Chicago Neighborhood Context and Racial/Ethnic Disparities in Maternal Diabetes.

OBJECTIVES: To determine if rates of maternal diabetes vary by race, ethnicity, and neighborhood hardship. METHODS: We conducted a secondary analysis of live births in Chicago from 2010 to 2017. Our sample was restricted to Non-Hispanic White, Non-Hispanic Black, Mexican, Non-Hispanic Asian, and Other Hispanic mothers between the ages of 15 and 50, with singleton births. The addresses of mothers were geocoded to specific neighborhoods, which we stratified into tertiles using the Economic Hardship Index. We used generalized logit mixed models to examine the interaction between race/ethnicity, neighborhood economic hardship, and maternal diabetes. RESULTS: In our cohort of 299,053 mothers, 4.75% were diagnosed with gestational diabetes. Asian mothers had the highest frequency of gestational diabetes (8.3%), followed by Mexican mothers (6.8%). Within their respective racial/ethnic groups, Asian and Mexican mothers living in medium hardship neighborhoods had the highest odds of gestational diabetes compared to the reference group (OR 2.80, 95%CI 2.53, 3.19; OR 2.30, 95%CI 2.12, 2.49 respectively). Overall rates of preexisting diabetes were 0.9% and were highest among Mexican and Black mothers (1.26% and 1.06%, respectively). Asian mothers in medium hardship neighborhoods had the greatest odds of preexisting diabetes, among all Asian mothers and compared to the reference (OR 4.71 95% CI 3.60, 6.16). CONCLUSIONS: For racial and ethnic minoritized mothers, gestational and preexisting diabetes do not increase in a step-wise fashion with neighborhood hardship; rates were often higher in low and medium hardship neighborhoods.

Transitioning the Healthy Chicago Survey From a Telephone Mode to Self-administered by Mail Mode.

CONTEXT: As response rates to health surveys conducted by telephone continue to decline and costs continue to increase, practitioners are increasingly considering a transition to self-administered mail contact modes. OBJECTIVE: To compare empirical differences observed across adjacent administrations of the Healthy Chicago Survey (HCS) conducted by telephone versus self-administered via mail contact. DESIGN: Data from the 2016, 2018, and 2020 administrations of the HCS are contrasted, and demographic distributions are benchmarked against the American Community Survey to investigate differences that may be linked to the HCS' transition from a telephone to self-administered mail mode between 2018 and 2020. SETTING: All survey data were collected from adult residents of Chicago, Illinois, between 2016 and 2020. MAIN OUTCOME MEASURES: Costs, response rates, key health statistics, demographic distributions, and measures of precision generated from the HCS. RESULTS: The mail mode led to a response rate increase of 6.8% to 38.2% at half the cost per complete. Mail respondents are more likely to be nonminority, female, and hold a college degree. Key health statistic differences are mixed, but design effects are larger in the mail mode, which we attribute to more detailed geographic stratification and weighting employed in 2020. CONCLUSIONS: The mail mode is a less costly data collection strategy for the HCS, but it comes with trade-offs. The quasi-random selection of an individual in the household exacerbates sociodemographic distribution disparities.

Association between Food Deserts and Gestational Diabetes Mellitus in a Large Metropolitan Area.

OBJECTIVE: The aim of this study is to determine the relationship between urban food deserts and frequency and obstetric outcomes related to gestational diabetes. STUDY DESIGN: We conducted a retrospective cohort study of singleton births in Chicago from 2010 to 2014. Birth certificate data were analyzed and geomapped by census tract. Census tracts were categorized as "food deserts" according to the USDA Food Access Research Atlas. The primary outcome was frequency of gestational diabetes. Secondary outcomes were assessed among women with gestational diabetes and their neonates. RESULTS: Of the 191,947 eligible women, 8,709 (4.5%) were diagnosed with gestational diabetes. Those in food deserts were more likely to be younger, obese, minority race/ethnicity, and multiparous. Women in food deserts were less likely to develop gestational diabetes (3.8 vs. 4.8%, p < 0.01; adjusted odds ratio 0.91, 95% confidence interval 0.86-0.96). Women with gestational diabetes did not experience worse maternal and neonatal outcomes after controlling for potential confounders. CONCLUSION: In contrast to prior work, women in Chicago living within food deserts were less likely to develop gestational diabetes and did not experience poorer outcomes, suggesting environmental factors other than food access contribute to perinatal outcomes.

Examining Time to Treatment and the Role of School-Based Health Centers in a School-Based Sexually Transmitted Infection Program.

BACKGROUND: Barriers to health care service utilization contribute to the spread of sexually transmitted infections (STIs) among teens. School-based STI screening programs reach adolescents outside of the clinic-based health care model and schools with school-based health centers (SBHCs) may expedite treatment because of their proximity to the population. This study examined whether students who tested positive for STIs in a school-based screening program had differing times to treatment based on treatment location. METHODS: All positive cases of chlamydia and gonorrhea from the 2012-2013 school year in a Chicago Department of Public Health (CDPH) and Chicago Public Schools school-based STI screening program were reviewed. Median time to treatment was compared for those treated at an SBHC versus those treated elsewhere (CDPH STI clinic, community health center, private physician). RESULTS: Overall, 540 students had positive results. The median age was 17 years, 427 had chlamydia (79.1%), 59 had gonorrhea (10.9%), and 54 had dual infections (10.0%); 144 were tested in a school with a SBHC on site (26.7%). Of the 483 students who received treatment (89.4%), those treated at a SBHC had a faster time to treatment compared to CDPH STI clinics (median 17 days versus 28 days, respectively, p < .001). CONCLUSIONS: For students testing positive in the Chicago school-based STI program, time to treatment is accelerated in locations with SBHCs.

