Access & Equity

How health care resources are distributed across the population and how access and health outcomes vary across different groups. LDI Senior Fellows focus on how to achieve greater access for vulnerable populations and how to reduce disparities in health outcomes.

Hepatitis C and The Layering of Disease-Related Stigma

Jul. 28, 2020
“That's exactly how I feel like they look at you. Like, ‘You on drugs, you dirty, you homeless, you don't got nowhere to take yourself, staying yourself and take yourself.’ Why should they try to help you and give you the best care possible? For what? They could save it for somebody else that's doing all the right things versus give it to the people that's doing all the wrong things.” – HIV/HCV-coinfected study participant

Observational Study Assessing Changes In Timing Of Readmissions Around Postdischarge Day 30 Associated With The Introduction Of The Hospital Readmissions Reduction Program

Jul. 21, 2020

Ashwin S. Nathan, Joseph R. Martinez, Jay Giri, Amol S. Navathe

Abstract [from journal]

Background: The Hospital Readmissions Reduction Program (HRRP) initially penalised hospitals for excess readmission within 30 days of discharge for acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA) and was expanded in subsequent years to include readmissions for chronic obstructive pulmonary disease, elective total hip arthroplasty, total knee arthroplasty and coronary artery bypass graft surgery. We assessed whether HRRP was associated with delays in readmissions from immediately


Overdose Awareness And Reversal Trainings At Philadelphia Public Libraries

Jul. 14, 2020

Margaret Lowenstein, Rachel Feuerstein-Simon, Roxanne Dupuis, Allison Herens, Jeffrey Hom, Meghana Sharma, Risha Sheni, Lonard Encarnacion, Carina Flaherty, Maria Cueller, Carolyn Cannuscio

Abstract [from journal]

Purpose: To evaluate an overdose response training program in public libraries.

Design: Mixed methods evaluation including pre- and post-intervention questionnaires and debriefing interviews.

Setting: Ten Philadelphia public libraries.

Sample: Overdose response training participants (library staff and community members).

Intervention: Public, hour-long overdose response trainings run by the Philadelphia Department of


Multiple Complications In Emergency Surgery: Identifying Risk Factors For Failure-to-Rescue

Jul. 10, 2020

Justin S. Hatchimonji, Robert A. Swendiman, Elinore J. Kaufman, Dane Scantling, Jesse E. Passman, Wei Yang, M. Kit Delgado, Daniel N. Holena

Abstract [from journal]

Background: While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death.

Methods: We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac,


Neighborhood Socioeconomic Status And Risk Of Hospitalization In Patients With Chronic Kidney Disease: A Chronic Renal Insufficiency Cohort Study

Jesse Yechih Hsu, PhD
Jul. 10, 2020

Milda R. Saunders, Ana C. Ricardo, Jinsong Chen, Amanda H. Anderson, Esteban A. Cedillo-Couvert, Michael J. Fischer, Jesus Hernandez-Rivera, Margaret T. Hicken, Jesse Y. Hsu, Xiaoming Zhang, Denise Hynes, Bernard Jaar, John W. Kusek, Panduranga Rao, Harold I. Feldman, Alan S. Go...

Abstract [from journal]

Patients with chronic kidney disease (CKD) experience significantly greater morbidity than the general population. The hospitalization rate for patients with CKD is significantly higher than the general population. The extent to which neighborhood-level socioeconomic status (SES) is associated with hospitalization has been less explored, both in the general population and among those with CKD.We evaluated the relationship between neighborhood SES and hospitalizations for adults with CKD participating in the Chronic Renal


Effects Of A Standardized Community Health Worker Intervention On Hospitalization Among Disadvantaged Patients With Multiple Chronic Conditions: A Pooled Analysis Of Three Clinical Trials

Jul. 8, 2020

Aditi Vasan, John W. Morgan, Nandita Mitra, Chang Xu, Judith A. Long, David A. Asch, Shreya Kangovi

Abstract [from journal]

Objective: To analyze the effects of a standardized community health worker (CHW) intervention on hospitalization.

Data sources/study setting: Pooled data from three randomized clinical trials (n = 1340) conducted between 2011 and 2016.

Study design: The trials in this pooled analysis were conducted across diseases and settings, with a common study design, intervention, and outcome measures. Participants were patients living in high-poverty regions of Philadelphia and


Benchmarking Accomplishments of Leaders In American Surgery And Justification For Enhancing Diversity And Inclusion

Jul. 7, 2020

Paris Butler, Carla Pugh, Elana Meer, Lanair Lett, Estifanos Tilahun, Hilary A. Sanfey, Cherisse Berry, Steven Stain, Ronald DeMatteo, Selwyn Vickers, L. D. Britt, Colin Martin


Objective: To comprehensively assess the level of achievement and demographics of national surgical society presidents.

Background: Data on the accomplishments needed to rise to positions of national surgical leadership is scarce and merit alone does not always yield such opportunities. Recognizing the shortcomings of sex and ethnic diversity within academic surgical leadership, the American College of Surgeon (ACS), American Surgical Association (ASA), Association of Women Surgeons (AWS), and the Society of Black Academic Surgeons...

Unsupervised Modeling And Genome-Wide Association Identify Novel Features Of Allergic March Trajectories

John Holmes, PhD
Jul. 7, 2020

Stanislaw J. Gabryszewski, Xiao Chang, Jesse W. Dudley, Frank Mentch, Michael March, John H. Holmes, Jason Moore, Robert W. Grundmeier, Hakon Hakonarson, David A. Hill

Abstract [from journal]

Background: The allergic march refers to the natural history of allergic conditions during infancy and childhood. However, population-level disease incidence patterns do not necessarily reflect the development of allergic disease in individuals. A better understanding of the factors that predispose to different allergic trajectories is needed.

Objective: Determine the demographic and genetic features that associate with the major allergic march trajectories.



Responding to the Trauma of COVID-19

Jul. 2, 2020

As the country looks to reopen and epidemiologists anticipate future waves of coronavirus (COVID-19) cases, we must address an equally important “pandemic:” the virus’ far-reaching mental health and trauma-related consequences. Whether balancing activities of essential work with exposure risk, bearing witness to suffering or loss, or feeling anguish or guilt for not “doing more” during this time, our society is facing great adversity with potentially devastating consequences.

Healthier Food And Beverage Interventions In Schools: Four Community Guide Systematic Reviews

Jul. 1, 2020

Holly R. Wethington, Ramona K. C. Finnie, Leigh Ramsey Buchanan, Devon L. Okasako-Schmucker, Shawna L. Mercer, Caitlin Merlo, Youfa Wang, Charlotte A. Pratt, Emmeline Ochiai, Karen Glanz, Community Preventive Services Task Force

Abstract [from journal]

Context: Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight.

Evidence acquisition: School obesity prevention programs aiming to improve diet were


The Income-Based Mortality Gradient Among US Health Care Workers: Cohort Study

Jun. 30, 2020

Sasmira Matta, Paula Chatterjee, Atheendar S. Venkataramani 

Abstract [from journal]

The health care industry is the largest employer in the USA. The health care workforce encompasses a range of occupations that vary widely by income, including home health aides, food service workers, clerical workers, nurses, physicians, and executives....