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Social Determinants of Health Disparities and Health Inequities in Populations
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Social Determinants of Health Disparities and Health Inequities in Populations

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 17466

Special Issue Editor

Dr. Ibraheem M. Karaye

E-Mail Website
Guest Editor
Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
Interests: social vulnerability; health disparities; disaster & injury epidemiology

Special Issue Information

Dear Colleagues,

Eliminating health disparities and attaining healthy well-being for all are key objectives of the Healthy People 2030 initiative. A substantial body of empirical work has examined health disparities in populations, but the literature is lacking on the specific contextual determinants of these disparities. While there is a growing appreciation of the role social, cultural, and economic factors play in shaping population health, modest progress has been made in identifying social variables that explain health disparities in specific contexts. For example, few studies have assessed the association between the historical redlining of neighborhoods and health disparities in the United States along the lines of examinations of the health associations of Jim Crow laws.

This Special Issue aims to broaden our understanding of social, cultural, political, and economic factors and their associations with health disparities or inequities in specific contexts. We are particularly interested in original research articles (empirical and theoretical) or systematic reviews that explore the determinants of health disparities or inequities in populations. We will also consider quantitative, qualitative, or mixed methods research that examines the distribution of health disparities or assesses the impacts of policies and interventions on improving disparities. It is imperative that every manuscript considered for publication focuses on social vulnerability, social determinants of health, and/or health inequity.

Dr. Ibraheem M. Karaye
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • social vulnerability
  • health disparities
  • social determinants
  • public health
  • health inequity

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Published Papers (6 papers)

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Research

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16 pages, 1077 KiB  
Article
Burden of Disease in Refugee Patients with Diabetes on the Island of Lesvos—The Experience of a Frontline General Hospital
by Nikolaos Bountouvis, Eirini Koumpa, Niki Skoutarioti, Dimitrios Kladitis, Aristomenis K. Exadaktylos and Charalampos Anitsakis
Int. J. Environ. Res. Public Health 2024, 21(7), 828; https://doi.org/10.3390/ijerph21070828 - 25 Jun 2024
Viewed by 1681
Abstract
Diabetes mellitus is a non-communicable disease which poses a great burden on refugee populations, who are confronted with limited access to healthcare services and disruption of pre-existing pharmacological treatment. Aims: We sought to evaluate the degree of hyperglycaemia in refugees with known or [...] Read more.
Diabetes mellitus is a non-communicable disease which poses a great burden on refugee populations, who are confronted with limited access to healthcare services and disruption of pre-existing pharmacological treatment. Aims: We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies. Methods: We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits. Results: For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m2 and 28.9 kg/m2 and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up. Conclusions: Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively. Full article
(This article belongs to the Special Issue Social Determinants of Health Disparities and Health Inequities in Populations)
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19 pages, 378 KiB  
Article
The Influence of Organizational Aspects of the U.S. Agricultural Industry and Socioeconomic and Political Conditions on Farmworkers’ COVID-19 Workplace Safety
by Fabiola M. Perez-Lua, Alec M. Chan-Golston, Nancy J. Burke and Maria-Elena De Trinidad Young
Int. J. Environ. Res. Public Health 2023, 20(23), 7138; https://doi.org/10.3390/ijerph20237138 - 3 Dec 2023
Cited by 2 | Viewed by 3129
Abstract
Farmworkers in the U.S. experienced high rates of COVID-19 infection and mortality during the COVID-19 pandemic. Their workplace may have been a significant place of exposure to the novel coronavirus. Using political economy of health theory, this study sought to understand how organizational [...] Read more.
Farmworkers in the U.S. experienced high rates of COVID-19 infection and mortality during the COVID-19 pandemic. Their workplace may have been a significant place of exposure to the novel coronavirus. Using political economy of health theory, this study sought to understand how organizational aspects of the agricultural industry and broader socioeconomic and political conditions shaped farmworkers’ COVID-19 workplace safety during the pandemic. Between July 2020 and April 2021, we conducted and analyzed fourteen in-depth, semi-structured phone interviews with Latinx farmworkers in California. Findings show that regulatory oversight reinforced COVID-19 workplace safety. In the absence of regulatory oversight, the organization of the agricultural industry produced COVID-19 workplace risks for farmworkers; it normalized unsafe working conditions and the worker—rather than employer—responsibility for workplace safety. Under these conditions, farmworkers enacted personal COVID-19 preventative practices but were limited by financial hardships that were exacerbated by the precarious nature of agricultural employment and legal status exclusions from pandemic-related aid. Unsafe workplace conditions negatively impacted workplace camaraderie. Study findings have implications for farmworkers’ individual and collective agency to achieve safe working conditions. Occupational safety interventions must address the organizational aspects that produce workplace health and safety inequities and disempower farmworkers in the workplace. Full article
(This article belongs to the Special Issue Social Determinants of Health Disparities and Health Inequities in Populations)

