Ji E Chang
Ji E Chang
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Associate Professor of Public Health Policy and Management
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Professional overview
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Ji Eun Chang, Ph.D., is an Associate Professor in the Department of Public Health Policy and Management at the New York University School of Global Public Health, where she also serves as the public health policy and management concentration director for the Ph.D. program. Professor Chang uses mixed-methods research designs and draws from qualitative, quantitative, and geospatial data to demonstrate disparities and highlight barriers faced by safety net providers and underserved patients in accessing equitable care.
Professor Chang is the principal investigator of the AI4Healthy Cities Initiative in New York City, a multi-city collaboration between the Novartis Foundation, Microsoft AI4Health, and local health officials to reduce cardiovascular health inequities through big data analytics. Dr. Chang is also the co-principal investigator of an NIH NIDA-funded study to support implementing transitional opioid programs in safety net hospitals. Dr. Chang received a B.A. in Economics from the University of California at Berkeley, an M.S. in Public Policy and Management from Carnegie Mellon University, and a Ph.D. in Public Administration from New York University in 2016. -
Education
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BA, Economics, University of California at Berkeley, Berkeley, CAMS, Public Policy and Management, Carnegie Mellon University, Pittsburgh, PAPhD, Public Administration, New York University, New York, NY
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Honors and awards
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Governor’s Scholar (2007)Regents and Chancellors’ Scholar (2005)
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Areas of research and study
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Cardiovascular DiseaseHealth DisparitiesHealth EquityPublic Health ManagementPublic Health ManagementSafety Net Providers and PatientsSubstance Use Disorders
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Publications
Publications
Association of Telehealth Utilization Among Patients with Heart Disease with Fewer Emergency Department Visits and Hospitalizations during COVID-19 Pandemic
AbstractLee, J., Bhatt, A., Jackson, S., Ton, X., Chang, J., Pollack, M., Luo, F., & Chang, J. E. (n.d.).Publication year
2024Journal title
Health Affairs ScholarIssue
2047-9980 (Electronic)Abstract~Barriers and Facilitators to Establishing Partnerships for Substance Use Disorder Care Transitions Between Safety-Net Hospitals and Community-Based Organizations
AbstractLindenfeld, Z., Franz, B., Lai, A. Y. Y., Pagán, J. A., Fenstemaker, C., Cronin, C. E., Chang, J. E. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of general internal medicineVolume
39Issue
12Page(s)
2150-2159AbstractThe effectiveness of hospital-based transitional opioid programs (TOPs), which aim to connect patients with substance use disorders (SUD) to ongoing treatment in the community following initiation of medication for opioid use disorder (MOUD) treatment in the hospital, hinges on successful patient transitions. These transitions are enabled by strong partnerships between hospitals and community-based organizations (CBOs). However, no prior study has specifically examined barriers and facilitators to establishing SUD care transition partnerships between hospitals and CBOs.Barriers and Facilitators to Establishing Partnerships for Substance Use Disorder Care Transitions Between Safety-Net Hospitals and Community-Based Organizations
AbstractLindenfeld, Z., Franz, B., Lai, A. Y. Y., Pagán, J. A., Fenstemaker, C., Cronin, C. E., Chang, J. E. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of general internal medicineVolume
39Issue
12Page(s)
2150-2159AbstractThe effectiveness of hospital-based transitional opioid programs (TOPs), which aim to connect patients with substance use disorders (SUD) to ongoing treatment in the community following initiation of medication for opioid use disorder (MOUD) treatment in the hospital, hinges on successful patient transitions. These transitions are enabled by strong partnerships between hospitals and community-based organizations (CBOs). However, no prior study has specifically examined barriers and facilitators to establishing SUD care transition partnerships between hospitals and CBOs.Comparing Rates of Undiagnosed Hypertension and Diabetes in Patients With and Without Substance Use Disorders
AbstractLindenfeld, Z., Chen, K., Kapur, S., Chang, J. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of general internal medicineVolume
39Issue
9Page(s)
