Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017

Zimmerman, Frederick J.; Anderson, Nathaniel

doi:10.1001/jamanetworkopen.2019.6386

Cited by 127 publications

(127 citation statements)

References 30 publications

(48 reference statements)

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“…The COVID-19 pandemic has highlighted significant health disparities in the United States, similar to the pre-existing health inequities driven by income inequality and racial injustice that existed in the country 32 . Understanding the role of behavioral interventions in driving variation in COVID-19 burden is crucial to our current and future outbreak response.…”

Section: Discussionmentioning

confidence: 99%

Socio-economic disparities in social distancing during the COVID-19 pandemic in the United States

Garnier

Benetka²,

Kraemer

et al. 2020

Preprint

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ImportanceEliminating disparities in the burden of COVID-19 requires equitable access to control measures across socio-economic groups. Limited research on socio-economic differences in mobility hampers our ability to understand whether inequalities in social distancing are occurring during the SARS-CoV-2 pandemic.ObjectiveTo assess how mobility patterns have varied across the United States during the COVID-19 pandemic, and identify associations with socio-economic factors of populations.Design, Setting, and ParticipantsWe used anonymized mobility data from tens of millions of devices to measure the speed and depth of social distancing at the county level between February and May 2020. Using linear mixed models, we assessed the associations between social distancing and socio-economic variables, including the proportion of people below the poverty level, the proportion of Black people, the proportion of essential workers, and the population density.Main outcomes and ResultsWe find that the speed, depth, and duration of social distancing in the United States is heterogeneous. We particularly show that social distancing is slower and less intense in counties with higher proportions of people below the poverty level and essential workers; and in contrast, that social distancing is intense in counties with higher population densities and larger Black populations.Conclusions and relevanceSocio-economic inequalities appear to be associated with the levels of adoption of social distancing, potentially resulting in wide-ranging differences in the impact of COVID-19 in communities across the United States. This is likely to amplify existing health disparities, and needs to be addressed to ensure the success of ongoing pandemic mitigation efforts.

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Section: Discussionmentioning

confidence: 99%

Socio-economic disparities in social distancing during the COVID-19 pandemic in the United States

Garnier

Benetka²,

Kraemer

et al. 2020

Preprint

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“…Self-management (e.g., medication adherence, physical activity, maintaining a healthy diet, and self-monitoring of blood glucose) optimizes glycemic control, which can prevent complications associated with diabetes [2]. However, marked disparities persist in diabetes prevalence, self-management, and outcomes [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…However, knowledge on efficacy and acceptance of these interventions among disadvantaged and vulnerable PWD is limited [30-32, 34, 35], but must be studied rigorously to avoid generating or widening disparities [36]. In the USA, the "digital divide" between racial/ ethnic minorities has narrowed somewhat in recent years [37,38], but socioeconomic Included studies were (1) published as original research articles (excluding review articles and meta-analyses), (2) written in the English language, (3) sampled people with T2D defined as ≥ 50% of the sample (excluding those with samples ≥ 50% having type 1 diabetes, gestational diabetes, or prediabetes), (4) employed a randomized control trial (RCT), non-randomized quasi-experimental design, or a one-arm prepost design, (5) included hemoglobin A1c (A1c) as an outcome, and (6) sampled people with low SES or racial/ethnic minorities defined as ≥ 50% of the sample, or sampled people from rural areas or LMICs. We extracted key attributes of the study and then performed a narrative synthesis ofthese articles with commentary and recommendations.…”

Section: Introductionmentioning

confidence: 99%

mHealth Interventions for Disadvantaged and Vulnerable People with Type 2 Diabetes

et al. 2019

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Background-Mobileand Internet-delivered (collectively, digital) interventions are widely used by persons with diabetes (PWD) to assist with self-management and improve/maintain glycemic control (hemoglobin A1c [A1c]). However, evidence concerning the acceptance and benefits of such interventions among disadvantaged/vulnerable PWD is still quite limited. Purpose of Review-We reviewed studies published from 2011-April 2019 evaluating the impact of diabetes self-management interventions delivered via mobile device and/or Internet on glycemic control of disadvantaged/vulnerable adults with type 2 diabetes (T2D). Included studies reported ≥ 50% of the sample having a low socioeconomic status and/or being a racial/ethnic minority, or living in a rural setting or low-/middle-income country (LMIC). We identified 21 studies evaluating a digital intervention among disadvantaged/vulnerable PWD. Recent Findings-Although many digital interventions found within-group A1c improvements (16 of 21 studies), only seven of the seventeen studies with a control group found between-group differences in A1c. Three studies found reductions in emergency room (ER) visits and hospitalizations. We synthesize this information, and provide recommendations for increasing access, and improving the design and usability of such interventions. We also discuss the role of human support in digital delivery, issues related to study design, reporting, economic value, and available research in LMICs. Summary-There is evidence suggesting that digital interventions can improve diabetes control, healthcare utilization, and healthcare costs. More research is needed to substantiate these early ✉ Monica E.

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“…Moreover, such interventions are often dependent upon followup services being available. Progress on health equity in the US and other countries must remain a priority to meet the behavioral health follow-up service needs of crisis line users (51).…”

Section: Limitationsmentioning

confidence: 99%

The Effectiveness of Crisis Line Services: A Systematic Review

Hoffberg

Stearns‐Yoder

Brenner

2020

Front. Public Health

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Background: Crisis lines are a standard component of a public health approach to suicide prevention. Clinical aims include reducing individuals' crisis states, psychological distress, and risk of suicide. Efforts may also include enhancing access and facilitating connections to behavioral health care. This review examines models of crisis line services for demonstrated effectiveness.Methods: Literature searches of Medline, EMBASE, PsycINFO, Web of Science, CINAHL, Cochrane Library, and Google Scholar were conducted from January 1, 1990, to May 7, 2018. Experts were contacted, and references were mined for additional studies. Eligible studies provided health-or utilization-related effectiveness outcome(s). Results were graded according to the Oxford Centre for Evidence-Based Medicine and evaluated for risk of bias using the Effective Public Health Practice Project quality assessment tool for quantitative studies.Results: Thirty-three studies yielded effectiveness outcomes. In most cases findings regarding crisis calls vs. other modalities were presented. Evaluation approaches included user-and helper-reported data, silent monitoring, and analyses of administrative records. About half of studies reported immediate proximal outcomes (during the crisis service), and the remaining reported distal outcomes (up to four years post-contact). Most studies were rated at Oxford level four evidence and 80% were assessed at high risk of bias.Conclusions: High quality evidence demonstrating crisis line effectiveness is lacking. Moreover, most approaches to demonstrating impact only measured proximal outcomes. Research should focus on innovative strategies to assess proximal and distal outcomes, with a specific focus on behavioral health treatment engagement and future selfdirected violence.

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Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017

Cited by 127 publications

References 30 publications

Socio-economic disparities in social distancing during the COVID-19 pandemic in the United States

Socio-economic disparities in social distancing during the COVID-19 pandemic in the United States

mHealth Interventions for Disadvantaged and Vulnerable People with Type 2 Diabetes

The Effectiveness of Crisis Line Services: A Systematic Review

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