Review

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27 pages, 541 KiB  
Review
Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings
by M. Lelinneth B. Novilla, Michael C. Goates, Tyler Leffler, Nathan Kenneth B. Novilla, Chung-Yuan Wu, Alexa Dall and Cole Hansen
Int. J. Environ. Res. Public Health 2023, 20(19), 6873; https://doi.org/10.3390/ijerph20196873 - 2 Oct 2023
Cited by 7 | Viewed by 5936
Abstract
Despite the substantial health and economic burdens posed by the social determinants of health (SDH), these have yet to be efficiently, sufficiently, and sustainably addressed in clinical settings—medical offices, hospitals, and healthcare systems. Our study contextualized SDH application strategies in U.S. clinical settings [...] Read more.
Despite the substantial health and economic burdens posed by the social determinants of health (SDH), these have yet to be efficiently, sufficiently, and sustainably addressed in clinical settings—medical offices, hospitals, and healthcare systems. Our study contextualized SDH application strategies in U.S. clinical settings by exploring the reasons for integration and identifying target patients/conditions, barriers, and recommendations for clinical translation. The foremost reason for integrating SDH in clinical settings was to identify unmet social needs and link patients to community resources, particularly for vulnerable and complex care populations. This was mainly carried out through SDH screening during patient intake to collect individual-level SDH data within the context of chronic medical, mental health, or behavioral conditions. Challenges and opportunities for integration occurred at the educational, practice, and administrative/institutional levels. Gaps remain in incorporating SDH in patient workflows and EHRs for making clinical decisions and predicting health outcomes. Current strategies are largely directed at moderating individual-level social needs versus addressing community-level root causes of health inequities. Obtaining policy, funding, administrative and staff support for integration, applying a systems approach through interprofessional/intersectoral partnerships, and delivering SDH-centered medical school curricula and training are vital in helping individuals and communities achieve their best possible health. Full article
(This article belongs to the Special Issue Social Determinants of Health Disparities and Health Inequities in Populations)

