Poverty and Health in Tennessee

Beatty, Kate E.; Egen, Olivia; Dreyzehner, John; Wykoff, Randy

doi:10.14423/smj.0000000000001055

Cited by 9 publications

(11 citation statements)

References 10 publications

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“…A study published in 2019 demonstrated that in the state of Tennessee, lower income is associated with significantly worse health outcomes and life expectancy, reinforcing the importance of identifying and addressing specific social determinants of health. 15 The same study also found that Tennessee was identified as one of five states among the 2% of wealthiest and poorest counties in the United States, meaning that it is one of the most diverse states as to economic differences between counties, with three counties among the poorest and one among the wealthiest in the United States. 15 We sought to determine if the distance traveled by patients, or the average median household income (MHI) of patients impacted the rates of reconstruction in our rural patient population.…”

Section: Discussionmentioning

confidence: 89%

“… 15 The same study also found that Tennessee was identified as one of five states among the 2% of wealthiest and poorest counties in the United States, meaning that it is one of the most diverse states as to economic differences between counties, with three counties among the poorest and one among the wealthiest in the United States. 15 We sought to determine if the distance traveled by patients, or the average median household income (MHI) of patients impacted the rates of reconstruction in our rural patient population.…”

Section: Discussionmentioning

confidence: 89%

“…This includes some of the counties with the lowest median household incomes and health disparities in Tennessee. 15 We offer comprehensive breast cancer management, including surgical oncology and breast surgery, plastic surgery services, medical oncology, and radiation oncology services with a multidisciplinary tumor board for individualized patient care with survivorship support. The plastic surgery faculty includes microsurgery fellowship-trained surgeons, and the center offers all autologous and allogenic breast reconstruction options.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Travel Distance and Income on Breast Reconstruction after Mastectomy in a Rural Population

Clegg

Salomon

Porter

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Factors that influence breast reconstruction after mastectomy have been previously examined in national databases. The purpose of this study was to determine the impact of patient travel distance and income on breast reconstruction after mastectomy in a rural population. Methods: Retrospective review of mastectomy patients from 2017 to 2021 was performed from our prospectively enrolled tumor registry. Analysis included frequencies and percentages, descriptive statistics, χ 2 analysis, independent sample t tests, and multivariable analysis. Results: In total, 462 patients were included. Median BMI was 27.6 kg/m 2 , 96.1% of patients were White, and median age at diagnosis was 60.0 years. Reconstruction rate was 52.6%, and median length of follow-up was 24.6 months. No significant difference was found in the distance traveled by patients who underwent reconstruction (16.6 versus 16.7 miles; P = 0.94). Rates of reconstruction in patients who traveled 0–10 miles, 11–30 miles, and over 30 miles did not differ significantly ( P = 0.16). Median household income was significantly different in reconstructed and nonreconstructed patients ($55,316.00 versus $51,629.00; P = 0.047). Rates of reconstruction were significantly higher in patients with median household income greater than $65,000 ( P = 0.024). This difference was not significant on multivariable analysis. Conclusions: Travel distance did not significantly impact reconstruction rates after mastectomy, while household income did on univariable analysis. Studies at an institutional or regional level remain valuable, especially in populations that may not be accurately represented in larger database studies. Our findings highlight the importance of patient education, resource allocation, and multidisciplinary approach to breast cancer care, especially in the rural setting.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Travel Distance and Income on Breast Reconstruction after Mastectomy in a Rural Population

Clegg

Salomon

Porter

et al. 2023

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

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“…36 This is a major problem, particularly for individuals living in southern US states such as Tennessee, where mental health disparities are well documented. 25 Southern states represent a major disparity because of the lack of access to healthcare services, higher poverty rates, and poorer overall health. [37][38][39] Our findings demonstrated a significantly higher association for individuals unable to see a doctor because of the cost and ≥ 20 past-month mentally unhealthy days.…”

Section: Discussionmentioning

confidence: 99%

“…Prior research has demonstrated that almost half of the patients with mental health disorders, who needed mental services, did not seek help because of cost and lack of health insurance 36 . This is a major problem, particularly for individuals living in southern US states such as Tennessee, where mental health disparities are well documented 25 . Southern states represent a major disparity because of the lack of access to healthcare services, higher poverty rates, and poorer overall health 37–39 …”

Section: Discussionmentioning

confidence: 99%

Association between Financial Barriers to Healthcare Access and Mental Health Outcomes in Tennessee

Ahuja

Cimilluca

Stamey

et al. 2023

Southern Medical Journal

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Objectives: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. Methods:We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables.Results: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001).Conclusions: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.

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Individual-Level Exposure to Residential Redlining in 1940 and Mortality Risk

Linde,

Egede

2024

JAMA Intern Med

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ImportanceHistoric redlining, the practice by the Home Owners’ Loan Corporation (HOLC) of systematically denying credit to borrowers in neighborhoods that were inhabited by primarily African American individuals, has been associated with poor community outcomes, but the association with individual risk of death is not clear.ObjectiveTo examine if exposure to residential redlining practices by HOLC in 1940 is associated with increased risk of death later in life.Design, Setting, and ParticipantsThe study linked individuals who resided within HOLC-graded neighborhoods (defined as Census Enumeration Districts) in 1940 with administrative death records data. The study estimated hazard ratios as well as age-specific life expectancy gaps (at age 55, 65, and 75 years) for HOLC grading exposure. This was done using methods that adapted standard parametric survival analysis to data with limited mortality coverage windows and incomplete observations of survivors. The analysis sample consisted of 961 719 individual-level observations across 13 912 enumeration districts within 30 of the largest US cities (based on 1940 population counts) across 23 states. Data were analyzed between December 1, 2023, and September 4, 2024.Main Outcome and MeasuresThe exposure was HOLC grade based on historic HOLC maps, with A representing “best” or creditworthy areas; B, “still desirable”; C, “definitely declining”; and D, “hazardous” areas not worthy of credit (ie, redlined), and the main outcome was age at death from the Social Security Numident file.ResultsThe 961 719-person individual sample had a mean (SD) age of 19.26 (9.26) years in 1940 and a mean (SD) age at death of 76.83 (9.22) years. In a model adjusted for sex (52.48% female; 47.52% male), race and ethnicity (7.36% African American; 92.64% White), and latent place effects, a 1-unit lower HOLC grade was associated with an 8% (hazard ratio, 1.08 [95% CI, 1.07-1.09]) increased risk of death. At age 65 years, these hazard differentials translated into an estimated life expectancy gap of −0.49 (95% CI, −0.56 to −0.43) years for each 1-unit decrease of the HOLC grade.ConclusionThis study found that individuals who resided within redlined neighborhoods in 1940 had lower life expectancy later in life than individuals who resided within other HOLC-graded areas.

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Poverty and Health in Tennessee

Cited by 9 publications

References 10 publications

The Impact of Travel Distance and Income on Breast Reconstruction after Mastectomy in a Rural Population

The Impact of Travel Distance and Income on Breast Reconstruction after Mastectomy in a Rural Population

Association between Financial Barriers to Healthcare Access and Mental Health Outcomes in Tennessee

Individual-Level Exposure to Residential Redlining in 1940 and Mortality Risk

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