Association of Socioeconomic and Age Group Status with Self- reported Health Outcomes of Persons...
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Transcript of Association of Socioeconomic and Age Group Status with Self- reported Health Outcomes of Persons...
Association of Socioeconomic and Age Group Status with Self-
reported Health Outcomes of Persons with SCD in Rural and Urban Areas of North Carolina
AUTHORS/REFERENCEAklaque Haque, PhD, Dept of Government and
Public Services - Sch. Of Social and Behavioral Sciences, University of Alabama at Birmingham
Joseph Telfair, DrPH, MSW/MPH, Sch. Of Public Health, University of Alabama at Birmingham
Reference: Haque, A & Telfair, J (in press). Socioeconomic distress and Health Status: The Urban-Rural dichotomy of services utilization for persons with SCD in NC. J. Rural Health
Individuals with SCD and their familiesMembers of the Duke/UNC CSCCStaff of the Four NC SC Community-based
programsDuke/UNC CSCC Biometry CoreDavid Redden CCC Biostatistical Core,
UAB
Thank You
BACKGROUNDResearch addressing risk factors associated with SCD
- predominantly biomedical & bioclinicalThis research has led to reduced morbidity, better
treatment outcomes & raised awareness of the need for comprehensive biomedical and psychosocial treatment strategies
This research has failed to consider impact of the interaction of socioeconomic background and geographic distribution has had on health care delivery and medical outcomes
NC SCD Consortium provides much of the outreach, education, social, health and medical care
NC SCD Consortium:3 state level administrative and 9 (regional) level
Educator/Counselor5 major tertiary medical centers (only 2 serve
adults) for comprehensive care4 community-based centers
Consortium survey suggested differential access
BACKGROUND: SCD IN NC
PURPOSE OF THE STUDY
To gain an understanding of how access & utilization of services may be affected separately and interactively by age, socioeconomic conditions, geographic location, functional status, severity of disease & distance to medical care
To introduce Social Epidemiological Methods to the study of issues impacting persons with SCD
METHODS: PARTICIPANTS
1189 [of 1298] adults and children with SCD at intake (1991-1995)
Served by the three medical centers in the Duke/UNC CSCC (68%) of estimated SCD population in NC, consent obtained
Intake Qs informationself-reported demographic, medical history,
psychological and social dataobjective physical exam, laboratory and medical
records
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UNC (Adult, Children)Duke (Adult, Children) ECU (Children)
Wilmington (Children)
40 0 40 80 120 Miles
N
MAP 1Sickle Cell Clients in Urban and Rural Areas
of North Carolina by Zip Code
Zip CodeUrbanRural
SCD Clients# 1 - 4# 5 - 11# 12 - 20# 21 - 31
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UNC (Adult, Children) Duke (Adult, Children)
Wilmington (Children)
ECU (Children)
Zip CodeUrbanRural
Utlization of Serives (%)# Low (0 - 30%)# Medium (50 - 90%)# High (100 - 600%)
50 0 50 100 Miles
N
MAP 2Utlization of Services in Urban and Rural Areas,
North Carolina by Zip Code
METHODS: MEASURESCommunity Distress Index(CDI)
Based on Haque’s Econometric Model5 indicators of poor QOL based on 1990 U.S.
Census Indicators income (Black per capita income)education (% Black not beyond HS)poverty (% Black below poverty)unemployment (% Black unemployed)not in labor force (% Black not in labor force)
Index Score(SUM) - Low, Medium, High distress
METHODS: MEASURESSCD Interference Index (SCDII) - Child/Adult
Based on Psychosocial Interference Scale (Kramer & Nash, 1992)
8 items for each (e.g., School/ Employment attendance, school/employment performance, household activities, etc.)
Coding Interference - YES (1) NO (0)Amount of Interference - Rare (1) Somewhat (2)
A lot (3) Index Score(SUM) - None, Low, Medium, High
METHODS: MEASURESMedical Problem Index (MPI)
Index items based on anecdotal, clinical and evidence-based research information
Event groupings (most common)- Problem (Acute Chest/Pneumo, Pain req Hosp)Condition (Ascep Nec Hips & Shoulders,
Gallstones, eye problems)Infection (osteomyelitis, pyelonephritis)Procedure (cholecystectomy & splenectomy)
Index score(SUM) - none, low, medium, high
Index CDI MPI SCDII Age Urb/RurlCDI -- -0.105 -.039 -0.114 0.568**MPI -0.105 -- 0.564** 0.691** -0.091**SCDII -0.038 0.564** -- 0.590** .001 Age -0.114**0.691** 0.590** -- -0.067*Urb/Rurl 0.568**-0.091** 0.001 -0.067* --
Correlation Coefficient for all Cases (n= 1189)
**Correlation is significant at the .01 level (2 tailed)
Results Ia
Controlling for Client
Age CDI MPI SCDII Urb/RurlCDI -- -0.053 -0.016 0.560**MPI -0.053 -- 0.253** -0.054SCDII -0.016 0.253** -- 0.019Urb/Rurl 0.560** -0.054 0.019 --
Correlation Coefficient for all
**Correlation is significant at the .01 level (2 tailed)* Correlation is significant at the .05 level (2 tailed)
Results Ib
Results IcControlling
for Location and Age CDI MPI SCDII
CDI -- -0.028 -0.033MPI -0.028 -- 0.255**SCDII -0.033* 0.255** --
**Correlation is significant at the .01 level (2 tailed)* Correlation is significant at the .05 level (2 tailed)
Results II
Age Category Location/N CDI MPI SCDII
18 and YoungerUrban N = 17 0.20 0.64 0.44Rural N = 95 0.24 0.77 0.24
18 - 34 Urban N = 10 0.10 0.42 0.71Rural N = 34 0.14 0.56 0.74
34 and Above Urban N = 11 0.09 0.49 0.73Rural N = 18 0.14 0.40 0.78
Correlation Coefficient* of Problem Indicators for Clients in Distressed Areas (HGB SS type)
*Modify: Sum of all problem indicators (community distress, medical problem and interference) = Community Distress + Medical Problems + Interference All coefficients are significant at 0.1 level.
CONCLUSIONSThis study has allowed for the the investigation
of the observation that a wide disparity has been observed in socioeconomic characteristics among urban and rural persons with SCD in NC
When controlling for age and location, the significant relationships between indices persist.
Specifically, rural clients of all ages live under relatively more distressed economic conditions than urban clients and younger clients are wore-off than older clients, yet for youngsters CDI is not a contributing factor to higher interference
Supports contention, youngsters with SCD, in NC have, in general, have better familial and systems level supports that may “buffer” physical and social consequences
For adults the supports are limited and inadequate to compensate for hardships, especially in rural areas
By changing the policy to create a more equitable of system of supports rural and age differentials can be effectively addressed
These findings have particular implications for states with a 40% or greater rural population
CONCLUSIONS
Limitations of the StudyThe study uses zip code linked SES data as the
basis for determining CDI score areas, a very good proxy measure, but may fully reflect the individual level SES of the client
Interference for children (not adolescents) is generally reported by parents and guardians, a good approach, but is limited by the parent’s perception
Current research is underway in Alabama aimed at addressing these limitations and improving on this study