Disparities and Health Equity

The differences in ability to access health care and in health outcomes across the population.

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.

Post-Mastectomy Breast Reconstruction: Reducing The Disparity Through Educational Outreach To The Underserved

Carmen Guerra, MD
Jun. 26, 2020

Olatomide Familusi, Arturo J. Rios-Diaz, Estifanos D. Tilahun, Jessica R. Cunning, Robyn B. Broach, Ari D. Brooks, Carmen E. Guerra, Paris D. Butler

Abstract [from journal]

Purpose: Poor health literacy and awareness are thought to be some of the major contributors to existing racial/ethnic disparities in access to breast reconstruction after mastectomy. This study aimed to determine whether physician led, community-based educational symposium improves understanding of breast cancer care and breast reconstruction in underserved populations.

Methods: Annual educational symposiums were held between 2017 and 2019 in underserved communities in the greater Philadelphia


Persistent Disparities In Smoking Rates Among PLWH Compared To The General Population In Philadelphia, 2009-2014

Robert Gross, MD, MSCE
Jun. 26, 2020

Cedric H. Bien-Gund, Grace H. Choi, Antonios Mashas, Pamela A. Shaw, Melissa Miller, Robert Gross, Kathleen A. Brady

Abstract [from journal]

Despite reductions in smoking rates in the general population, little is known about recent smoking trends among people living with HIV (PLWH). We compared the risk for smoking and temporal trends in smoking among PLWH and the general population in the Philadelphia metropolitan area between 2009 and 2014. We used weighted logistic regression to assess the relation between HIV and smoking, and examined temporal smoking trends. The adjusted odds ratio (OR) for smoking comparing PLWH to the general population was 1.80 (95% CI 1.55-2.09)


Assessing The Effects Of Maternal HIV Infection On Pregnancy Outcomes Using Cross-Sectional Data In Malawi

Dylan S. Small, PhD
Jun. 22, 2020

Halima S. Twabi, Samuel O. Manda, Dylan S. Small

Abstract [from journal]

Background: Several studies have shown that maternal HIV infection is associated with adverse pregnancy outcomes such as low birth weight and perinatal mortality. However, the association is conflicted with the effect of antiretroviral therapy (ART) on the pregnancy outcomes and it remains unexamined. If the association is confirmed then it would guide policy makers towards more effective prevention of mother to child HIV transmission interventions. Using methods for matching possible confounders, the objectives of


Low Health Literacy Is Associated With Frailty And Reduced Likelihood Of Liver Transplant Listing: A Prospective Cohort Study

Jun. 21, 2020

Therese Bittermann, Kristen Dwinnells, Sakshum Chadha, Michael S. Wolf, Kim M. Olthoff, Marina Serper

Abstract [from journal]

The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplant (LT) evaluation. From 2014-2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign (NVS), a brief validated assessment. Multivariable


Association of Homelessness with Hospital Readmissions—An Analysis of Three Large States

Jun. 17, 2020

Sameed Ahmed M. Khatana, Rishi K. Wadhera, Eunhee Choi, Peter W. Groeneveld, Dennis P. Culhane, Margot Kushel, Dhruv S. Kazi, Robert W. Yeh, Changyu Shen

Abstract [from journal]

Background: Individuals experiencing homelessness have higher hospitalization and mortality rates compared with the housed. Whether they also experience higher readmission rates, and if readmissions vary by region or cause of hospitalization is unknown.

Objective: Evaluate the association of homelessness with readmission rates across multiple US states.


Setting Standards for Affordable Health Care

Issue Brief
Jun. 16, 2020

In the run-up to the presidential election, the affordability of health care remains a top concern of the American voting public. But how do we know when health care is affordable? On a policy level, how do we set a standard for affordability that can be implemented in a reformed system? Sometimes policy debates about affordability focus only on whether insurance premiums are affordable, although consumers tend to be concerned about both premiums and out-of-pocket costs. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers, policy experts, and consumer advocates discussed and debated affordability in theory and practice. This issue brief summarizes the panel’s insights.

Pathways To Help-Seeking Among Black Male Trauma Survivors: A Fuzzy Set Qualitative Comparative Analysis

Jun. 9, 2020

John A. Rich, Theodore J. Corbin, Sara F. Jacoby, Jessica L. Webster, Therese S. Richmond

Abstract [from journal]

Many Black men suffer symptoms of traumatic stress in the aftermath of traumatic injury, and they also often carry social concerns, including experiences of discrimination and stigma, and a lack of financial resources. The objective of the present study was to understand how traumatic symptoms and social factors combine in complex ways toward the outcome of psychological help-seeking. We analyzed qualitative and quantitative data from 32 injured Black men admitted to a Level 1 trauma center. Qualitative interviews explored their


Models For Acute On Chronic Liver Failure Development And Mortality In A Veterans Affairs Cohort

Jun. 9, 2020

Karen Y. Xiao, Rebecca A. Hubbard, David E. Kaplan, Tamar H. Taddei, David S. Goldberg, Nadim Mahmud

Abstract [from journal]

Background and purpose: The diagnosis of acute on chronic liver failure (ACLF) carries a high short-term mortality, making early identification of at-risk patients crucial. To date, there are no models that predict which patients with compensated cirrhosis will develop ACLF, and limited models exist to predict ACLF mortality. We sought to create novel risk prediction models using a large North American cohort.

Methods: We performed a retrospective study of 75,922 patients with compensated


Association Of Clinical Nursing Work Environment With Quality And Safety In Maternity Care In The United States

Jun. 8, 2020

Rebecca R. S. Clark, Eileen T. Lake

Abstract [from journal]

Purpose: Maternal outcomes in the United States are the poorest of any highincome country. Efforts to improve the quality and safety of maternity care are frequently reported by individual hospitals, limiting generalizability. The purpose of this study is to describe maternity care quality and safety in hospitals in four states.

Study design and methods: This cross-sectional study is a secondary analysis of the Panel Study of Effects of Changes in Nursing on Patient Outcomes data. Registered