Assessing the impact of socioeconomic status on incidental lung nodules at an urban safety net hospital.

INTRODUCTION: Lower socioeconomic status has been identified as an emerging risk factor for health disparities, including lung cancer outcomes. Most research investigating these outcomes includes patients from formal lung cancer screening programs. There is a paucity of studies assessing the relationship between socioeconomic status and incidental lung nodules. This study aimed to investigate the association between socioeconomic status and the size of incidental lung nodules on initial presentation at an urban safety net hospital, which did not have a formal lung cancer screening program or incidental lung nodule program. METHODS: A retrospective chart review was conducted on patients with incidental lung nodules on CT chest imaging who were referred from primary care to a pulmonology clinic at a safety net hospital. Patients with incomplete nodule characteristics information were excluded. Data on demographics, comorbidities, smoking history, insurance type, immigration status, and geographical factors were collected. Less commonly studied determinants such as crime index, cost of living, and air quality index were also assessed. Logistic regression analysis was performed to assess relationships between nodule size and socioeconomic determinants. RESULTS: Out of 3,490 patients with chest CT scans, 268 patients with ILNs were included in the study. 84.7% of patients represented racial or ethnic minorities, and most patients (67.8%) had federal insurance. Patients with non-commercial insurance were more likely to have larger, inherently higher-risk nodules (> 8 mm) compared to those with commercial insurance (OR 2.18, p 0.01). Patients from areas with higher unemployment rates were also less likely (OR 0.75, p 0.04) to have smaller nodules (< 6 mm). Patients representing racial or ethnic minorities were also more likely to have nodules > 8 mm (OR 1.6, p 0.24), and less likely to have nodules < 6 mm (OR 0.6, p 0.32), however, these relationships were not statistically significant. CONCLUSION: This study found that lower socioeconomic status, indicated by having non-commercial insurance, was associated with larger incidental lung nodule size on initial presentation. While it is established that socioeconomic status is associated with disparities in lung cancer screening, these findings suggest that inequalities may also be present in those with incidental lung nodules. Further research is needed to understand the underlying mechanisms and develop interventions to address these disparities in incidental lung nodule evaluation and improve outcomes.

Community Perceptions of Health Equity: A Qualitative Study.

INTRODUCTION: Notable inequities in patient experiences exist in the healthcare system. Communities with a large concentration of blacks and immigrants are often marginalized rather than centralized in the healthcare system. These inequities may fuel distrust and exacerbate adverse outcomes, thereby widening the health gap. Addressing differences in patients' experiences of care is paramount for reducing health inequities. METHODS: In this qualitative study, we used a purposive sampling method to recruit 62 participants to conduct 10 FGs (44 participants total) and 18 key informant interviews with stakeholders across Central Brooklyn. RESULTS: The data revealed three primary themes: Trust, Discrimination, and Social Determinants of Health (SDOHs). Each theme comprised subthemes as follows: For Trust, the subthemes included (1) confidence in the healthcare professional, (2) provider empathy, and (3) active participation in healthcare decisions. Regarding Discrimination, the subthemes involved (1) racism and identity, as well as (2) stigma related to diagnosis, disease state, and pain management. Lastly, for Social Determinants of Health, the key subtheme was the acknowledgment by providers that patients encounter competing priorities acting as barriers to care, such as housing instability and food insecurity. For the first theme, participants' interactions with the healthcare system were prompted by a necessity for medical attention, and not by trust. The participants reported that experiences of discrimination resulting from identity and stigma associated with diagnosis, disease state, and pain management amplified the disconnect between the community, the patients, and the healthcare system. This also exacerbated the poor healthcare experiences suffered by many people of color. For SDOHs, the participants identified housing, food security, and other various social factors that may undermine the effectiveness of the healthcare that patients receive. CONCLUSIONS: Improvements in the health system, based on feedback from patients of color regarding their unique care experiences, are important initiatives in combating inequities in healthcare.

Predictors of severity of alcohol withdrawal in hospitalized patients.

BACKGROUND: Alcohol withdrawal is a relatively common problem among chronic alcohol users, and its severity will determine the setting in which it will be more appropriate to take care of the patients. Those with mild symptoms will be managed in an outpatient setting, as opposed to those with advanced moderate or severe symptoms who will require inpatient management. Among those patients who will require hospitalization, some of them will do well in a regular floor, but some of them will have to be managed in an intensive care unit. We tried to determine whether some variables could be predictive of an increased risk of being managed in an intensive care unit as opposed to being managed in a regular medical floor. METHODS: A retrospective non-randomized review trial design was implemented and a total of 110 medical charts of patients admitted to our institution with severe alcohol withdrawal during the calendar year of 2009 were reviewed. Different demographic and clinical parameters were analyzed, and their significance established in regard to the clinical settings (ICU vs. medical floor) in which the patients were managed. RESULTS: The patients managed in the ICU were found to be younger than their counterparts who were managed in the medical floor, and they were more likely to be white and unemployed. On the other hand, being diabetic, using over-the-counter drugs or prescribed medications appeared to be protective factors, resulting in management of alcohol withdrawal on the medical floors. CONCLUSION: A likely explanation to our findings could be that patients exhibiting better health protective behaviors have a better chance to stay away from the ICU. However no tools could be developed to stratify the patients' risks and more behavioral and observational cohort studies will be needed for that purpose.