Other

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8 pages, 558 KiB  
Brief Report
Regional Differences in American Indian/Alaska Native Chronic Respiratory Disease Disparity: Evidence from National Survey Results
by Kimberly G. Laffey, Alfreda D. Nelson, Matthew J. Laffey, Quynh Nguyen, Lincoln R. Sheets and Adam G. Schrum
Int. J. Environ. Res. Public Health 2024, 21(8), 1070; https://doi.org/10.3390/ijerph21081070 - 15 Aug 2024
Viewed by 851
Abstract
American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive [...] Read more.
American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive pulmonary disease (COPD) in a BRFSS-defined subset of 11 states historically recognized as having a relatively high proportion of AI/AN residents. Here, we investigate the contributions of the AI/AN variable and other sociodemographic determinants to disease disparity in the remaining 39 US states and territories. Using BRFSS surveys from 2011 to 2019, we demonstrate that irrespective of race, the yearly adjusted prevalence for asthma and/or COPD was higher in the 39-state region than in the 11-state region. Logistic regression analysis revealed that the AI/AN race/ethnicity variable was positively associated with disease in the 39-state region after adjusting for sociodemographic covariates, unlike in the 11-state region. This shows that the distribution of disease prevalence and disparity for asthma and/or COPD is non-uniform in the US. Although AI/AN populations experience this disease disparity throughout the US, the AI/AN variable was only observed to contribute to this disparity in the 39-state region. It may be important to consider the geographical distribution of respiratory health determinants and factors uniquely impactful for AI/AN disease disparity when formulating disparity elimination policies. Full article
(This article belongs to the Special Issue Social Determinants of Health Disparities and Health Inequities in Populations)
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14 pages, 337 KiB  
Brief Report
Racial and Ethnic Disparities in Alcohol-Attributed Deaths in the United States, 1999–2020
by Ibraheem M. Karaye, Nasim Maleki and Ismaeel Yunusa
Int. J. Environ. Res. Public Health 2023, 20(8), 5587; https://doi.org/10.3390/ijerph20085587 - 20 Apr 2023
Cited by 9 | Viewed by 2796
Abstract
The disparities in alcohol-attributed death rates among different racial and ethnic groups in the United States (US) have received limited research attention. Our study aimed to examine the burden and trends in alcohol-attributed mortality rates in the US by race and ethnicity from [...] Read more.
The disparities in alcohol-attributed death rates among different racial and ethnic groups in the United States (US) have received limited research attention. Our study aimed to examine the burden and trends in alcohol-attributed mortality rates in the US by race and ethnicity from 1999 to 2020. We used national mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database and employed the ICD-10 coding system to identify alcohol-related deaths. Disparity rate ratios were calculated using the Taylor series, and Joinpoint regression was used to analyze temporal trends and calculate annual and average annual percentage changes (APCs and AAPCs, respectively) in mortality rates. Between 1999 and 2020, 605,948 individuals died from alcohol-related causes in the US. The highest age-adjusted mortality rate (AAMR) was observed among American Indian/Alaska Natives, who were 3.6 times more likely to die from alcohol-related causes than Non-Hispanic Whites (95% CI: 3.57, 3.67). An examination of trends revealed that recent rates have leveled among American Indians/Alaska Natives (APC = 17.9; 95% CI: −0.3, 39.3) while increasing among Non-Hispanic Whites (APC = 14.3; 95% CI: 9.1, 19.9), Non-Hispanic Blacks (APC = 17.0; 95% CI: 7.3, 27.5), Asians/Pacific Islanders (APC = 9.5; 95% CI: 3.6, 15.6), and Hispanics (APC = 12.6; 95% CI: 1.3, 25.1). However, when the data were disaggregated by age, sex, census region, and cause, varying trends were observed. This study underscores the disparities in alcohol-related deaths among different racial and ethnic groups in the US, with American Indian/Alaska Natives experiencing the highest burden. Although the rates have plateaued among this group, they have been increasing among all other subgroups. To address these disparities and promote equitable alcohol-related health outcomes for all populations, further research is necessary to gain a better understanding of the underlying factors and develop culturally sensitive interventions. Full article
(This article belongs to the Special Issue Social Determinants of Health Disparities and Health Inequities in Populations)
10 pages, 1811 KiB  
Brief Report
Investigating the Spatial Relationship between Social Vulnerability and Healthcare Facility Distribution in Nassau County, New York
by Alea Jones, Ijeoma Nnadi, Kelly Centeno, Giselle Molina, Rida Nasir, Gina G. Granger, Nicholas R. Mercado, Andrea A. Ault-Brutus, Martine Hackett and Ibraheem M. Karaye
Int. J. Environ. Res. Public Health 2023, 20(5), 4353; https://doi.org/10.3390/ijerph20054353 - 28 Feb 2023
Cited by 2 | Viewed by 1969
Abstract
Health is a fundamental human right, yet healthcare facilities are not distributed equitably across all communities. This study aims to investigate the distribution of healthcare facilities in Nassau County, New York, and examine whether the distribution is equitable across different social vulnerability levels. [...] Read more.
Health is a fundamental human right, yet healthcare facilities are not distributed equitably across all communities. This study aims to investigate the distribution of healthcare facilities in Nassau County, New York, and examine whether the distribution is equitable across different social vulnerability levels. An optimized hotspot analysis was conducted on a dataset of 1695 healthcare facilities—dental, dialysis, ophthalmic, and urgent care—in Nassau County, and social vulnerability was measured using the FPIS codes. The study found that healthcare facilities were disproportionately distributed in the county, with a higher concentration in areas of low social vulnerability compared to areas of high social vulnerability. The majority of healthcare facilities were found to be clustered in two ZIP codes—11020 and 11030—that rank among the top ten wealthiest in the county. The results of this study suggest that socially vulnerable residents in Nassau County are at a disadvantage when it comes to attaining equitable access to healthcare facilities. The distribution pattern highlights the need for interventions to improve access to care for marginalized communities and to address the underlying determinants of healthcare facility segregation in the county. Full article
(This article belongs to the Special Issue Social Determinants of Health Disparities and Health Inequities in Populations)
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