Take Care
Road Crash Fatalities on US Income Tax Days
Donald Redelmeier & Christopher Yarnell
Journal of the American Medical Association, 11 April 2012, Pages 1486-1488
"We retrieved tax deadline data from the Internal Revenue Service and fatal road crash data from the National Highway Traffic Safety Administration for the past 3 decades (1980-2009). We used the Fatality Analysis Reporting System, a validated database that included all crashes involving a motor vehicle on public roadways in which at least 1 person died within 30 days (including passengers, pedestrians, or other involved individuals). For each tax day, we identified controls as the day 1 week before and 1 week after to evaluate the number of individuals involved in a fatal road crash. This design controlled for year, month, and weekday as well as minimized bias from differences in vehicle technology, gasoline prices, health care access, driver training, and other confounders...Comparisons of tax days with control days yielded an odds ratio of 1.06 (95% CI, 1.03-1.10; P<.001), equivalent to an absolute increase of 404 individuals in fatal road crashes on tax days over the study interval or about 13 individuals during the average tax day. The relative increase in risk was most apparent during the last 20 years and in adults younger than 65 years. The increase in risk persisted for different regions, locations, hours, sexes, initial outcomes, and extended to passengers and pedestrians...Tax days are associated with an increase in fatal crash risk, which is similar in magnitude to the increase in crashes on Super Bowl Sunday."
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Race/Ethnicity and All-Cause Mortality in US Adults: Revisiting the Hispanic Paradox
Luisa Borrell & Elizabeth Lancet
American Journal of Public Health, May 2012, Pages 836-843
Objectives: We examined the association between race/ethnicity and all-cause mortality risk in US adults and whether this association differs by nativity status.
Methods: We used Cox proportional hazards regression to estimate all-cause mortality rates in 1997 through 2004 National Health Interview Survey respondents, relating the risk for Hispanic subgroup, non-Hispanic Black, and other non-Hispanic to non-Hispanic White adults before and after controlling for selected characteristics stratified by age and gender.
Results: We observed a Hispanic mortality advantage over non-Hispanic Whites among women that depended on nativity status: US-born Mexican Americans aged 25 to 44 years had a 90% (95% confidence interval [CI] = 0.03, 0.31) lower death rate; island- or foreign-born Cubans and other Hispanics aged 45 to 64 years were more than two times less likely to die than were their non-Hispanic White counterparts. Island- or foreign-born Puerto Rican and US-born Mexican American women aged 65 years and older exhibited at least a 25% lower rate of dying than did their non-Hispanics White counterparts.
Conclusions: The "Hispanic paradox" may not be a static process and may change with this population growth and its increasing diversity over time.
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Survival Differences among Native-Born and Foreign-Born Older Adults in the United States
Matthew Dupre, Danan Gu & James Vaupel
PLoS ONE, May 2012
Background: Studies show that the U.S. foreign-born population has lower mortality than the native-born population before age 65. Until recently, the lack of data prohibited reliable comparisons of U.S. mortality by nativity at older ages. This study provides reliable estimates of U.S. foreign-born and native-born mortality at ages 65 and older at the end of the 20th century. Life expectancies of the U.S. foreign born are compared to other developed nations and the foreign-born contribution to total life expectancy (TLE) in the United States is assessed.
Methods: Newly available data from Medicare Part B records linked with Social Security Administration files are used to estimate period life tables for nearly all U.S. adults aged 65 and older in 1995. Age-specific survival differences and life expectancies are examined in 1995 by sex, race, and place of birth.
Results: Foreign-born men and women had lower mortality at almost every age from 65 to 100 compared to native-born men and women. Survival differences by nativity were substantially greater for blacks than whites. Foreign-born blacks had the longest life expectancy of all population groups (18.73 [95% confidence interval {CI}, 18.15-19.30] years at age 65 for men and 22.76 [95% CI, 22.28-23.23] years at age 65 for women). The foreign-born population increased TLE in the United States at older ages, and by international comparison, the U.S. foreign born were among the longest-lived persons in the world.
Conclusion: Survival estimates based on reliable Medicare data confirm that foreign-born adults have longer life expectancy at older ages than native-born adults in the United States.
