Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Pleis JR [original query] |
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Reduced Access to Preventive Care Due to the COVID-19 Pandemic, by Chronic Disease Status and Race and Hispanic Origin, United States, 2020-2021.
Irimata KE , Pleis JR , Heslin KC , He Y . Public Health Rep 2022 138 (2) 333549221138855 OBJECTIVES: The COVID-19 pandemic has disproportionately affected racial and ethnic minority populations in the United States. The National Center for Health Statistics adapted the Research and Development Survey (RANDS), a commercial panel survey, to track selected health outcomes during the pandemic using the series RANDS during COVID-19 (RC-19). We examined access to preventive care among adults by chronic condition status, race, and Hispanic origin. METHODS: NORC at the University of Chicago conducted RC-19 among US adults in 3 rounds (June-July 2020 [round 1, N = 6800], August 2020 [round 2, N = 5981], and May-June 2021 [round 3, N = 5458]) via online survey and telephone. We evaluated reduced access to ≥1 type of preventive care due to the pandemic in the past 2 months for each round by using logistic regression analysis stratified by chronic condition status and race and Hispanic origin, adjusting for sociodemographic and health variables. RESULTS: Overall, 35.8% of US adults reported missing ≥1 type of preventive care in the previous 2 months in round 1, 26.0% in round 2, and 11.2% in round 3. Reduced access to preventive care was significantly higher among adults with ≥1 chronic condition (vs no chronic conditions) in rounds 1 and 2 (adjusted odds ratios [aOR)] = 1.5 and 1.4, respectively). Compared with non-Hispanic White adults, non-Hispanic Black adults reported significantly lower reduced access to preventive care in round 1 (aOR = 0.7), and non-Hispanic Other adults reported significantly higher reduced access to preventive care in round 2 (aOR = 1.5). CONCLUSIONS: Our findings may inform policies and programs for people at risk of reduced access to preventive care. |
Social determinants of health and race disparities in kidney transplant
Wesselman H , Ford CG , Leyva Y , Li X , Chang CH , Dew MA , Kendall K , Croswell E , Pleis JR , Ng YH , Unruh ML , Shapiro R , Myaskovsky L . Clin J Am Soc Nephrol 2021 16 (2) 262-274 BACKGROUND AND OBJECTIVES: Black patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Via medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010-2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome. RESULTS: Even after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant. CONCLUSIONS: Race and social determinants of health are associated with the likelihood of undergoing kidney transplant. |
Does racial disparity in kidney transplant waitlisting persist after accounting for social determinants of health
Ng YH , Pankratz VS , Leyva Y , Ford CG , Pleis JR , Kendall K , Croswell E , Dew MA , Shapiro R , Switzer GE , Unruh ML , Myaskovsky L . Transplantation 2020 104 (7) 1445-1455 BACKGROUND: African Americans (AA) have lower rates of kidney transplantation (KT) compared with Whites (WH), even after adjusting for demographic and medical factors. In this study, we examined whether the racial disparity in KT waitlisting persists after adjusting for social determinants of health (eg, cultural, psychosocial, and knowledge). METHODS: We prospectively followed a cohort of 1055 patients who were evaluated for KT between 3 of 10 to 10 of 12 and followed through 8 of 18. Participants completed a semistructured telephone interview shortly after their first KT evaluation appointment. We used the Wilcoxon rank-sum and Pearson chi-square tests to examine race differences in the baseline characteristics. We then assessed racial differences in the probability of waitlisting while accounting for all predictors using cumulative incidence curves and Fine and Gray proportional subdistribution hazards models. RESULTS: There were significant differences in the baseline characteristics between non-Hispanic AA and non-Hispanic WH. AA were 25% less likely (95% confidence interval, 0.60-0.96) to be waitlisted than WH even after adjusting for medical factors and social determinants of health. In addition, being older, having lower income, public insurance, more comorbidities, and being on dialysis decreased the probability of waitlisting while having more social support and transplant knowledge increased the probability of waitlisting. CONCLUSIONS: Racial disparity in kidney transplant waitlisting persisted even after adjusting for medical factors and social determinants of health, suggesting the need to identify novel factors that impact racial disparity in transplant waitlisting. Developing interventions targeting cultural and psychosocial factors may enhance equity in access to transplantation. |