1632-1641AbstractIndividuals with substance use disorders (SUDs) have increased risk for developing chronic conditions, though few studies assess rates of diagnosis of these conditions among patients with SUDs.Comparing Rates of Undiagnosed Hypertension and Diabetes in Patients with and without Substance Use Disorders
AbstractLindenfeld, Z., Chen, K., Kapur, S., Chang, J., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of General Internal MedicineAbstract~Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program
AbstractWang, V. H.-C. H., Cuevas, A. G., Osokpo, O. H. H., Chang, J. E. E., Zhang, D., Hu, A., Yun, J., Lee, A., Du, S., Williams, D. R., Pagán, J. A., & Chang, J. E. (n.d.).Publication year
2024Journal title
American journal of preventive medicineVolume
67Issue
4Page(s)
568-580AbstractDiscrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations.Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017-2020
AbstractLindenfeld, Z., Silver, D., Pagán, J. A., Zhang, D. S. S., Chang, J. E. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5Page(s)
e0304256AbstractDespite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017-2020.Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017–2020
AbstractLindenfeld, Z., Silver, D. R., Pagán, J. A., Zhang, D. S., & Chang, J. E. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5 MAYAbstractIntroduction Despite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017–2020. Methods This longitudinal analysis of 2,846 counties from 2017–2020 used bivariate and multivariate Generalized Estimating Equations models to estimate associations between county overdose mortality rates and SDOH characteristics, including the fines and forfeitures measure. Results In our multivariate model, higher per capita fine and forfeiture revenue (5.76; CI: 4.76, 6.78), households receiving food stamps (1.15; CI: 0.77, 1.53), residents that are veterans (1.07; CI: 0.52, 1.63), substance use treatment availability (4.69; CI: 3.03, 6.33) and lower population density (-0.002; CI: -0.004, -0.001) and percent of Black residents (-0.7‘; CI: -1.01, -0.42) were significantly associated with higher overdose death rates. There was a significant additive interaction between the fines and forfeitures measure (0.10; CI: 0.03, 0.17) and the percent of Black residents. Conclusions Our findings suggest that structural racism, along with other SDOH, is associated with overdose deaths. Future research should focus on connecting individual-level data on fines and forfeitures to overdose deaths and other health outcomes, include measures of justice-related fines, such as court fees, and assess whether interventions aimed at increasing economic vitality in disadvantaged communities impact overdose deaths in a meaningful way.Hospital use of common Z-codes for Medicare fee-for-service beneficiaries, 2017-2021
AbstractChang, J. E., Smith, N., Lindenfeld, Z., & Weeks, W. B. (n.d.).Publication year
2024Journal title
Health affairs scholarVolume
2Issue
1Page(s)
qxad086AbstractRecognizing the impact of the social determinants of health (SDOH) on health outcomes, in 2016, the Centers for Medicare and Medicaid Services recommended the use of (ICD-10), Z-codes to capture patients' health-related social needs. We examined changes in Z-code utilization to document health-related social needs for Medicare fee-for-service recipients among US hospitals between 2017 and 2021 across 5 common SDOH domains. We found that, while 56.9% of hospitals had at least 1 Z-code recorded in at least 1 patient per year, apart from those referring to housing needs, rates of Z-code adoption were low. Additionally, hospitals that were general medical, part of a teaching institution, affiliated with larger health systems, and of medium to large size had greater odds of utilizing Z-codes. Findings from this study highlight the need for continued efforts in promoting the consistent use of standardized SDOH capturing methods like Z-code documentation, such as provider training.Hospital use of common Z-codes for Medicare fee-for-service beneficiaries, 2017-2021
AbstractChang, J. E., Smith, N., Lindenfeld, Z., Weeks, W. B., & Chang, J. E. (n.d.).Publication year
2024Journal title
Health affairs scholarVolume
2Issue
1Page(s)
qxad086AbstractRecognizing the impact of the social determinants of health (SDOH) on health outcomes, in 2016, the Centers for Medicare and Medicaid Services recommended the use of (ICD-10), Z-codes to capture patients' health-related social needs. We examined changes in Z-code utilization to document health-related social needs for Medicare fee-for-service recipients among US hospitals between 2017 and 2021 across 5 common SDOH domains. We found that, while 56.9% of hospitals had at least 1 Z-code recorded in at least 1 patient per year, apart from those referring to housing needs, rates of Z-code adoption were low. Additionally, hospitals that were general medical, part of a teaching institution, affiliated with larger health systems, and of medium to large size had greater odds of utilizing Z-codes. Findings from this study highlight the need for continued efforts in promoting the consistent use of standardized SDOH capturing methods like Z-code documentation, such as provider training.Identifying and Characterizing Models of Substance Use Treatment in Outpatient Substance Use Treatment Facilities