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Phuong Do, Reanne Frank & Brian Karl Finch
Social Science & Medicine, May 2012, Pages 1385-1393
Abstract:
Studies of racial health gaps often find that disparities persist even after adjusting for socioeconomic status (SES). We contend that the persistent residual variation may, in part, be the result of conceptual and methodological problems in the operationalization of SES. These include inadequate attention to the content validity of SES measures and insufficient adjustments for SES differences across racial groups. Using data from the 1997-2007 U.S. Panel Study of Income Dynamics (N = 9932), we use longitudinal and multi-level measures of SES and apply a propensity score adjustment strategy to examine the black/white disparity in self-rated health. Compared to conventional regression estimates that yield unexplained racial health gaps, propensity score adjustment accounts for the entire racial disparity in self-rated health. Results suggest that previous studies may have inadequately adjusted for differences in SES across racial groups, that social factors should be carefully and conscientiously considered, and that acknowledgment of the possibility of incomplete SES adjustments should be weighed before any inferences to non-SES etiology can be made.
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Racial/Ethnic Disparities in Mortality Risk Among US Veterans With Traumatic Brain Injury
Leonard Egede, Clara Dismuke & Carrae Echols
American Journal of Public Health, May 2012, Pages S266-S271
Objectives: We examined the association of race/ethnicity with mortality risk in a national cohort of US veterans clinically diagnosed with traumatic brain injury.
Methods: Between January 1, 2006 and December 31, 2006, we obtained data from a national cohort study of 7885 non-Hispanic White, 1748 Non-Hispanic Black, 314 Hispanic, and 4743 other or missing race/ethnicity veterans clinically diagnosed with traumatic brain injury in Veterans Affairs medical centers and community-based outpatient clinics.
Results: Overall mortality at 48 months was 6.7% in Hispanic, 2.9% in non-Hispanic White, and 2.7% in non-Hispanic Black veterans. Compared with non-Hispanic White, Hispanic ethnicity was positively associated with a higher mortality risk (hazard ratio [HR] = 2.33; 95% confidence interval [CI] = 1.49, 3.64) in the race/ethnicity-only adjusted model. After adjusting for sociodemographic characteristics and comorbidities, Hispanic ethnicity continued to be positively associated (HR = 1.61; 95% CI = 1.00, 2.58) with a higher mortality risk relative to non-Hispanic White ethnicity.
Conclusions: Hispanic ethnicity is positively associated with higher mortality risk among veterans clinically diagnosed with traumatic brain injury. More research is needed to understand the reasons for this disparity.
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Melissa Parker et al.
Health Services Research, April 2012, Pages 572-593
Objective: To examine ethnic differences in appointment-keeping in a managed care setting.
Data Sources/Study Setting: Kaiser Permanente Diabetes Study of Northern California (DISTANCE), 2005-2007, n = 12,957.
Study Design: Cohort study. Poor appointment-keeping (PAK) was defined as missing >1/3 of planned, primary care appointments. Poisson regression models were used to estimate ethnic-specific relative risks of PAK (adjusting for demographic, socio-economic, health status, and facility effects).
Data Collection/Extraction Methods: Administrative/electronic health records and survey responses.
Principal Findings: Poor appointment-keeping rates differed >2-fold across ethnicities: Latinos (12 percent), African Americans (10 percent), Filipinos (7 percent), Caucasians (6 percent), and Asians (5 percent), but also varied by medical center. Receiving >50 percent of outpatient care via same-day appointments was associated with a 4-fold greater PAK rate. PAK was associated with 20, 30, and 40 percent increased risk of elevated HbA1c (>7 percent), low-density lipoprotein (>100 mm/dl), and systolic blood pressure (>130 mmHg), respectively.
Conclusions: Latinos and African Americans were at highest risk of missing planned primary care appointments. PAK was associated with a greater reliance on same-day visits and substantively poorer clinical outcomes. These results have important implications for public health and health plan policy, as primary care rapidly expands toward open access to care supported by the patient-centered medical home model.
