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The burden and social determinants of asthma for adults in the state of GeorgiaBackground: Asthma is a serious chronic health condition, and social determinants may affect its prevalence. Methods: Data from the Behavioral Risk Factors Surveillance Survey (BRFSS), the Georgia Asthma Call-back Survey (ACBS), and the Georgia hospital and emergency department survey for patients with a diagnosis of asthma were used. All data were from the years 2011 through 2014. SAS and SUDAAN software were used to calculate weighted prevalence estimates and to perform univariate and multivariate analyses of the association between social determinants, other risk factors, and asthma outcomes. Results: The prevalence of asthma was highest among non-Hispanic blacks, women, and persons with less than a high school education, with an annual household income below $25,000, and in rural parts of the state (south and northwest Georgia). Those without insurance for more than three years had a higher prevalence of asthma than those who had insurance or had been uninsured less than 6 months. Although the percentage without insurance declined from 2012 to 2014, more than 1 in 5 adults of working age with asthma still lacked health insurance, and more than half had been without it for more than 3 years. One-third of Georgians with asthma could not see a doctor, at least on one occasion, because of cost, and more than a third were currently paying off medical bills. Approximately one quarter did not report having a personal physician, and a similar percentage reported having more than one year since their last check-up. In multivariate analyses, women (adjusted odds ratio [aOR] 1.61), smokers (aOR 1.54), and persons with a higher BMI (aOR 1.56) were all independently associated with having asthma. Conclusions: For the state of Georgia, there are associations between social determinants, such as education, income, and geography, and the prevalence of asthma, and many patients lack access to care. Addressing social determinants, including having affordable health insurance, is necessary to improve management of asthma.
Predictors of mammogram and Pap screenings among US womenBackground: The most common cancers among women are breast and cervical cancer. Although early detection of cancer has been shown to increase the likelihood of survival, many women are not screened for these cancers as often as practice guidelines recommend. The objective of this study was to examine the mammography and Papanicolaou (Pap) smear screening practices among women within the United States, and to determine predictors of screening. Methods: Data from the 2012 and 2014 Behavioral Risk Factor Surveillance System were used. The association between demographic predictors (age, marital status, education level, employment status, income, health insurance, and medical cost concerns) and having Pap or mammogram screening consistent with guideline recommendations was assessed using logistic regression analysis. Results: Pap and mammography screenings were positively associated with younger age, minority race, being married, having a higher level of education, being employed, having higher household income, having health insurance and not having financial concerns regarding affording doctor visits. Blacks and Hispanic women were more than twice as likely to have Pap screenings (Black: OR=2.16, 95% CI 1.97-2.36; Hispanic: OR=2.33, 95% CI = 2.11-2.58) and mammograms (Blacks: OR=2.11, 95% CI 1.88-2.36; Hispanics OR=1.82, 95% CI 1.60-2.07) compared to White women. Women earning less than $10,000 per annum were much less likely to have cervical cancer screenings (OR=0.57, 95% CI 0.51-0.65) compared to women with higher incomes while mammography screening was less likely among women who reported financial barriers to health care (OR=0.59, 95% CI 0.53-0.64). Conclusions: Women from minority ethnic groups were more likely to be screened for cervical cancer compared to White, non-Hispanic women. Women from low-income households and women who could not visit a doctor due to costs had the strongest association with lacking screenings.