Healthcare disparities in trauma: why they exist and what we can do

Bradley, A. Steven; Adeleke, Ibukun O; Estime, Stephen

doi:10.1097/aco.0000000000001094

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…Some previously described strategies to address implicit bias among clinicians in the healthcare system include implicit bias training, increasing diversity among healthcare workers, and partnering with community advocates. 44,45,[53][54][55][56][57] Clearly, effort is needed to routinely incorporate these strategies as a means to address the multi-tiered effects of SDOH.…”

Section: Discussionmentioning

confidence: 99%

“…Implicit bias is the subconscious stereotype or attitude that consequentially affects behavior and actions, which can contribute to healthcare disparities. 44, 45 The concept of SDOH contributing to implicit bias with a subsequent effect on care provision is not new. 16, 46, 47 However, this is one of the first studies to suggest that low income can contribute to implicit bias.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure

Zhang

Onyebeke

Nahid

et al. 2023

Preprint

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Background: The involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced mortality and readmission rates. However, not all patients see a cardiologist when hospitalized for HF. Since reasons remain unclear, we sought to determine whether social determinants of health (SDOH) are associated with cardiologist involvement. Methods: We included adult participants from the national REasons for Geographic And Racial Difference in Stroke (REGARDS) cohort, who experienced an adjudicated hospitalization for HF from 2009-2017. We excluded participants who were hospitalized at institutions that lacked cardiology services (n=246). We examined nine candidate SDOH: Black race, social isolation, social network, educational attainment, annual household income, living in rural areas, living in a zip code with high poverty, living in a Health Professional Shortage Area, and residing in a state with poor public health infrastructure. The primary outcome was cardiologist involvement. We examined associations between each SDOH and cardiologist involvement using Poisson regression with robust standard errors. Candidate SDOH with significant associations were retained for multivariable analysis. Covariates included age, race, sex, HF characteristics, comorbidities, and hospital characteristics. Results: We examined 876 participants hospitalized at 549 unique US hospitals. The median age was 77.5 years, 45.9% were female, 41.4% were Black, and 56.2% had low income. Low household income (<$35,000/year) was the only SDOH significantly associated with cardiologist involvement. After adjusting for potential confounders, low income remained inversely associated (RR: 0.89 [95% CI: 0.82-0.97]). Conclusions: Adults with low household income were 11% less likely to have a cardiologist involved in their care during a hospitalization for HF. This suggests that socioeconomic status may implicitly bias their care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure

Zhang

Onyebeke

Nahid

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…This raises concern that our observation could relate to implicit or even explicit bias. Implicit bias is the subconscious stereotype or attitude that consequentially affects behavior and actions, which can contribute to health care disparities . The concept of SDOH contributing to implicit bias with a subsequent effect on care provision is not new .…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, it is critical that efforts intended to increase elicitation and documentation of SDOH be paired with strategies to address implicit bias from the health care system. Some previously described strategies to address implicit bias among clinicians in the health care system include implicit bias training, increasing diversity among health care workers, and partnering with community advocates . Clearly, effort is needed to routinely incorporate these strategies as a means to address the multitiered effects of SDOH.…”

Section: Discussionmentioning

confidence: 99%

Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure

Zhang,

Onyebeke,

Nahid

et al. 2023

JAMA Netw Open

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ImportanceInvolvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF.ObjectiveTo determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF.Design, Setting, and ParticipantsThis retrospective cohort study used data from the Reasons for Geographic and Racial Difference in Stroke (REGARDS) cohort. Participants included adults who experienced an adjudicated hospitalization for HF between 2009 and 2017 in all 48 contiguous states in the US. Data analysis was performed from November 2022 to January 2023.ExposuresA total of 9 candidate SDOH, aligned with the Healthy People 2030 conceptual model, were examined: Black race, social isolation, social network and/or caregiver availability, educational attainment less than high school, annual household income less than $35 000, living in rural area, living in a zip code with high poverty, living in a Health Professional Shortage Area, and living in a state with poor public health infrastructure.Main Outcomes and MeasuresThe primary outcome was cardiologist involvement, defined as involvement of a cardiologist as the primary responsible clinician or as a consultant. Bivariate associations between each SDOH and cardiologist involvement were examined using Poisson regression with robust SEs.ResultsThe study included 1000 participants (median [IQR] age, 77.8 [71.5-84.0] years; 479 women [47.9%]; 414 Black individuals [41.4%]; and 492 of 876 with low income [56.2%]) hospitalized at 549 unique US hospitals. Low annual household income (&lt;$35 000) was the only SDOH with a statistically significant association with cardiologist involvement (relative risk, 0.88; 95% CI, 0.82-0.95). In a multivariable analysis adjusting for age, race, sex, HF characteristics, comorbidities, and hospital characteristics, low income remained inversely associated with cardiologist involvement (relative risk, 0.89; 95% CI, 0.82-0.97).Conclusions and RelevanceThis cohort study found that adults with low household income were 11% less likely than adults with higher incomes to have a cardiologist involved in their care during a hospitalization for HF. These findings suggest that socioeconomic status may bias the care provided to patients hospitalized for HF.

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“…In addition, the distribution of types of traumatic injuries is associated with several of these determinants. Ethnicity, type of insurance, and socioeconomic status are correlated with worse outcomes for patients receiving trauma care 30 . In nonresuscitative contexts, disadvantaged patients are less likely to receive regional analgesia, 31 less likely to receive outpatient rehab, 32 and more likely to suffer greater mortality and morbidity.…”

Section: Autonomymentioning

confidence: 99%