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Geographic and Racial Variation in Premature Mortality in the U.S.: Analyzing the Disparities
Mark Cullen, Clint Cummins & Victor Fuchs
PLoS ONE, April 2012
Abstract:
Life expectancy at birth, estimated from United States period life tables, has been shown to vary systematically and widely by region and race. We use the same tables to estimate the probability of survival from birth to age 70 (S70), a measure of mortality more sensitive to disparities and more reliably calculated for small populations, to describe the variation and identify its sources in greater detail to assess the patterns of this variation. Examination of the unadjusted probability of S70 for each US county with a sufficient population of whites and blacks reveals large geographic differences for each race-sex group. For example, white males born in the ten percent healthiest counties have a 77 percent probability of survival to age 70, but only a 61 percent chance if born in the ten percent least healthy counties. Similar geographical disparities face white women and blacks of each sex. Moreover, within each county, large differences in S70 prevail between blacks and whites, on average 17 percentage points for men and 12 percentage points for women. In linear regressions for each race-sex group, nearly all of the geographic variation is accounted for by a common set of 22 socio-economic and environmental variables, selected for previously suspected impact on mortality; R2 ranges from 0.86 for white males to 0.72 for black females. Analysis of black-white survival chances within each county reveals that the same variables account for most of the race gap in S70 as well. When actual white male values for each explanatory variable are substituted for black in the black male prediction equation to assess the role explanatory variables play in the black-white survival difference, residual black-white differences at the county level shrink markedly to a mean of -2.4% (+/-2.4); for women the mean difference is -3.7% (+/-2.3).
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The racial disparity in breast cancer mortality in the 25 largest cities in the United States
Steven Whitman, Jennifer Orsi & Marc Hurlbert
Cancer Epidemiology, April 2012, Pages e147-e151
Introduction: Although the racial disparity in breast cancer mortality is widely discussed there are no studies that analyze this phenomenon at the city level.
Methods: We used national death files, abstracting those cases for which the cause was malignant neoplasm of the breast (ICD-10 = C50) for the numerators and American Community Survey data for the denominators. The 25 largest cities in the US were the units of analysis. Non-Hispanic Black:non-Hispanic White rate ratios (RRs) were calculated, along with their confidence intervals, as measures of the racial disparity. Seven ecological (city-level) variables were examined as possible correlates.
Results: Almost all the NHB rates were greater than almost all the NHW rates. All but 3 of the RRs (range 0.78-2.09; median = 1.44) were >1, 13 of them significantly so. None of the RRs < 1 were significant. From among the 7 potential correlates, only median household income (r = -0.43, p = 0.037) and a measure of segregation (r = 0.42, r = 0.039) were significantly related to the RR.
Conclusion: This is the first study that we have been able to locate which examines city-level racial disparities in breast cancer mortality. The results are of concern for several cities and for the field in general. A strategy for reducing this disparity in Chicago is in place and may serve as a model for other cities wanting to initiate a similar process. Clearly it is time to take action.
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Carey Maslow et al.
American Journal of Public Health, June 2012, Pages 1186-1194
Objectives: We assessed associations between new-onset (post-September 11, 2001 [9/11]) lower respiratory symptoms reported on 2 surveys, administered 3 years apart, and acute and chronic 9/11-related exposures among New York City World Trade Center-area residents and workers enrolled in the World Trade Center Health Registry.
Methods: World Trade Center-area residents and workers were categorized as case participants or control participants on the basis of lower respiratory symptoms reported in surveys administered 2 to 3 and 5 to 6 years after 9/11. We created composite exposure scales after principal components analyses of detailed exposure histories obtained during face-to-face interviews. We used multivariate logistic regression models to determine associations between lower respiratory symptoms and composite exposure scales.
Results: Both acute and chronic exposures to the events of 9/11 were independently associated, often in a dose-dependent manner, with lower respiratory symptoms among individuals who lived and worked in the area of the World Trade Center.
Conclusions: Study findings argue for detailed assessments of exposure during and after events in the future from which potentially toxic materials may be released and for rapid interventions to minimize exposures and screen for potential adverse health effects.
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State-Level Variations in Racial Disparities in Life Expectancy
Nazleen Bharmal et al.
Health Services Research, February 2012, Pages 544-555
Objective: To explore state patterns in the racial life expectancy gap.
Data Sources: The 1997-2004 Multiple Cause of Death PUF, 2000 U.S. Census.
Study Design: We calculated life expectancy at birth for black and white men and women.
