Increasing Equity While Improving the Quality of Care

Schneider, Eric C.; Chin, Marshall H.; Graham, Garth; López, Lenny; Obuobi, Shirlene; Sequist, Thomas D.; McGlynn, Elizabeth A.

doi:10.1016/j.jacc.2021.06.057

Cited by 9 publications

(5 citation statements)

References 44 publications

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“…82 Taking this all into consideration, it is clear that interventions and programs focused on improving healthcare quality and safety should address the drivers of disparities in health outcomes both within and outside healthcare systems to make these programs more effective. 83 Our results demonstrate an important role of neighborhood and built environment in the prediction of MACE, especially in NHB females. Historically, places with a large Black population were segregated as a result of social divestment in local infrastructure, perpetuating a disadvantage for this population.…”

Section: Discussionmentioning

confidence: 57%

Social Determinants of Health and Racial Disparities in Cardiac Events in Breast Cancer

Stabellini

Dmukauskas

Bittencourt

et al. 2023

Journal of the National Comprehensive Cancer Network

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Background: Racial disparities have been reported for breast cancer and cardiovascular disease (CVD) outcomes. The determinants of racial disparities in CVD outcomes are not yet fully understood. We aimed to examine the impact of individual and neighborhood-level social determinants of health (SDOH) on the racial disparities in major adverse cardiovascular events (MACE; consisting of heart failure, acute coronary syndrome, atrial fibrillation, and ischemic stroke) among female patients with breast cancer. Methods: This 10-year longitudinal retrospective study was based on a cancer informatics platform with electronic medical record supplementation. We included women aged ≥18 years diagnosed with breast cancer. SDOH were obtained from LexisNexis, and consisted of the domains of social and community context, neighborhood and built environment, education access and quality, and economic stability. Race-agnostic (overall data with race as a feature) and race-specific machine learning models were developed to account for and rank the SDOH impact in 2-year MACE. Results: We included 4,309 patients (765 non-Hispanic Black [NHB]; 3,321 non-Hispanic white). In the race-agnostic model (C-index, 0.79; 95% CI, 0.78–0.80), the 5 most important adverse SDOH variables were neighborhood median household income (SHapley Additive exPlanations [SHAP] score [SS], 0.07), neighborhood crime index (SS = 0.06), number of transportation properties in the household (SS = 0.05), neighborhood burglary index (SS = 0.04), and neighborhood median home values (SS = 0.03). Race was not significantly associated with MACE when adverse SDOH were included as covariates (adjusted subdistribution hazard ratio, 1.22; 95% CI, 0.91–1.64). NHB patients were more likely to have unfavorable SDOH conditions for 8 of the 10 most important SDOH variables for the MACE prediction. Conclusions: Neighborhood and built environment variables are the most important SDOH predictors for 2-year MACE, and NHB patients were more likely to have unfavorable SDOH conditions. This finding reinforces that race is a social construct.

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Section: Discussionmentioning

confidence: 57%

Social Determinants of Health and Racial Disparities in Cardiac Events in Breast Cancer

Stabellini

Dmukauskas

Bittencourt

et al. 2023

Journal of the National Comprehensive Cancer Network

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“…These factors may include socioeconomic status, education, access to care and resources, mistrust in the medical system, or implicit biases among healthcare providers. 12 For example, in 2020, 17% of Hispanic and 19.5% of African American persons were living at or below the poverty line, compared to 8.2% of White individuals. 13 Lower household income in the United States is associated with a higher prevalence of comorbid conditions, and according to data from the 2020 Commonwealth Fund International Health Policy Survey, lower-income Americans are also more likely to miss doctor’s appointments, forgo necessary testing and treatment, or choose not to fill prescription medications owing to cost.…”

Section: Discussionmentioning

confidence: 99%

The association of racial differences with in-hospital outcomes of patients admitted for sinus node dysfunction

et al. 2022

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“…There is an urgent need to drastically redesign the delivery of healthcare to ensure equity for all. 34…”

Section: Social Determinants Of Cardiovascular Healthmentioning

confidence: 99%

Lifestyle Medicine: An Antidote to Cardiovascular Diseases

Reddy

Freeman

2022

American Journal of Lifestyle Medicine

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Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn’t been much decline in heart disease related morality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals’ focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3–10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.

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Increasing Equity While Improving the Quality of Care

Cited by 9 publications

References 44 publications

Social Determinants of Health and Racial Disparities in Cardiac Events in Breast Cancer

Social Determinants of Health and Racial Disparities in Cardiac Events in Breast Cancer

The association of racial differences with in-hospital outcomes of patients admitted for sinus node dysfunction

Lifestyle Medicine: An Antidote to Cardiovascular Diseases

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