Reducing Disparities Downstream: Prospects and Challenges

Franks, Peter; Fiscella, Kevin

doi:10.1007/s11606-008-0509-0

Cited by 39 publications

(37 citation statements)

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“…20,21 Although the concept of treating SES-related risk may seem misdirected at fi rst, minimizing the disparity in coronary heart disease will likely require a multipronged approach that addresses both current, remediable, intervening risk factors, eg, behavioral risk factors, health care access, and affordability, in addition to use of pharmacotherapy based on realistic estimates of coronary heart disease risk. 22 Even though our analyses do not address differences in SES-based statin use, 23 the growing availability of low-cost statins may promote diffusion to lower SES groups. 24 It is unknown whether lower treatment thresholds for lower SES persons will reduce growing SES disparities in coronary heart disease.…”

Section: Discussionmentioning

confidence: 99%

Including Socioeconomic Status in Coronary Heart Disease Risk Estimation

Franks

Tancredi²,

Winters³

et al. 2010

The Annals of Family Medicine

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PURPOSE Socioeconomic status (SES) predicts coronary heart disease independently of the Framingham risk-scoring factors included in cholesterol treatment guidelines, possibly resulting in undertreatment of lower SES persons. We examined whether hybrid SES measures (based on area measures of income and individual education) address this bias and derived an approach to incorporating SES information into treatment guidelines. METHODSThe Atherosclerosis Risk in Communities study data (initiated in 1987 with a 10-year follow-up of 15,495 adults aged 45 to 64 years in 4 southern and midwestern communities) were used to assess the calibration bias of 4 Cox models predicting 10-year coronary heart disease risk: Framingham risk score alone, and Framingham risk score plus SES using an individual-based measure (income less than 150% federal poverty level or less then 12 years of schooling), and 2 hybrid SES measures substituting area-based income measures (block group or zip code median incomes of less than 25th national percentiles) for the individual income component. Revised cholesterol treatment thresholds based on SES risk were also derived. RESULTSUse of either the block group hybrid or individual-based SES measures eliminated the signifi cant SES bias observed using Framingham risk score alone. Cholesterol treatment guideline thresholds of 10% and 20% coronary heart disease risk (based on the Framingham risk score) were reduced to 6% and 13% for those with low SES.CONCLUSIONS Using patient income based on block group and individual education minimizes the SES bias in Framingham risk scoring and suggests more aggressive cholesterol treatment thresholds for low-SES persons. Ann Fam Med 2010;8:447-453. doi:10.1370/afm.1167. INTRODUCTIONF ramingham risk scoring underestimates coronary heart disease risk for persons of lower socioeconomic status (SES), because SES is an independent risk factor not included in Framingham risk scoring. 1,2 Consequent inappropriately high treatment thresholds for low-SES persons may contribute to worsening SES disparities in coronary heart disease. 3 We have previously found that incorporating an individual-based SES measure (using individual patient education and household income) into coronary heart disease risk assessment mitigates underestimation of coronary heart disease risk among low SES persons determined by the Framingham risk score alone.2 That approach, however, required knowledge of patients' household income and family size, and their conversion into a percentage of the federal poverty level. Clinicians may be reluctant to ask patients about income; patients may be reluctant to disclose the information. In addition, no approach to incorporating SES risk into risk-based cholesterol treatment decision making was provided. Here we explore alternative approaches to assessing SES risk (using the patient's place of residence) and derive an approach to incorporating SES risk into treatment guidelines. SES A ND CORONA RY HE A R T DISE A SE R ISKArea-based SES measures (using t...

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Section: Discussionmentioning

confidence: 99%

Including Socioeconomic Status in Coronary Heart Disease Risk Estimation

Franks

Tancredi²,

Winters³

et al. 2010

The Annals of Family Medicine

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“…Numerous factors including patient preferences, access to care, and health literacy have been suggested to contribute to differential use of services across patient groups [3,13]. Additional research is needed to understand the optimal use of this procedure, to interpret and account for patient preferences, and to eliminate undesirable sociodemographic disparities in the use of autologous blood for orthopaedic surgery.…”

Section: Discussionmentioning

confidence: 99%

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

Menendez

Ring

2014

Clinical Orthopaedics &Amp; Related Research

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Background Surgeons commonly arrange for patients to perform autologous blood donation before elective orthopaedic surgery. Understanding sociodemographic patterns of use of autologous blood transfusion can help improve quality of care and cost containment. Questions/purposes We sought to determine whether there were (1) racial disparities, (2) insurance-based disparities, or (3) income-based disparities in autologous blood use. Additionally, we evaluated the combined effect of (4) race and insurance and (5) race and income on autologous blood use, and we compared ratios of autologous with allogeneic blood use.

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“…These emerging findings regarding the role of vitamin D in cardiovascular disparities have important implications for addressing racial disparities in cardiovascular morbidity and mortality using a simple downstream intervention. 60 They suggest the possibility of partially mitigating these disparities through oral supplementation with sufficient doses. 61 Thus, there is an urgent need for randomized controlled trials conducted across a range of ages and using various outcomes to rigorously test the hypothesis that vitamin D represents an important contributor to racial disparities in hypertension and cardiovascular conditions.…”

Section: Discussionmentioning

confidence: 99%