AbstractLindenfeld, Z., Cantor, J. H., Chang, J. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of studies on alcohol and drugsAbstractGiven that individuals with substance use disorders (SUDs) have a variety of needs beyond substance use, it is critical to examine the comprehensiveness of services offered within outpatient SUD treatment facilities, where many individuals with SUDs receive care. This study's objective is to develop clusters of services offered, and assess organizational, policy, and environmental characteristics associated with having a more comprehensive treatment model.Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals
AbstractKrawczyk, N., Rivera, B. D., Chang, J. E., Lindenfeld, Z., & Franz, B. (n.d.).Publication year
2024Journal title
Journal of Addiction MedicineVolume
18Issue
2Page(s)
115-121AbstractBackground Hospitals are a key touchpoint to reach patients with substance use disorders (SUDs) and link them with ongoing community-based services. Although there are many acute care interventions to initiate SUD treatment in hospital settings, less is known about what services are offered to transition patients to ongoing care after discharge. In this study, we explore what SUD care transition strategies are offered across nonprofit US hospitals. Methods We analyzed administrative documents from a national sample of US hospitals that indicated SUD as a top 5 significant community need in their Community Health Needs Assessment reports (2019-2021). Data were coded and categorized based on the nature of described services. We used data on hospitals and characteristics of surrounding counties to identify factors associated with hospitals' endorsement of transition interventions for SUD. Results Of 613 included hospitals, 313 prioritized SUD as a significant community need. Fifty-three of these hospitals (17%) offered acute care interventions to support patients' transition to community-based SUD services. Most (68%) of the 53 hospitals described transition strategies without further detail, 23% described scheduling appointments before discharge, and 11% described discussing treatment options before discharge. No hospital characteristics were associated with offering transition interventions, but such hospitals were more likely to be in the Northeast, in counties with higher median income, and states that expanded Medicaid. Conclusions Despite high need, most US hospitals are not offering interventions to link patients with SUD from acute to community care. Efforts to increase acute care interventions for SUD should identify and implement best practices to support care continuity.Machine learning to evaluate the relationship between social determinants and diabetes prevalence in New York City
AbstractTanner, D., Zhang, Y., Chang, J. E. E., Speyer, P., Adamson, E., Aerts, A., Lavista Ferres, J. M., Weeks, W. B., & Chang, J. E. (n.d.).Publication year
2024Journal title
BMJ public healthVolume
2Issue
2Page(s)
e001394AbstractDiabetes is a leading contributor to cardiovascular disease and mortality; social determinants of health (SDOH) are associated with disparities in diabetes risk. Quantifying the cumulative impact of SDOH and identifying the SDOH most associated with diabetes prevalence at the neighbourhood level can help policy-makers design and target local interventions to mitigate these disparities. Machine learning (ML) methods can provide novel insights and help inform public health intervention strategies in a place-based manner.Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services
AbstractFranz, B., Cronin, C. E., Lindenfeld, Z., Pagan, J. A., Lai, A. Y. Y., Krawczyk, N., Rivera, B. D., Chang, J. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of substance use and addiction treatmentVolume
160Page(s)
209280AbstractHospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use-related complications. Transitional opioid programs-which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services-have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States.Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services
AbstractFranz, B., Cronin, C. E., Lindenfeld, Z., Pagan, J. A., Lai, A. Y., Krawczyk, N., Rivera, B. D., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of Substance Use and Addiction TreatmentVolume
