Chelsea N Wong, Louisa H Smith, Robert Cavanaugh, Dae H Kim, Carl G Streed, Farzana Kapadia, Brianne Olivieri-Mui
{"title":"在 \"我们所有人 \"研究计划中,评估虚弱和医疗保健延误如何调节性少数群体和性别少数群体身份与医疗保健利用率之间的关联。","authors":"Chelsea N Wong, Louisa H Smith, Robert Cavanaugh, Dae H Kim, Carl G Streed, Farzana Kapadia, Brianne Olivieri-Mui","doi":"10.1093/jamia/ocae205","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization.</p><p><strong>Materials and methods: </strong>Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses).</p><p><strong>Results: </strong>Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]).</p><p><strong>Discussion: </strong>Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.</p>","PeriodicalId":50016,"journal":{"name":"Journal of the American Medical Informatics Association","volume":null,"pages":null},"PeriodicalIF":4.7000,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessing how frailty and healthcare delays mediate the association between sexual and gender minority status and healthcare utilization in the All of Us Research Program.\",\"authors\":\"Chelsea N Wong, Louisa H Smith, Robert Cavanaugh, Dae H Kim, Carl G Streed, Farzana Kapadia, Brianne Olivieri-Mui\",\"doi\":\"10.1093/jamia/ocae205\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization.</p><p><strong>Materials and methods: </strong>Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses).</p><p><strong>Results: </strong>Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]).</p><p><strong>Discussion: </strong>Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.</p>\",\"PeriodicalId\":50016,\"journal\":{\"name\":\"Journal of the American Medical Informatics Association\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-07-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Medical Informatics Association\",\"FirstCategoryId\":\"91\",\"ListUrlMain\":\"https://doi.org/10.1093/jamia/ocae205\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"COMPUTER SCIENCE, INFORMATION SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Medical Informatics Association","FirstCategoryId":"91","ListUrlMain":"https://doi.org/10.1093/jamia/ocae205","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"COMPUTER SCIENCE, INFORMATION SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
摘要了解虚弱和医疗保健延误如何在不同程度上介导性少数群体和性别少数群体老年人(OSGM)状况与医疗保健利用率之间的关联:采用边际结构模型对 "我们所有人研究计划"(All of Us Research Program)中年龄≥50岁的参与者的数据进行分析,以评估虚弱或医疗保健延误是否会介导OSGM状况和医疗保健利用率。OSGM状况、医疗保健延误和虚弱程度通过调查数据进行评估。电子健康记录(EHR)数据用于测量计算出 "我们所有人 "虚弱指数后 12 个月内的就诊次数或精神健康(MH)就诊天数。分析对年龄、种族和民族、收入、HIV、婚姻状况±一般 MH(仅 MH 分析)进行了调整:与非 OSGM 相比,OSGM 成年人的就诊率(调整后比率比 [aRR]:1.14;95% CI:1.03,1.24)和 MH 就诊率(aRR:1.85;95% CI:1.07,2.91)更高。虚弱是 OSGM 状况与就诊次数之间关系的中介(控制直接效应 [Rcde] aRR:1.03,95% CI [0.87,1.22]),但不是 MH 就诊次数的中介(Rcde aRR:0.37 [95% CI:0.06,1.47])。延迟介导了 OSGM 状态与 MH 就诊天数之间的关联(Rcde aRR:2.27,95% CI [1.15,3.76]),但不介导医疗就诊(Rcde aRR:1.06 [95% CI:0.97,1.17]):讨论:体弱是 OSGM 成年人对医疗护理的一种需求,突出了解决体弱问题以改善健康和医疗使用差异的重要性。与此相反,医疗保健延误是获得医疗保健服务的障碍,因此有必要采取有针对性的策略,确保为 OSGM 成年人提供及时的医疗保健服务。
Assessing how frailty and healthcare delays mediate the association between sexual and gender minority status and healthcare utilization in the All of Us Research Program.
Objectives: To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization.
Materials and methods: Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses).
Results: Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]).
Discussion: Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.
期刊介绍:
JAMIA is AMIA''s premier peer-reviewed journal for biomedical and health informatics. Covering the full spectrum of activities in the field, JAMIA includes informatics articles in the areas of clinical care, clinical research, translational science, implementation science, imaging, education, consumer health, public health, and policy. JAMIA''s articles describe innovative informatics research and systems that help to advance biomedical science and to promote health. Case reports, perspectives and reviews also help readers stay connected with the most important informatics developments in implementation, policy and education.