Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey

Labban, Muhieddine; Chen, Chang-Rong; Frego, Nicola; Nguyen, David‐Dan; Lipsitz, Stuart R.; Reich, Amanda J.; Rebbeck, Timothy R.; Choueiri, Toni K.; Kibel, Adam S.; Iyer, Hari S.; Trinh, Quoc‐Dien

doi:10.1001/jamanetworkopen.2023.25291

Cited by 20 publications

(1 citation statement)

References 40 publications

(75 reference statements)

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“…In non-white counties, the co-occuring negative change in grocery/pharmacy and transit usage, which corresponds to greater time at home, suggests a degree of transit captivity to reach essential services during heatwaves. Racial minority groups, who are disproportionately at risk of heatwaves and more reliant on public transit (Labban et al, 2023), may encounter greater barriers to essential activities during heatwaves.…”

Section: Urban and Socio-economic Impacts On Adaptationmentioning

confidence: 99%

Heatwave adaptation conditioned by everyday life: Analyzing interacting changes to daily activities during Pacific Northwest summers

Yucel,

Schwanen

2024

Preprint

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As heatwaves increase in intensity, frequency, and duration, there is an urgent need for adaptation to limit their adverse effects on health, well-being, and livelihoods. Heat exposure and adaptive responses during heatwaves are tightly linked to mobility behaviours – the subject of a rapidly growing body of literature. However, knowledge of the processes which shape and constrain opportunities to seek cooling remains limited, as academic research has yet to examine how people alter the various activities of everyday life in response to heatwaves. Addressing this gap, the current paper simultaneously models these interdependent activity changes, shedding light on behavioural adaptations during heatwaves and the underlying structures which condition them. Combining Google Community Mobility Reports, ERA5 climate re-analysis, and socio-economic data across the Pacific Northwest region of North America, the analysis uses a multivariate multi-level model to examine how anchor (home, work, transit), essential (grocery/pharmacy), and discretionary (retail/recreation, parks) activity change together during summer heatwaves. Focusing on a climatically diverse region and modelling heatwaves as distinct multi-day events, these interdependent responses are explored with the climatic, temporal, and contextual features of heatwaves. Four main conclusions about behavioural adaptation to heatwaves are drawn: (1) A region’s typical climate impacts workplace rigidity and adaptations to non-work activities during heatwaves; (2) Absolute and relative intensities have distinct yet comparably large impacts on behavioural responses; (3) Adaptation evolves over time, both between and within heatwaves; (4) Urban form and socio-economic disparities influence activity trade-offs during heatwaves. By contextualizing heatwaves within people’s everyday lives, this study highlights the diverse, dynamic, and yet constrained processes by which adaptation occurs.

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Section: Urban and Socio-economic Impacts On Adaptationmentioning

confidence: 99%

Heatwave adaptation conditioned by everyday life: Analyzing interacting changes to daily activities during Pacific Northwest summers

Yucel,

Schwanen

2024

Preprint

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Race, Social Determinants of Health, and the Quality of Diabetic Eye Care

Chaudhury,

Ige,

Marwah

et al. 2024

JAMA Ophthalmol

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ImportanceBesides race, little is known about how other social determinants of health (SDOH) affect quality of diabetic eye care.ObjectiveTo evaluate the association between multiple SDOH and monitoring for diabetic retinopathy (DR) in accordance with clinical practice guidelines (CPGs).Design, Setting, and ParticipantsThis cohort study was conducted in 11 US medical centers and included adult patients (18-75 years old) with diabetes. Patients received care from 2012 to 2023 and had 18 months or more of follow-up.ExposuresMultiple SDOH and associated factors, including ethnicity, urbanicity of residence, health insurance type, and diabetes type.Main Outcomes and MeasuresAdjusted odds ratio (aOR) of receiving 1 or more eye-care visits and 1 or more dilated fundus examinations in accordance with CPGs.ResultsThe study cohort included 37 397 adults with diabetes: 10 157 Black patients and 27 240 White patients. The mean (SD) age was 58 (11) years for Black patients and 59 (11) years for White patients. Of the Black patients, 6422 (63.2%) were female and 3735 (36.8%) male; of the White patients, 13 120 (48.1) were female and 14 120 (51.8) were male. Compared with those of the same race in urban communities, Black patients (aOR, 0.12; 95% CI, 0.04-0.31) and White patients (aOR, 0.75; 95% CI, 0.62-0.91) with diabetes living in rural communities had 88% and 25% lower odds of having eye-care visits, respectively. Sicker Black and White patients, defined by the Charlson Comorbidity Index, had 4% (aOR, 1.04; 95% CI, 1.02-1.06) and 5% (aOR, 1.05, CI 1.04-1.06) higher odds of having an eye-care visit, respectively. Black patients with preexisting DR had 15% lower odds of visits (aOR, 0.85, CI 0.73-0.99) compared with those without preexisting DR while White patients with preexisting DR had 16% higher odds of eye-care visits (aOR, 1.16; 95% CI, 1.05-1.28). White patients with Medicare (aOR, 0.85; 95% CI, 0.80-0.91) and Medicaid (aOR, 0.81; 95% CI, 0.68-0.96) had lower odds of eye-care visits vs patients with commercial health insurance. Hispanic White patients had 15% lower odds of eye-care visits (aOR, 0.85; 95% CI, 0.74-0.98) vs non-Hispanic White patients. White patients with type 1 diabetes had 17% lower odds of eye-care visits (aOR, 0.83; 95% CI, 0.76-0.90) vs those with type 2 diabetes. Among patients who had eye-care visits, those with preexisting DR (Black: aOR, 1.68; 95% CI, 1.11-2.53; White: aOR, 1.51; 95% CI, 1.16-1.96) were more likely to undergo dilated fundus examinations.Conclusions and RelevanceThis study found that certain SDOH affected monitoring for DR similarly for Black and White patients with diabetes while others affected them differently. Patients living in rural communities, Black patients with preexisting DR, and Hispanic White patients were not receiving eye care in accordance with CPGs, which may contribute to worse outcomes.

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A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts

Labban,

Stone,

Steele

et al. 2024

Cancer

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BackgroundDespite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race‐based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts.MethodsFour hospitals offering PCa treatment in Massachusetts were selected using a case‐mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns.ResultsOf the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan.ConclusionsThis statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment.Plain Language Summary Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.

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Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey

Cited by 20 publications

References 40 publications

Heatwave adaptation conditioned by everyday life: Analyzing interacting changes to daily activities during Pacific Northwest summers

Heatwave adaptation conditioned by everyday life: Analyzing interacting changes to daily activities during Pacific Northwest summers

Race, Social Determinants of Health, and the Quality of Diabetic Eye Care

A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts

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