Data Extraction Methods: Data were obtained by the NCHS and U.S. Census Bureau.
Principal Findings: States with small racial differences are due to higher-than-expected life expectancy for blacks or lower-than-expected for whites. States with large disparity are explained by higher-than-average life expectancy among whites or lower-than-average life expectancy among blacks.
Conclusions: Heterogeneous state patterns in racial disparity in life expectancy exist. Eliminating disparity in states with large black populations would make the greatest impact nationally.
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Acute and Chronic Effects of Particles on Hospital Admissions in New-England
Itai Kloog et al.
PLoS ONE, April 2012
Background: Many studies have reported significant associations between exposure to PM2.5 and hospital admissions, but all have focused on the effects of short-term exposure. In addition all these studies have relied on a limited number of PM2.5 monitors in their study regions, which introduces exposure error, and excludes rural and suburban populations from locations in which monitors are not available, reducing generalizability and potentially creating selection bias.
Methods: Using our novel prediction models for exposure combining land use regression with physical measurements (satellite aerosol optical depth) we investigated both the long and short term effects of PM2.5 exposures on hospital admissions across New-England for all residents aged 65 and older. We performed separate Poisson regression analysis for each admission type: all respiratory, cardiovascular disease (CVD), stroke and diabetes. Daily admission counts in each zip code were regressed against long and short-term PM2.5 exposure, temperature, socio-economic data and a spline of time to control for seasonal trends in baseline risk.
Results: We observed associations between both short-term and long-term exposure to PM2.5 and hospitalization for all of the outcomes examined. In example, for respiratory diseases, for every10-µg/m3 increase in short-term PM2.5 exposure there is a 0.70 percent increase in admissions (CI = 0.35 to 0.52) while concurrently for every10-µg/m3 increase in long-term PM2.5 exposure there is a 4.22 percent increase in admissions (CI = 1.06 to 4.75).
Conclusions: As with mortality studies, chronic exposure to particles is associated with substantially larger increases in hospital admissions than acute exposure and both can be detected simultaneously using our exposure models.
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Diverging Racial and Ethnic Disparities in Access to Physician Care: Comparing 2000 and 2007
Elham Mahmoudi & Gail Jensen
Medical Care, April 2012, Pages 327-334
Objective: To examine recent changes in racial and ethnic disparities in access to physician services in the United States, and investigate the economic factors driving the changes observed.
Methods: Using nationally representative data on adults aged 25-64 from the 2000 and 2007 Medical Expenditure Panel Survey, we examine changes in two measures of access: whether the individual reported having a usual source of care, and whether he/she had any doctor visits during the past year. In each year, we calculate disparities in access between African Americans and Whites, and between Hispanics and Whites, applying the Institute of Medicine's definition of a disparity. Nonlinear regression decomposition techniques are then used to quantify how changes in personal characteristics, comparing 2000 and 2007, helped shape the changes observed.
Results: Large disparities in access to physician care were evident for both minority groups in 2000 and 2007. Disparities in no doctor visits during the past year diminished for African Americans, but disparities in both measures worsened sharply for Hispanics.
Conclusions: Disparities in access to physician care are improving for African Americans in one dimension, but eroding for Hispanics in multiple dimensions. The most important contributing factors to the growing disparities between Hispanics and Whites are health insurance, education, and income differences.
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Racial/Ethnic Disparities in Health and Health Care among U.S. Adolescents
May Lau, Hua Lin & Glenn Flores
Health Services Research, forthcoming
Objective: To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents.
Data Source: Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0-17 years old.
Study Design: Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10-17 years old (n = 48,742) to identify disparities in 40 measures of health and health care.
Principal Findings: Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth.
Conclusions: U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.
