Santacroce Leah, Yang Sherry, Summit Rebecca, Valle Ana, Collins Jamie E, Dellaripa Paul F, Feldman Candace H
Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Kennedy School of Government, Cambridge and Harvard Medical School, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2025 Jan;77(1):116-126. doi: 10.1002/acr.25431. Epub 2024 Oct 1.
Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between exposure to adverse environmental burden concentrated in areas with high social vulnerability and care fragmentation (missed appointments, emergency department visits, and hospitalizations) and social needs (eg, food and housing insecurity) among individuals with rheumatic conditions.
We identified adults receiving care in a Massachusetts multihospital system with at least two rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social-Environmental Ranking (SER), which combines census-tract social vulnerability variables (eg, socioeconomic status) with environmental hazards (eg, air and water pollution). Social needs were obtained from self-reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles and care fragmentation and social need burden, accounting for demographics and comorbidities.
Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER quartile 4) areas. Among 7,083 with social needs data, 19% experienced more than one challenge. Individuals in SER quartile 4 areas (vs quartile 1) had 2.02 (95% confidence interval [CI] 1.67-2.46) times greater odds of at least four care fragmentation occurrences (vs 0) and 2.37 (95% CI 1.73-3.25) times greater odds of at least two social needs (vs 0).
Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities.
环境危害与社区社会脆弱性加剧并存，且对少数族裔人群的影响尤为严重。我们调查了暴露于集中在社会脆弱性高的地区的不良环境负担与护理碎片化（错过预约、急诊就诊和住院）以及风湿性疾病患者的社会需求（如食品和住房不安全）之间的关联。
我们在马萨诸塞州的一个多医院系统中确定了接受护理的成年人，他们至少有两个风湿性疾病代码和完整的街道地址。地理编码地址与疾病控制和预防中心/有毒物质和疾病登记机构社会环境排名（SER）相关联，该排名将人口普查区社会脆弱性变量（如社会经济地位）与环境危害（如空气和水污染）相结合。社会需求通过自我报告调查获得。多水平多项回归模型估计了SER四分位数与护理碎片化和社会需求负担之间的关联，并考虑了人口统计学和合并症因素。
在16856名风湿性疾病患者中，70%为女性，6%为黑人，82%为白人，7%居住在社会脆弱性和环境负担综合最高（SER四分位数4）的地区。在7083名有社会需求数据的患者中，19%经历了不止一项挑战。SER四分位数4地区的个体（与四分位数1相比）至少发生四次护理碎片化事件（与0次相比）的几率高2.02倍（95%置信区间[CI]1.67-2.46），至少有两项社会需求（与0项相比）的几率高2.37倍（95%CI 1.73-3.25）。
居住在不良环境负担和社会脆弱性综合较高的地区与护理碎片化和社会需求的几率显著增加有关。解决导致这些不良暴露的结构性因素和新出现的环境威胁对于减少风湿性疾病护理不平等至关重要。
