Leah Santacroce, Sherry Yang, Rebecca Summit, Ana Valle, Jamie E Collins, Paul Dellaripa, Candace H Feldman
{"title":"社会脆弱性和环境负担对风湿病患者护理分散和社交需求的影响。","authors":"Leah Santacroce, Sherry Yang, Rebecca Summit, Ana Valle, Jamie E Collins, Paul Dellaripa, Candace H Feldman","doi":"10.1002/acr.25431","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between adverse environmental burden concentrated in areas with high social vulnerability with care fragmentation (missed appointments, Emergency Department (ED) visits and hospitalizations) and social needs (e.g., food and housing insecurity) among individuals with rheumatic conditions.</p><p><strong>Methods: </strong>We identified adults receiving care in a Massachusetts multihospital system with >2 rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the CDC/ATSDR Social-Environmental Ranking (SER), which combines census tract social vulnerability variables (e.g., socioeconomic status) with environmental hazards (e.g., air and water pollution). Social needs were from self-reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles, care fragmentation, and social need burden, accounting for demographics and comorbidities.</p><p><strong>Results: </strong>Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER Quartile 4) areas. Among 7,083 with social needs data, 19% experienced >1 challenge. Individuals in SER Quartile 4 areas (vs. Quartile 1), had 2.02 (95% CI 1.67-2.46) times greater odds of >4 care fragmentation occurrences (vs. 0) and 2.37 (95% CI 1.73-3.25) times greater odds of >2 social needs (vs. 0).</p><p><strong>Conclusions: </strong>Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7000,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of Social Vulnerability and Environmental Burden on Care Fragmentation and Social Needs Among Individuals with Rheumatic Conditions.\",\"authors\":\"Leah Santacroce, Sherry Yang, Rebecca Summit, Ana Valle, Jamie E Collins, Paul Dellaripa, Candace H Feldman\",\"doi\":\"10.1002/acr.25431\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between adverse environmental burden concentrated in areas with high social vulnerability with care fragmentation (missed appointments, Emergency Department (ED) visits and hospitalizations) and social needs (e.g., food and housing insecurity) among individuals with rheumatic conditions.</p><p><strong>Methods: </strong>We identified adults receiving care in a Massachusetts multihospital system with >2 rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the CDC/ATSDR Social-Environmental Ranking (SER), which combines census tract social vulnerability variables (e.g., socioeconomic status) with environmental hazards (e.g., air and water pollution). Social needs were from self-reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles, care fragmentation, and social need burden, accounting for demographics and comorbidities.</p><p><strong>Results: </strong>Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER Quartile 4) areas. Among 7,083 with social needs data, 19% experienced >1 challenge. Individuals in SER Quartile 4 areas (vs. Quartile 1), had 2.02 (95% CI 1.67-2.46) times greater odds of >4 care fragmentation occurrences (vs. 0) and 2.37 (95% CI 1.73-3.25) times greater odds of >2 social needs (vs. 0).</p><p><strong>Conclusions: </strong>Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities.</p>\",\"PeriodicalId\":8406,\"journal\":{\"name\":\"Arthritis Care & Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-09-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthritis Care & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/acr.25431\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthritis Care & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/acr.25431","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Effects of Social Vulnerability and Environmental Burden on Care Fragmentation and Social Needs Among Individuals with Rheumatic Conditions.
Objective: Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between adverse environmental burden concentrated in areas with high social vulnerability with care fragmentation (missed appointments, Emergency Department (ED) visits and hospitalizations) and social needs (e.g., food and housing insecurity) among individuals with rheumatic conditions.
Methods: We identified adults receiving care in a Massachusetts multihospital system with >2 rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the CDC/ATSDR Social-Environmental Ranking (SER), which combines census tract social vulnerability variables (e.g., socioeconomic status) with environmental hazards (e.g., air and water pollution). Social needs were from self-reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles, care fragmentation, and social need burden, accounting for demographics and comorbidities.
Results: Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER Quartile 4) areas. Among 7,083 with social needs data, 19% experienced >1 challenge. Individuals in SER Quartile 4 areas (vs. Quartile 1), had 2.02 (95% CI 1.67-2.46) times greater odds of >4 care fragmentation occurrences (vs. 0) and 2.37 (95% CI 1.73-3.25) times greater odds of >2 social needs (vs. 0).
Conclusions: Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities.
期刊介绍：
Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
