RISE looks at recent headlines concerning social determinants of health (SDoH).
New diabetes study aims to evaluate SDoH-centered approach
A team of researchers from the University of Alabama at Birmingham (UAB) and the University of Mississippi Medical Center are conducting a $3.6 million study to evaluate how SDoH-targeted interventions could impact diabetes management.
Given the disproportionate burden of diabetes-related heart and kidney disease on Black Americans, the Food Delivery, Remote Monitoring and Coaching-Enhanced Education for Optimized Diabetes Management (FREEDOM) study will aim to address existing racial health disparities by combatting barriers related to transportation, access to health care, quality of care, and food insecurity among Black adults with Type 2 diabetes. Researchers will enroll 304 Black adult patients in self-management education and support programs as well as a varying combination of three SDoH-related interventions, including health coaching, food delivery, and remote patient monitoring. The patients’ blood sugar levels will be monitored after six months and again at 12 months to evaluate the impact of the SDoH approach.
“Our study will leverage multi-health care system and health care system-industry partnerships to promote health equity and to improve diabetes outcomes in socially vulnerable Black adults living in the Deep South,” said Tapan Mehta, Ph.D., vice chair for research in UAB’s Department of Family and Community Medicine, in a statement. “To our knowledge, this is the first optimization trial that brings three intervention components—health coaching, remote patient monitoring and food box delivery—together to identify the most sustainable intervention package. This study is important and will inform health systems as leaders consider population health management and value-based care and pilot some of these intervention components in isolation.”
Racial disparities in cardiac care put Black patients at greater risk of readmission or death
SDoH are causing troubling disparities in cardiac care outcomes among Black patients, according to a Michigan Medicine study. Researchers found that Black patients who received coronary stenting were more likely than white patients to be readmitted to the hospital or even die following the procedure.
The study used data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium between 2013 and 2018 to evaluate more than 29,000 patients with Medicare who received percutaneous coronary intervention, a common procedure used in situations such as a heart attack. The findings show that Black patients were 1.62 times more likely to be readmitted to the hospital within 90 days of the procedure and were 1.45 times more likely to die in long-term follow-up. The study also found that while 75 percent of white patients were referred for cardiac rehabilitation, only 58.5 percent of Black patients received the same referral.
SDoH including community economic well-being, personal income and wealth, and preexisting health conditions played a significant role in the disproportionate health outcomes, explained researchers.
“Our findings demonstrate that these disparities may be, at least in part, explained by multiple complex factors including social determinants of health,” said senior author Devraj Sukul, M.D., M.S., interventional cardiologist at the U-M Health Frankel Cardiovascular Center and a clinical assistant professor of cardiology at U-M Medical School, in a statement. “All of these factors, such as wealth, community economic stress and comorbidities, are interconnected and accumulate over time. Lower socioeconomic status can potentially lead to worse health status, just as illness may undermine financial security and economic opportunity. Preventative action must be taken to address the complex social, environmental, and behavioral factors that contribute to these outcomes.”
Study: Hispanic adults face greater SDoH, psychological distress amid pandemic
Hispanic adults have the highest rate of moderate to severe psychological distress amid the COVID-19 pandemic, according to a new study published by BMC Public Health.
Using data from the 2020 California Health Interview Survey Adult Data Files, researchers analyzed racial disparities in mental health associated with COVID-19 among four racial/ethnic groups, including white, Hispanic, Asian, and Black individuals.
Through their research, they found Hispanic adults are struggling the most with psychological distress associated with SDoH, leading to poor health outcomes. The distress was linked to SDoH including unemployment, food insecurity, housing instability, education, access to and quality of health care, delayed medical care, and lack of community support/safety.
“Given the cultural diversity within the US, including citizens of different races and ethnicities, attention toward the unique impact of the pandemic within the US for specific groups of people will be critical to fully understanding the psychological impact of the COVID-19 pandemic,” noted researchers, calling for public health practice and policy to highlight the social needs associated with different racial/ethnic groups in order to create tailored programs to address psychological distress.
WHO calls for increased efforts in injury prevention, violence worldwide
The World Health Organization (WHO) is pushing for greater injury and violence prevention around the world in its recent report, Preventing injuries and violence: an overview, and cites SDoH as a critical action area.
According to the organization, preventable injuries and violence cause 12,000 deaths worldwide each day, with three of the top five causes among those ages 5-29 being road traffic injuries, homicide, and suicide. The organization underscored that low-income individuals are at a far greater risk.
Addressing longstanding health inequities and SDoH will be a key intervention in the unnecessary deaths, said WHO. “People living in poverty are significantly more likely to suffer an injury than the wealthy,” said Tedros Adhanom Ghebreyesus, Ph.D, director-general, WHO. “The health sector has a major role in addressing these health inequities and in preventing injuries and violence, through collecting data, developing policies, providing services and programming for prevention and care, building capacities, and advocating for greater attention to underserved communities.”