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Material community deprivation and hospital utilization during the first year of life: an urban population-based cohort study.

ABSTRACT: PURPOSE:The purpose of the study was to conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases health care utilization. METHODS:We used a population-based perinatal data repository based on linkage of electronic health records from regional delivery hospitals to subsequent hospital utilization at the region's only dedicated children's hospital. Zero-inflated Poisson and Cox proportional hazards regression models were used to quantify the causal role of a census tract-based deprivation index on the total number, length, and time until hospital utilization during the first year of life. RESULTS:After adjusting for any neonatal intensive care unit admission, chronic complex conditions, race and ethnicity, insurance status, birth season, and very low birth weight, we found that a 10% increase in the deprivation index caused a 1.032-fold increase (95% confidence interval (CI), [1.025-1.040]) in post initial hospitalization length of stay, a 1.011-fold increase (95% CI, [1.002-1.021]) in number of post initial hospital encounters, and 1.022-fold increase (95% CI, [1.009-1.035]) in hazard for hospitalization utilization during the first year of life. CONCLUSIONS:Interventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization.

SUBMITTER: Brokamp C

PROVIDER: S-EPMC6370517 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Material community deprivation and hospital utilization during the first year of life: an urban population-based cohort study.

Brokamp Cole C Beck Andrew F AF Goyal Neera K NK Ryan Patrick P Greenberg James M JM Hall Eric S ES

Annals of epidemiology 20181129

<h4>Purpose</h4>The purpose of the study was to conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases health care utilization.<h4>Methods</h4>We used a population-based perinatal data repository based on linkage of electronic health records from regional delivery hospitals to subsequent hospital utilization at the region's only dedicated children's hospital. Zero-inflated Poisson and Cox pro ...[more]

PMID: 30563729

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Project description:BackgroundThe first chikungunya virus (CHIKV) outbreaks during the modern scientific era were identified in the Americas in 2013, reaching high attack rates in Caribbean countries. However, few cohort studies have been performed to characterize the initial dynamics of CHIKV transmission in the New World.Methodology/principal findingsTo describe the dynamics of CHIKV transmission shortly after its introduction in Brazil, we performed semi-annual serosurveys in a long-term community-based cohort of 652 participants aged ≥5 years in Salvador, Brazil, between Feb-Apr/2014 and Nov/2016-Feb/2017. CHIKV infections were detected using an IgG ELISA. Cumulative seroprevalence and seroincidence were estimated and spatial aggregation of cases was investigated. The first CHIKV infections were identified between Feb-Apr/2015 and Aug-Nov/2015 (incidence: 10.7%) and continued to be detected at low incidence in subsequent surveys (1.7% from Aug-Nov/2015 to Mar-May/2016 and 1.2% from Mar-May/2016 to Nov/206-Feb/2017). The cumulative seroprevalence in the last survey reached 13.3%. It was higher among those aged 30-44 and 45-59 years (16.1% and 15.6%, respectively), compared to younger (12.4% and 11.7% in <15 and 15-29 years, respectively) or older (10.3% in ≥60 years) age groups, but the differences were not statistically significant. The cumulative seroprevalence was similar between men (14.7%) and women (12.5%). Yet, among those aged 15-29 years, men were more often infected than women (18.1% vs. 7.4%, respectively, P = 0.01), while for those aged 30-44, a non-significant opposite trend was observed (9.3% vs. 19.0%, respectively, P = 0.12). Three spatial clusters of cases were detected in the study site and an increased likelihood of CHIKV infection was detected among participants who resided with someone with CHIKV IgG antibodies.Conclusions/significanceUnlike observations in other settings, the initial spread of CHIKV in this large urban center was limited and focal in certain areas, leaving a high proportion of the population susceptible to further outbreaks. Additional investigations are needed to elucidate the factors driving CHIKV spread dynamics, including understanding differences with respect to dengue and Zika viruses, in order to guide prevention and control strategies for coping with future outbreaks.

Project description:Discrimination is a type of social adversity defined as unfair treatment and prejudice against individuals due to membership of a specific group. Discrimination has been linked to several age-related outcomes such as cognitive decline, inflammation, and cardiovascular disease. However, the molecular drivers to these observations are poorly understood. Social adverse factors have been associated with proinflammatory and interferon gene expression, a phenomenon described as Conserved Transcriptome Response to Adversity. It is not known whether there are additional genes whose transcription is associated with exposure to discrimination among both African American and White adults. In this study, we have examined how perceived discrimination in African American and White adults affects genome-wide transcriptome differences using RNA sequencing. Perceived discrimination was measured based on responses to lifetime discrimination and racial discrimination questionnaires. Differential gene expression and pathway analysis was conducted in a cohort (N=59) stratified by race, sex, and discrimination exposure. We found that there were 28 significantly differentially expressed genes associated with high discrimination exposure in African American adults when compared to White adults with high discrimination exposure. The most significantly upregulated genes among African Americans with high discrimination exposure were related to immune function immunoglobulin lambda variable 2-11 (IGLV2-11), S100 calcium binding protein B (S100B), immunoglobulin kappa variable 3-20 (IGKV3-20), immunoglobulin kappa variable 4-1 (IGKV4-1); the most significantly downregulated genes were associated with immune modulation and cancer, lung cancer associated transcript 1 (LUCAT1), thrombospondin 1 (THBS1), and actin related protein 2/3 complex inhibitor (ARPIN). In addition, the most significantly upregulated Gene Ontology (GO) biological process among African American men with high exposure to discrimination compared to White male adults with high exposure to discrimination was regulation of cytokine biosynthetic processes. Conversely, immune response was the most significantly downregulated GO biological process among African American women with high discrimination exposure compared White women with high discrimination exposure. Understanding the biological pathways through which adverse social factors like discrimination affect gene expression will be critical in advancing knowledge of age-related health disparities.

Dataset Information

Material community deprivation and hospital utilization during the first year of life: an urban population-based cohort study.

Publications

Material community deprivation and hospital utilization during the first year of life: an urban population-based cohort study.

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