160AbstractIntroduction: Hospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use–related complications. Transitional opioid programs—which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services—have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States. Methods: Using hospital administrative data paired with county-level demographic data, we conducted bivariate and regression analyses to assess rural-urban differences in the availability of transitional opioid services including screening, addiction consult services, and MOUD in U.S general medical centers, controlling for hospital- and community-level factors. Our sample included 2846 general medical hospitals that completed the 2021 American Hospital Association (AHA) Annual Survey of Hospitals. Our primary outcomes were five self-reported measures: whether the hospital provided screening in the ED; provided screening in the inpatient setting; whether the hospital provided addiction consult services in the ED; provided addiction consult services in the inpatient setting; and whether the hospital provided medications for opioid use disorder. Results: Rural hospitals did not have lower odds of screening for OUD or other SUDs than urban hospitals, but both micropolitan rural counties and noncore rural counties had significantly lower odds of having addiction consult services in either the ED (OR: 0.74, 95 % CI: 0.58, 0.95; OR: 0.68, 95 % CI: 0.50, 0.91) or inpatient setting (OR: 0.76, 95 % CI: 0.59, 0.97; OR: 0.68, 95 % CI: 0.50, 0.93), respectively, or of offering MOUD (OR: 0.69, 95 % CI: 0.52, 0.90; OR: 0.52, 95 % CI: 0.37, 0.74). Conclusions: Our study suggests that evidence-based interventions, such as medications for opioid use disorder and addiction consult services, are less often available in rural hospitals, which may contribute to rural-urban disparities in health outcomes secondary to OUD. A priority for population health improvement should be developing implementation strategies to support rural hospital adoption of transitional opioid programs.Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services.
AbstractFranz, B., Cronin, C. E., Lindenfeld, Z., Pagan, J. A., Lai, A. Y., Krawczyk, N., Rivera, B. D., Chang, J. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of Substance Use and Addiction TreatmentIssue
2949-8759 (Electronic)Abstract~Suicide ideation and behavior disparities among high school students: Examining Asian and multiracial race/ethnicity groups
AbstractChoi, S., & Chang, J. E. (n.d.).Publication year
2024Abstract~Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization
AbstractLee, J. S. S., Bhatt, A., Pollack, L. M., Jackson, S. L., Chang, J. E. E., Tong, X., Luo, F., & Chang, J. E. (n.d.).Publication year
2024Journal title
Health affairs scholarVolume
2Issue
1AbstractTelehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022). We used difference-in-differences methodology adjusting for patients' characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1000 persons), and number of inpatient admissions (by -32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.The Ecology of Economic Distress and Life Expectancy
AbstractWeeks, W. B. B., Chang, J. E., Pagán, J. A., Adamson, E., Weinstein, J., Ferres, J. M. L., & Chang, J. E. (n.d.).Publication year
2024Journal title
International journal of public healthVolume
69Page(s)
1607295AbstractTo determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level.The Ecology of Economic Distress and Life Expectancy
AbstractWeeks, W. B., Chang, J. E., Pagán, J. A., Adamson, E., Weinstein, J., & Ferres, J. M. (n.d.).Publication year
2024Journal title
International Journal of Public HealthVolume
69AbstractObjectives: To determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level. Methods: Between 12/1/22 and 2/28/23, we conducted a retrospective analysis of 2000 and 2019 data from 3,123 United States counties. For Total, White, and Black populations, we compared LE changes for counties across the rural-urban continuum, the local economic prosperity continuum, and for counties in which local economic prosperity dramatically improved or declined. Results: In both years, overall, across the rural-urban continuum, and for all studied populations, LE decreased with each progression from the most to least prosperous quintile (all p < 0.001); improving county prosperity between 2000–2019 was associated with greater LE gains (p < 0.001 for all). Conclusion: At the county level, race, rurality, and local economic distress were all associated with LE; improvements in local economic conditions were associated with accelerated LE. Policymakers should appreciate the health externalities of investing in areas experiencing poor economic prosperity if their goal is to improve population health.Toward a Consensus on Strategies to Support Opioid Use Disorder Care Transitions Following Hospitalization : A Modified Delphi Process
AbstractKrawczyk, N., Miller, M., Englander, H., Rivera, B. D., Schatz, D., Chang, J. E., Cerdá, M., Berry, C., & McNeely, J. (n.d.).Publication year
2024Journal title