Unexpected race and ethnicity differences in the US National Veterans Affairs Kidney Transplant Program
Myaskovsky L , Kendall K , Li X , Chang CH , Pleis JR , Croswell E , Ford CG , Switzer GE , Langone A , Mittal-Henkle A , Saha S , Thomas CP , Adams Flohr J , Ramkumar M , Dew MA . Transplantation 2019 103 (12) 2701-2714 BACKGROUND: Racial/ethnic minorities have lower rates of deceased kidney transplantation (DDKT) and living donor kidney transplantation (LDKT) in the United States. We examined whether social determinants of health (eg, demographics, cultural, psychosocial, knowledge factors) could account for differences in the Veterans Affairs (VA) Kidney Transplantation (KT) Program. METHODS: We conducted a multicenter longitudinal cohort study of 611 Veterans undergoing evaluation for KT at all National VA KT Centers (2010-2012) using an interview after KT evaluation and tracking participants via medical records through 2017. RESULTS: Hispanics were more likely to get any KT (subdistribution hazard ratios [SHR] [95% confidence interval (CI)]: 1.8 [1.2-2.8]) or DDKT (SHR [95% CI]: 2.0 [1.3-3.2]) than non-Hispanic white in univariable analysis. Social determinants of health, including marital status (SHR [95% CI]: 0.6 [0.4-0.9]), religious objection to LDKT (SHR [95% CI]: 0.6 [0.4-1.0]), and donor preference (SHR [95% CI]: 2.5 [1.2-5.1]), accounted for some racial differences, and changes to Kidney Allocation System policy (SHR [95% CI]: 0.3 [0.2-0.5]) mitigated race differences in DDKT in multivariable analysis. For LDKT, non-Hispanic African American Veterans were less likely to receive an LDKT than non-Hispanic white (SHR [95% CI]: 0.2 [0.0-0.7]), but accounting for age (SHR [95% CI]: 1.0 [0.9-1.0]), insurance (SHR [95% CI]: 5.9 [1.1-33.7]), presenting with a living donor (SHR [95% CI]: 4.1 [1.4-12.3]), dialysis duration (SHR [95% CI]: 0.3 [0.2-0.6]), network of potential donors (SHR [95% CI]: 1.0 [1.0-1.1]), self-esteem (SHR [95% CI]: 0.4 [0.2-0.8]), transplant knowledge (SHR [95% CI]: 1.3 [1.0-1.7]), and changes to Kidney Allocation System policy (SHR [95% CI]: 10.3 [2.5-42.1]) in multivariable analysis eliminated those disparities. CONCLUSIONS: The VA KT Program does not exhibit the same pattern of disparities in KT receipt as non-VA centers. Transplant centers can use identified risk factors to target patients who may need more support to ensure they receive a transplant. |
Characteristics of dual drug benefit use among veterans with dementia enrolled in the Veterans Health Administration and Medicare Part D
Schleiden LJ , Thorpe CT , Cashy JP , Gellad WF , Good CB , Hanlon JT , Mor MK , Niznik JD , Pleis JR , Van Houtven CH , Thorpe JM . Res Social Adm Pharm 2018 15 (6) 701-709 BACKGROUND: Obtaining prescription medications from multiple health systems may complicate coordination of care. Older Veterans who obtain medications concurrently through Veterans Affairs (VA) benefits and Medicare Part D benefits (dual users) are at higher risk of unintended negative outcomes. OBJECTIVE: To explore characteristics predicting dual drug benefit use from both VA and Medicare Part D in a national sample of older Veterans with dementia. METHODS: Administrative data were obtained from the VA and Medicare for a national sample of 110,828 Veterans with dementia ages 68 and older in 2010. Veterans were classified into three drug benefit user groups based on the source of all prescription medications they obtained in 2010: VA-only, Part D-only, and Dual Use. Multinomial logistic regression was used to examine predictors of drug benefit user group. The source of prescriptions was described for each of the ten most frequently used drug classes and opioids. RESULTS: Fifty-six percent of Veterans received all of their prescription medications from VA-only, 28% from Part D-only, and 16% from both VA and Part D. Veterans who were eligible for Medicaid or who had a priority group score conferring less generous drug benefits within the VA were more likely to be Part D-only or dual users. Nearly one fourth of Veterans taking opioids concurrently received opioid prescriptions from dual sources (24.7%). CONCLUSIONS: Medicaid eligibility and Veteran priority group status, which largely decrease copayments for drugs obtained outside versus within the VA, respectively, were the main factors predicting drug user benefit group. Policies to encourage single-system prescribing and enhance communication across health systems are crucial to preventing negative health outcomes related to care fragmentation. |
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