, Patient-Centered Outcomes Research, Social Determinants of Health, Stroke