Journal of general internal medicineAbstractBackground: Despite proliferation of acute-care interventions to initiate medications for opioid use disorder (MOUD), significant challenges remain to supporting care continuity following discharge. Research is needed to inform effective hospital strategies to support patient transitions to ongoing MOUD in the community. Objective: To inform a taxonomy of care transition strategies to support MOUD continuity from hospital to community-based settings and assess their perceived impact and feasibility among experts in the field. Design: A modified Delphi consensus process through three rounds of electronic surveys. Participants: Experts in hospital-based opioid use disorder (OUD) treatment, care transitions, and hospital-based addiction treatment. Main Measures: Delphi participants rated the impact and feasibility of 14 OUD care transition strategies derived from a review of the scientific literature on a scale from 1 to 9 over three survey rounds. Panelists were invited to suggest additional care transition strategies. Agreement level was calculated based on proportion of ratings within three points of the median. Key Results: Forty-five of 71 invited panelists participated in the survey. Agreement on impact was strong for 12 items and moderate for 10. Agreement on feasibility was strong for 11 items, moderate for 7, and poor for 4. Strategies with highest ratings on impact and feasibility included initiation of MOUD in-hospital and provision of buprenorphine prescriptions or medications before discharge. All original 14 strategies and 8 additional strategies proposed by panelists were considered medium- or high-impact and were incorporated into a final taxonomy of 22 OUD care transition strategies. Conclusions: Our study established expert consensus on impactful and feasible hospital strategies to support OUD care transitions from the hospital to community-based MOUD treatment, an area with little empirical research thus far. It is the hope that this taxonomy serves as a stepping-stone for future evaluations and clinical practice implementation toward improved MOUD continuity and health outcomes.Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022
AbstractLindenfeld, Z., Cantor, J. H., Chang, J. E., & Chang, J. E. (n.d.).Publication year
2024Journal title
The American journal of drug and alcohol abuseVolume
50Issue
5Page(s)
715-726AbstractLittle is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs. To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022. We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities ( = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics. Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30-1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30-1.74), performed community outreach (OR: 2.05; 95%CI: 1.80-2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06-3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08-2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99-0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00-1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01-1.45), had significantly higher odds of adopting a comprehensive service model. Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022
AbstractLindenfeld, Z., Cantor, J. H., & Chang, J. E. (n.d.).Publication year
2024Journal title
American Journal of Drug and Alcohol AbuseAbstractBackground: Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients’ medical and social needs. Objective: To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022. Methods: We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities (n = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics. Results: Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30–1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30–1.74), performed community outreach (OR: 2.05; 95%CI: 1.80–2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06–3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08–2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99–0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00–1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01–1.45), had significantly higher odds of adopting a comprehensive service model. Conclusion: Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.Academy Health Annual Research Meeting Health Disparities Special Session Coordinator and Moderator: AI Applications in Health and Public Health: Cross-Sector Strategies to Mitigate Bias
AbstractChang, J. E. (n.d.).Publication year
2023Abstract~An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health
AbstractWeeks, W. B., Chang, J. E., Pagán, J. A., Aerts, A., Weinstein, J. N., & Ferres, J. L. (n.d.).Publication year
2023Journal title
International Journal for Equity in HealthVolume
22Issue
1AbstractBackground: Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. Methods: For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group’s 2015–2019 Distressed Community Index Scores. Results: With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. Conclusions: In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.