Associations of Social and Structural Determinants of Health with Forgone Care during the COVID-19 Pandemic in Baltimore, Maryland

马里兰州巴尔的摩市 COVID-19 大流行期间健康的社会和结构性决定因素与放弃护理的关联

• 批准号: 10676580
• 负责人: Diane Alyce Meyer
• 金额: $ 3.78万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-09 至 2023-10-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10676580
• 关键词: 2019-nCoV; Address; Adult; Appointment; Area; Baltimore; Black race; COVID-19; COVID-19 Prevention Network; COVID-19 pandemic; Caring; Censuses; Characteristics; Chronic; Chronic Care; Cities; Clinical; Communities; Community Health; Coronavirus; Crime; Cross-Sectional Studies; Data; Data Analyses; Data Set; Development; Dose; Drug Prescriptions; Education; Emergency Care; Enrollment; Exclusion; Financial Support; Funding; Future; Health; Health system; Healthcare; Healthcare Systems; Hospitals; Housing; Income; Individual; Inequity; Insurance Coverage; Internet; Knowledge; Life Expectancy; Literature; Low income; Maryland; Measures; Medicaid; Methodology; Methods; Minority; Minority Groups; Mission; Modeling; Morbidity - disease rate; Movement; Neighborhoods; Newly Diagnosed; Outpatients; Parents; Participant; Patients; Persons; Population; Poverty; Prevalence; Prevalence Study; Preventive care; Procedures; Prognosis; Readiness; Reporting; Research; Risk; Sampling; Social Impacts; Telemedicine; Time; Training; Transportation; Underserved Population; United States; United States National Institutes of Health; Vulnerable Populations; combat; community setting; community-level factor; cost; deprivation; experience; health care model; health care service; health care service utilization; health inequalities; improved; indexing; mortality; neighborhood disadvantage; pandemic disease; pandemic impact; public health emergency; recruit; segregation; social determinants; social factors; sociodemographics; socioeconomics; structural determinants; structural health determinants; transportation access; trend; underserved area; underserved community; vulnerable community; walkability

PROJECT SUMMARY Lack of health system readiness during the Coronavirus 2019 (COVID-19) pandemic has led to widespread disruptions in healthcare utilization. This includes forgone care, which is defined as someone who perceives a need for healthcare but does not receive it. These disruptions have exacerbated the morbidity and mortality associated with the pandemic and have disproportionately impacted those who experience inequities across the social and structural determinants of health (SDoH). This includes social and structural factors at both the individual and community levels, such as income, access to public transportation, and proximity to healthcare services, that may influence healthcare use during the pandemic. Existing literature on the impacts of the pandemic on healthcare utilization predominately describe outpatient and hospital trends. However, very few studies have captured patient-reported forgone care. Those studies that do look at forgone care during the pandemic have evaluated national-level data or used convenience sampling methods, which may limit generalizability to minoritized and economically vulnerable communities. The purpose of this study is to further describe forgone care during the COVID-19 pandemic and its associations with the SDoH among a sample of adults living in Baltimore, Maryland. The applicant will conduct a secondary data analysis using a combined analytic dataset from the Community Collaborative to Combat COVID-19 (C-Forward) and COVID- 19 Prevention Network 5002 (CoVPN) studies. Each of these studies used separate, yet complimentary sampling strategies that will help improve representativeness of the Baltimore population. The C-Forward study uses a population representative sampling strategy, organized by census block groups. The CoVPN study used venue-based sampling, with oversampling of venues located in lower-income and underserved areas of Baltimore. This sub-study will use questions on forgone care completed on enrollment in each parent study. The aims are to: Aim 1: To characterize the prevalence of forgone care in Baltimore during the COVID-19 pandemic by individual-level factors through a cross-sectional analysis of a combined analytic sample of CoVPN and C-Forward participants. Aim 2: To examine the relative importance of individual and community level SDoH with the odds of forgone care. Aim 3: In an exploratory analysis, compare the predictors of forgone emergency care with predictors of forgone chronic and preventive care. Understanding the overall prevalence of forgone care during the COVID-19 pandemic and its intersections with the SDoH is critical to providing a comprehensive view of the health impacts of the pandemic and informing the development of models of care that can be leveraged during COVID-19 and future public health emergencies to maintain individual and community health. The proposed dissertation study and training plan directly align with the NINR’s mission to address health inequities and the SDoH, specifically within the context of public health emergencies.

项目摘要 2019年冠状病毒期间缺乏卫生系统准备就绪（COVID-19）大流行导致了宽度 医疗保健利用中的破坏。这包括原谅护理，该护理被定义为感知的人 需要医疗保健，但没有得到医疗保健。这些破坏加剧了发病率和死亡率 与大流行有关，并对那些经历不平等的人产生了不成比例的影响 卫生的社会和结构决定者（SDOH）。这两个都包括社会和结构性因素 个人和社区层面，例如收入，获得公共交通以及靠近医疗保健 服务可能会影响大流行期间的医疗保健。现有有关影响的影响 医疗保健利用的大流行主要描述门诊和医院趋势。但是，很少 研究捕获了患者报告的忘记护理。那些确实看着忘记关怀的研究 大流行已经评估了国家级别的数据或使用便利抽样方法，这可能会限制 对少数和经济脆弱社区的普遍性。这项研究的目的是进一步 描述忘记在19009年大流行期间及其与SDOH的关联 居住在马里兰州巴尔的摩的成年人样本。申请人将使用 从社区合作到COMBAT COVID-19（C-Forward）和Covid-的合并分析数据集 19预防网络5002（COVPN）研究。这些研究中的每一个都使用了独立但免费的 采样策略将有助于提高巴尔的摩人口的代表性。 C前向研究 使用代表采样策略的种群，该策略由人口普查块组组织。 COVPN研究 使用基于场地的抽样，对位于低收入和服务不足的地区的场地过采样 巴尔的摩。这个子研究将使用有关每个父母研究的入学率完成的忘记遗忘问题的问题。 目的是：目标1：表征在19日期间巴尔的摩忘记的流行率 通过个人级别因素大流行，通过对合并的分析样本的横截面分析 COVPN和C-Forward参与者。目标2：检查个人和社区的相对重要性 SDOH级别，忘记了。目标3：在探索性分析中，比较忘记的预测指标 - 急诊护理，可预测慢性和预防性护理的预测因素。了解总体流行 在COVID-19大流行期间的忘记护理及其与SDOH的交集对于提供一个至关重要的 全面看出大流行的健康影响并告知护理模型的发展 可以在Covid-19和未来的公共卫生紧急情况下利用这种情况，以维持个人和 社区健康。拟议的论文研究和培训计划直接符合Ninr的使命 解决健康不平等和SDOH，特别是在公共卫生紧急情况下。