Examining Variation in Life Expectancy Estimates by ZIP Code Tabulation Area (ZCTA) in Hawaii’s Four Main Counties, 2008–2012

Holmes, Joshua R.; Tootoo, Joshua; Chosy, Julia; Bowie, Amber Y.; Starr, Ranjani R.

doi:10.5888/pcd15.180035

Cited by 8 publications

(7 citation statements)

References 3 publications

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“…Residents of these regions experience well-documented shortages of health care services and decreased life expectancies, suggesting that Native Hawaiian individuals in our study may have certain advantages over those elsewhere in the state, a possibility that will be explored in future work. 28 , 29 Our observation that there were such significant outcome disparities among Filipino individuals, consistent with analysis by the HDOH, also merits further exploration and potential targeting of resources to improve these outcomes.…”

Section: Discussionsupporting

confidence: 66%

COVID-19 Hospitalization in Hawaiʻi and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination

Santi,

Verhoef

2024

JAMA Netw Open

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ImportanceThe people of Hawaiʻi have both high rates of health insurance and high levels of racial and ethnic diversity, but the degree to which insurance status and race and ethnicity contribute to health outcomes in COVID-19 remains unknown.ObjectiveTo evaluate the associations of insurance coverage, race and ethnicity (using disaggregated race and ethnicity data), and vaccination with outcomes for COVID-19 hospitalization.Design, Setting, and ParticipantsThis retrospective cohort study included hospitalized patients at a tertiary care medical center between March 2020 and March 2022. All patients hospitalized for acute COVID-19, identified based on diagnosis code or positive results on polymerase chain reaction–based assay for SARS-CoV-2, were included in analysis. Data were analyzed from May 2022 to May 2023.ExposureCOVID-19 requiring hospitalization.Main Outcome and MeasuresElectronic medical record data were collected for all patients. Associations among race and ethnicity, insurance coverage, receipt of at least 1 COVID-19 vaccine, intensive care unit (ICU) transfer, in-hospital mortality, and COVID-19 variant wave (pre-Delta vs Delta and Omicron) were assessed using adjusted multivariable logistic regression.ResultsA total of 1176 patients (median [IQR] age of 58 [41-71] years; 630 [54%] male) were hospitalized with COVID-19, with a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 (25-36) and Sequential Organ Failure Assessment score of 1 (0-2). The sample included 16 American Indian or Alaska Native patients, 439 Asian (not otherwise specified) patients, 15 Black patients, 66 Chinese patients, 246 Filipino patients, 76 Hispanic patients, 107 Japanese patients, 10 Korean patients, 299 Native Hawaiian patients, 523 Pacific Islander (not otherwise specified) patients, 156 Samoan patients, 5 Vietnamese patients, and 311 White patients (patients were able to identify as &gt;1 race or ethnicity). When adjusting for age, BMI, sex, medical comorbidities, and socioeconomic neighborhood status, there were no differences in either ICU transfer (eg, Medicare vs commercial insurance: odds ratio [OR], 0.84; 95% CI, 0.43-1.64) or in-hospital mortality (eg, Medicare vs commercial insurance: OR, 0.85; 95% CI, 0.36-2.03) as a function of insurance type. Disaggregation of race and ethnicity revealed that Filipino patients were more likely to die in the hospital (OR, 1.79; 95% CI, 1.04-3.03; P = .03). When considering variant waves, mortality among Filipino patients was highest during the pre-Delta time period (OR, 2.72; 95% CI, 1.02-7.14; P = .04), when mortality among Japanese patients was lowest (OR, 0.19; 95% CI, 0.03-0.78; P = .04); mortality among Native Hawaiian patients was lowest during the Delta and Omicron period (OR, 0.35; 95% CI, 0.13-0.79; P = .02). Patients with Medicare, compared with those with commercial insurance, were more likely to have received at least 1 COVID-19 vaccine (OR, 1.85; 95% CI, 1.07-3.21; P = .03), but all patients, regardless of insurance type, who received at least 1 COVID-19 vaccine had reduced ICU admission (OR, 0.40; 95% CI, 0.21-0.70; P = .002) and in-hospital mortality (OR, 0.42; 95% CI, 0.21-0.79; P = .01).Conclusions and RelevanceIn this cohort study of hospitalized patients with COVID-19, those with government-funded insurance coverage (Medicare or Medicaid) had similar outcomes compared with patients with commercial insurance, regardless of race or ethnicity. Disaggregation of race and ethnicity analysis revealed substantial outcome disparities and suggests opportunities for further study of the drivers underlying such disparities. Additionally, these findings illustrate that vaccination remains a critical tool to protect patients from COVID-19 mortality.