Regional infection control assessment of antibiotic resistance knowledge and practice.

OBJECTIVE: Multidrug-resistant organisms (MDROs) are an increasing burden among healthcare facilities. We assessed facility-level perceived importance of and responses to various MDROs. DESIGN: A pilot survey to assess staffing, knowledge, and the perceived importance of and response to various multidrug resistant organisms (MDROs) SETTING: Acute care and long-term healthcare facilities METHODS: In 2012, a survey was distributed to infection preventionists at ~300 healthcare facilities. Pathogens assessed were Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant (defined as bacterial resistance to ≥3 antibiotic classes) Pseudomonas, and extended-spectrum ß-lactamase-producing Escherichia coli. RESULTS: A total of 74 unique facilities responded, including 44 skilled nursing facilities (SNFs) and 30 acute care facilities (ACFs). While ACFs consistently isolated patients with active infections or colonization due to these MDROs, SNFs had more variable responses. SNFs had more multi-occupancy rooms and reported less specialized training in infection control and prevention than did ACFs. Of all facilities with multi-occupancy rooms, 86% employed a cohorting practice for patients, compared with 50% of those without multi-occupancy rooms; 20% of ACFs and 7% of SNFs cohorted staff while caring for patients with the same MDRO. MRSA and C. difficile were identified as important pathogens in ACFs and SNFs, while CRE importance was unknown or was considered important in <50% of SNFs. CONCLUSION: We identified stark differences in human resources, knowledge, policy, and practice between ACFs and SNFs. For regional control of emerging MDROs like CRE, there is an opportunity for public health officials to provide targeted education and interventions. Education campaigns must account for differences in audience resources and baseline knowledge.

Use of the vector index and geographic information system to prospectively inform West Nile virus interventions.

We sought to estimate West Nile virus (WNV) activity in mosquito populations weekly at the census tract level in Chicago, IL, and to provide this information graphically. Each week we calculated a vector index (VI) for each mosquito trap then generated tract estimates using geographic information systems. During June 29-September 13, 2008, a median of 527 (60%) of 874 possible tracts per week had a VI value. Overall, 94% of the weekly VI tract estimates were 0; among those with a VI estimate greater than 0, the median was 0.33 (range 0.003-3.5). Officials deemed risk levels and weather conditions appropriate for adulticide treatments on 3 occasions, resulting in the treatment of approximately 252 linear kilometers of residential streets and alleys. Our analysis successfully converted complex, raw surveillance data into a format that highlighted areas of elevated WNV activity and facilitated the determination of appropriate response procedures.

Clostridium difficile outbreak strain BI is highly endemic in Chicago area hospitals.

OBJECTIVE: Describe the clinical and molecular epidemiology of incident Clostridium difficile infection (CDI) cases in Chicago area acute healthcare facilities (HCFs). DESIGN AND SETTING: Laboratory, clinical, and epidemiologic information was collected for patients with incident CDI who were admitted to acute HCFs in February 2009. Stool cultures and restriction endonuclease analysis typing of the recovered C. difficile isolates was performed. PATIENTS: Two hundred sixty-three patients from 25 acute HCFs. RESULTS: Acute HCF rates ranged from 2 to 7 patients with CDI per 10,000 patient-days. The crude mortality rate was 8%, with 20 deaths occurring in patients with CDI. Forty-two (16%) patients had complications from CDI, including 4 patients who required partial, subtotal, or total colectomy, 3 of whom died. C. difficile was isolated and typed from 129 of 178 available stool specimens. The BI strain was identified in 79 (61%) isolates. Of patients discharged to long-term care who had their isolate typed, 36 (67%) had BI-associated CDI. CONCLUSIONS: Severe disease was common and crude mortality was substantial among patients with CDI in Chicago area acute HCFs in February 2009. The outbreak-associated BI strain was the predominant endemic strain identified, accounting for nearly two-thirds of cases. Focal HCF outbreaks were not reported, despite the presence of the BI strain. Transfer of patients between acute and long-term HCFs may have contributed to the high incidence of BI cases in this investigation.

Acute emergence of Elizabethkingia meningoseptica infection among mechanically ventilated patients in a long-term acute care facility.

OBJECTIVE: To describe an outbreak of infection associated with an infrequently implicated pathogen, Elizabethkingia meningoseptica, in an increasingly prominent setting for health care of severely ill patients, the long-term acute care hospital. DESIGN: Outbreak investigation. SETTING: Long-term acute care hospital with 55 patients, most of whom were mechanically ventilated. METHODS: We defined a case as E. meningoseptica isolated from any patient specimen source from December 2007 through April 2008, conducted an investigation of case patients, obtained environmental specimens, and performed microbiologic testing. RESULTS: Nineteen patients had E. meningoseptica infection, and 8 died. All case patients had been admitted with respiratory failure that required mechanical ventilation. Among the 8 individuals who died, the time from collection of the first specimen positive for E. meningoseptica to death ranged from 6 to 43 days (median, 16 days). Environmental sampling was performed on 106 surfaces; E. meningoseptica was isolated from only one swab. Three related pulsed-field gel electrophoresis patterns were identified in patient isolates; the environmental isolate yielded a fourth, unrelated pattern. CONCLUSION: Long-term acute care hospitals with mechanically ventilated patients could serve as an important transmission setting for E. meningoseptica. This multidrug-resistant bacterium could pose additional risk when patients are transferred between long-term acute care hospitals and acute care hospitals.