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Racial differences in physician usage among the elderly poor in the United States
Corey Abramson & Martín Sánchez-Jankowski
Research in Social Stratification and Mobility, June 2012, Pages 203-217
Abstract:
Despite the rapidly growing ranks of the elderly in America, the increasing racial and ethnic diversity of this population, and the large number of seniors who are poor, there are relatively few systematic investigations that examine the causes of racial differences in health care use specifically among elders living in poverty. This article addresses this issue by examining differences in patterns of having and using a physician among the elderly poor, the role that race plays and what might explain it. We demonstrate that even within this disadvantaged and medically engaged population there are persistent and significant racial differences in having and using a doctor. Specifically, we show: (1) Whites and women are more likely to have a regular doctor than men and African Americans; (2) Among those who have a doctor, whites and women also visit the doctor with greater frequency than other groups even at the same levels of health or illness; (3) After accounting for the varying levels and effects of social connectedness, racial differences in having a doctor essentially disappear; and (4) While differences in having a regular doctor can be accounted for using measures of social connectedness, substantial and robust racial and gender differences in doctor use remain. In the end, we provide an analysis that examines typical factors known to influence health care use, and find that while need, structural factors, perceptions of care, and social connectedness have a powerful effect on doctor visits, the racial variation in using a doctor cannot be explained away with the available measures.
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Safety Belt Laws and Disparities in Safety Belt Use Among US High-School Drivers
Felipe García-España, Flaura Winston & Dennis Durbin
American Journal of Public Health, June 2012, Pages 1128-1134
Objectives: We compared reported safety belt use, for both drivers and passengers, among teenagers with learner's permits, provisional licenses, and unrestricted licenses in states with primary or secondary enforcement of safety belt laws.
Methods: Our data source was the 2006 National Young Driver Survey, which included a national representative sample of 3126 high-school drivers. We used multivariate, log-linear regression analyses to assess associations between safety belt laws and belt use.
Results: Teenaged drivers were 12% less likely to wear a safety belt as drivers and 15% less likely to wear one as passengers in states with a secondary safety belt law than in states with a primary law. The apparent reduction in belt use among teenagers as they progressed from learner to unrestricted license holder occurred in only secondary enforcement states. Groups reporting particularly low use included African American drivers, rural residents, academically challenged students, and those driving pickup trucks.
Conclusions: The results provided further evidence for enactment of primary enforcement provisions in safety belt laws because primary laws are associated with higher safety belt use rates and lower crash-related injuries and mortality.
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Malavika Subramanyam et al.
Social Science & Medicine, April 2012, Pages 1146-1154
Abstract:
Subjective social status has been shown to be inversely associated with multiple cardiovascular risk factors, independent of objective social status. However, few studies have examined this association among African Americans and the results have been mixed. Additionally, the influence of discrimination on this relationship has not been explored. Using baseline data (2000-2004) from the Jackson Heart Study, an African American cohort from the U.S. South (N = 5301), we quantified the association of subjective social status with selected cardiovascular risk factors: depressive symptoms, perceived stress, waist circumference, insulin resistance and prevalence of diabetes. We contrasted the strength of the associations of these outcomes with subjective versus objective social status and examined whether perceived discrimination confounded or modified these associations. Subjective social status was measured using two 10-rung "ladders," using the U.S. and the community as referent groups. Objective social status was measured using annual family income and years of schooling completed. Gender-specific multivariable linear and logistic regression models were fit to examine associations. Subjective and objective measures were weakly positively correlated. Independent of objective measures, subjective social status was significantly inversely associated with depressive symptoms (men and women) and insulin resistance (women). The associations of subjective social status with the outcomes were modest and generally similar to the objective measures. We did not find evidence that perceived racial discrimination strongly confounded or modified the association of subjective social status with the outcomes. Subjective social status was related to depressive symptoms but not consistently to stress or metabolic risk factors in African Americans.
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Residential Segregation and the Availability of Primary Care Physicians
Darrell Gaskin et al.
Health Services Research, forthcoming
Objective: To examine the association between residential segregation and geographic access to primary care physicians (PCPs) in metropolitan statistical areas (MSAs).
Data Sources: We combined zip code level data on primary care physicians from the 2006 American Medical Association master file with demographic, socioeconomic, and segregation measures from the 2000 U.S. Census. Our sample consisted of 15,465 zip codes located completely or partially in an MSA.
Methods: We defined PCP shortage areas as those zip codes with no PCP or a population to PCP ratio of >3,500. Using logistic regressions, we estimated the association between a zip code's odds of being a PCP shortage area and its minority composition and degree of segregation in its MSA.