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Section: Discussionsupporting

confidence: 66%

COVID-19 Hospitalization in Hawaiʻi and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination

Santi,

Verhoef

2024

JAMA Netw Open

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“…Postal Service and were not explicitly designed to be units of observation in population-based studies. However, the use of small geographic units of observation such as ZIP codes in population-based and gerontological research to understand critical small-scale geographic patterns of health and disease has become much more common over the recent decades (Holmes et al, 2018; Jerrett et al, 2010; Spring, 2018; Zahnd et al, 2010). Future studies could examine other geographic units, such as counties and census tracts, to determine if associations are consistent across different geographic units of analyses.…”

Section: Discussionmentioning

confidence: 99%

Rural-Urban Differences in Caregiver Burden Due to the COVID-19 Pandemic among a National Sample of Informal Caregivers

Cohen

Kunicki

Nash

et al. 2021

Gerontology and Geriatric Medicine

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The objective of this exploratory study was to explore potential associations between changes to caregiver burden (CB) due to the COVID-19 pandemic and rural-urban status using a nationally representative sample of 761 informal caregivers. Tertiles of two measures of rural-urban status were used: Rural-Urban Commuting Areas (RUCAs) and population density. Bivariate and multivariable binary and ordinal logistic regression were used to asses study objectives. Using RUCAs, rural informal caregivers were more than twice as likely as urban informal caregivers to report a substantial increase in CB due to COVID-19 (OR 2.27, 95% CI [1.28–4.02]). Similar results were observed for population density tertiles (OR 2.20, 95% CI [1.22–3.96]). Having a COVID-19 diagnosis was also significantly associated with increased CB. Understanding and addressing the root causes of rural-urban disparities in CB among informal caregivers is critical to improving caregiver health and maintaining this critical component of the healthcare system.

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“…The state has notable health disparities; compared to Whites, Native Hawaiians, Filipinos, and other Pacific Islanders are diagnosed with diabetes at earlier ages, have higher rates of hospitalizations for preventable chronic conditions and shorter longevity [19,21,22]. While Hawai'i's official poverty rate is very low, when cost-ofliving is factored in, in 2017 Hawai'i had the 10th highest poverty rate of all states, [23] and rural populations and lower income communities in the state have similar poor outcomes [19,24]. Unlike many other US locations, Hawai'i has one centralized Department of Health (DOH) with satellite district health offices, and one state school district with 15 complex areas.…”

Section: Hawai'i Contextmentioning

confidence: 99%

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

et al. 2020

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Background: The Healthy Hawai'i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. Methods: From interviews with key informants, we analyze two decades of the Healthy Hawai'i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. Results: The Healthy Hawai'i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making "the healthy choice the easiest choice." Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. Conclusions: This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

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Examining Variation in Life Expectancy Estimates by ZIP Code Tabulation Area (ZCTA) in Hawaii’s Four Main Counties, 2008–2012

Cited by 8 publications

References 3 publications

COVID-19 Hospitalization in Hawaiʻi and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination

COVID-19 Hospitalization in Hawaiʻi and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination

Rural-Urban Differences in Caregiver Burden Due to the COVID-19 Pandemic among a National Sample of Informal Caregivers

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

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