Background: Alzheimer's Disease-Related Dementias (ADRD) and diabetes disproportionately affect women, who face increased dementia risk and cardiovascular risks from diabetes. Socioeconomic disadvantages may exacerbate poor outcomes and limited care access.

Objective: Investigate the overlapping U.S. county-level prevalence of ADRD, diabetes, and poverty among women across ethnicities to identify geographical hotspots warranting further study.

Method: Conducted cluster and outlier spatial analysis (Anselin Local Moran's I) on 2012-2022 Medicare/Medicaid claims for females over 65 across ethnicities and 2020 CDC Social Vulnerability Index poverty data. Identified significant hotspots of high ADRD, diabetes prevalence, and poverty, then intersected these variables.

Results: Significant clusters and intersections emerged in the Midwest and Southeast counties, within notable ethnic disparities. Counties with high prevalence of ADRD, diabetes, and poverty across strata are found in the states of Alabama, Georgia, Kentucky, Louisiana, North Carolina, and Virginia. Data limitations for non-White groups may influence observed distributions.

Conclusion: These findings highlight the need for detailed local investigations and tailored health interventions in these areas, emphasizing ongoing monitoring to reduce geographic health disparities and improve disease management for socioeconomically disadvantaged women.

Background:

Insurance type may impact decisions to forego medical visits or medications necessary for Type 2 Diabetes (T2DM) management. However, little is known about how neighborhood-level vulnerability may affect these decisions alongside insurance types.

Objective:

This study examined the impact of neighborhood social vulnerability on the relationship between insurance type and health behaviors in an academic health system.

Methods:

This cross-sectional study utilized electronic health record data collected from patients with T2DM attending primary care visits from January 1, 2017-December 31, 2022 Patients self-reported whether they skipped a medical visit or medication in the past year. Insurance was categorized as private (reference), Medicare, or Medicaid based on the primary payor billed for the visit. Patient home addresses were matched to the CDC’s Social Vulnerability Index (SVI) and were stratified into low (SVI <.5) or high (SVI ≥.5) vulnerability. The association between insurance and skipping behavior was evaluated using multivariable logistic regression for each stratum.

Results:

Among the low SVI group, insurance type was associated with skipping medical visits (Medicare: OR: 0.50, 95% CI: 0.29-0.84, P=0.01; Medicaid: OR: 1.95, 95% CI: 0.98-3.39; P=0.06) and skipping medications (Medicare: OR: 0.51, 95% CI: 0.32-0.81, P=0.005; Medicaid OR: 1.50, 95% CI: 0.78-2.89, P=0.22). No associations were observed among the high SVI group.

Conclusion:

Type of insurance may hinder access to diabetes care, especially among primary care patients residing in neighborhoods with low SVI. Future projects should investigate differences in coverage within each insurance type by SVI and how they impact avoidant health behaviors.

Background: Social, economic, and demographic factors are recognized health determinants. The CDC Social Vulnerability Index (SVI) aggregates these factors by census tract to describe susceptibility to health disasters. Developing similar indices at an individual level may help explore social determinants in population studies.

Objective: To develop an individual-level SVI in the National Health and Nutrition Examination Survey (NHANES) and evaluate its association with mortality.

Methods: Adult data from annual NHANES cycles (1999-2018) were combined. The SVI summed adversity indicators for seven components: income, education, race/ethnicity, health insurance, housing tenure, employment, and food security. Higher scores indicated higher vulnerability. Mortality (all-cause, cardiovascular disease, and cancer) was ascertained via the National Death Index. Survey-weighted Cox proportional hazard models evaluated the association between SVI and mortality, adjusted for age, sex, smoking status, and BMI.

Results: Participants (N = 59,064) were 46.1 ± 17.5 years at baseline and followed for 9.9 ± 5.7 years. Deceased participants (N = 9,249) had higher SVI scores (2.34 ± 1.58) compared to surviving participants (1.86 ± 1.74). A one unit increase in SVI was associated with 1.19 times higher hazard of all-cause mortality (95% CI 1.17-1.21), 1.21 times higher hazard of cardiovascular disease mortality (95% CI 1.17-1.24), and 1.08 times higher hazard of cancer mortality (95% CI 1.04-1.12).

Conclusion: Having a greater number of social vulnerability factors was associated with all-cause, cardiovascular disease, and cancer mortality over follow-up. Future directions include evaluating additional approaches for SVI construction.

Background In the United States, disparities in access to kidney transplantation persist despite legislative entitlement to Medicare for patients with end-stage renal disease.

Objective Examine whether other social determinants of health (SDOH), not collected in national registries, explain persisting disparities among Medicare versus privately insured kidney candidates.

Methods We merged Organ Procurement and Transplantation Network data with SDOH measures from LexisNexis, area deprivation index (ADI), and social vulnerability index (SVI). We included adult kidney-alone transplant candidates on the waiting list in 2022.

Results: A total of 89,820 kidney candidates were included in our analysis including 50.9% who were privately insured and compared to candidates with Medicare (49.1%). Privately insured candidates were more likely to be White (44% versus 39%), college educated (37% versus 25%) have a lower median ADI (lower deprivation) and SVI (lower vulnerability) coupled with higher median income at the individual ($61,000 (IQR: $38,000-$81,000) versus $72,000 (IQR: $45,000-$92,000)) and neighborhood($59,000 (IQR: $44,000-$80,000)) versus privately insured patients ($69,000 (IQR: $51,000-$93,000)) level. A greater proportion of privately insured patients preemptively waitlisted (34% versus 21%).

Conclusion We demonstrated that patients on Medicare experienced more adverse individual- and area-level SDOH compared with those on private insurance and may explain the observed disparities between individuals with Medicare and private insurance in access to transplant and outcomes.