Principal Findings: We found that odds of being a PCP shortage area were 67 percent higher for majority African American zip codes but 27 percent lower for majority Hispanic zip codes. The association varied with the degree of segregation. As the degree of segregation increased, the odds of being a PCP shortage area increased for majority African American zip codes; however, the converse was true for majority Hispanic and Asian zip codes.
Conclusions: Efforts to address PCP shortages should target African American communities especially in segregated MSAs.
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Emergency Department Volume and Racial and Ethnic Differences in Waiting Times in the United States
Nancy Sonnenfeld et al.
Medical Care, April 2012, Pages 335-341
Background: Racial and ethnic differences in emergency department (ED) waiting times have been observed previously.
Objectives: We explored how adjusting for ED attributes, particularly visit volume, affected racial/ethnic differences in waiting time.
Research Design: We constructed linear models using generalized estimating equations with 2007-2008 National Hospital Ambulatory Medical Care Survey data.
Subjects: We analyzed data from 54,819 visits to 431 US EDs.
Measures: Our dependent variable was waiting time, measured from arrival to time seen by physician, and was log transformed because it was skewed. Primary independent variables were individual race/ethnicity (Hispanic and non-Hispanic white, black, other) and ED race/ethnicity composition (covariates for percentages of Hispanics, blacks, and others). Covariates included patient age, triage assessment, arrival by ambulance, payment source, volume, region, and teaching hospital.
Results: Geometric mean waiting times were 27.3, 37.7, and 32.7 minutes for visits by white, black, and Hispanic patients. Patients waited significantly longer at EDs serving higher percentages of black patients; per 25 point increase in percent black patients served, waiting times increased by 23% (unadjusted) and 13% (adjusted). Within EDs, black patients waited 9% (unadjusted) and 4% (adjusted) longer than whites. The ED attribute most strongly associated with waiting times was visit volume. Waiting times were about half as long at low-volume compared with high-volume EDs (P<0.001). For Hispanic patients, differences were smaller and less robust to model choice.
Conclusions: Non-Hispanic black patients wait longer for ED care than whites primarily because of where they receive that care. ED volume may explain some across-ED differences.
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Erin Mayfield & Catherine Shelley Norman
Journal of Environmental Management, 15 September 2012, Pages 93-101
Abstract:
We examine the progress of the phaseout of the use of the pesticide methyl bromide in the production of California field strawberries. This phaseout is required under the Montreal Protocol and has been contentious in this sector, which receives exemptions from the schedule initially agreed under the treaty, and in international negotiations over the future of the Protocol. We examine the various ex-ante predictions of the impacts on growers, consumers and trade patterns in light of several years of declining allocations under the Critical Use provisions of the Protocol and the 2010 approval of iodomethane for use in California and subsequent 2012 withdrawal of this alternative from the US market. We find that, contrary to ex-ante industry claims, the years of declining methyl bromide use have been years of rising yields, acreage, exports, revenues and market share for California growers, even when faced with a global recession and increased imports from Mexican growers who retain the right to use the chemical under the Protocol. This has implications for the Protocol as a whole and for the remainder of the US phaseout of this chemical in particular.
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Patrick Richard et al.
Ageing International, June 2012, Pages 155-164
Abstract:
Minority elderly patients with diabetes receive lower quality of care based on an array of quality measures across various health care settings. However, the documentation of racial/ethnic disparities in quality of care for elderly patients with diabestes relies on a few major data sets such as claims data from Medicare beneficiaries, the Veterans Health Administration (VHA) databases, or the Health Plan Employer Data and Information Set (HEDIS) databases. The current study examines if racial/ethnic disparities in the quality of diabetes care found among elderly patients have begun to abate by using data from a nationally representative survey not frequently used in the literature. Using pooled data from the 2002-2007 Medical Expenditure Panel Survey, we found that elderly black patients with diabetes were less likely to receive appropriate quality of care as reported by patients, or eye examination and more likely to receive a foot examination compared to their white counterparts. Similarly, elderly Asian patients with diabetes were less likely to report receiving appropriative quality of care compared to their white counterparts. These results have important implication for future research that would seek to understand the mechanisms through which racial minority status is associated with poorer quality of diabetes care.
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Neal Sikka et al.
Journal of Health Communication, May 2012, Pages 37-43
Abstract:
There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.