Jose Pagan
Jose Pagan
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Chair and Professor of the Department of Public Health Policy and Management
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Professional overview
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Dr. Pagán received his PhD in economics from the University of New Mexico and is a former Robert Wood Johnson Foundation Health & Society Scholar with expertise in health economics and population health. He has led research, implementation, and evaluation projects on the redesign of health care delivery and payment systems. He is interested in population health management, health care payment and delivery system reform, and the social determinants of health. Over the years his research has been funded through grants and contracts from the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the European Commission, and the Robert Wood Johnson Foundation, among others.
Dr. Pagán is Chair of the Board of Directors of NYC Health + Hospitals, the largest public healthcare system in the United States. He also served as Chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Health Policy Research Scholars and was a member of the Board of Directors of the Interdisciplinary Association for Population Health Science and the American Society of Health Economists.
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Areas of research and study
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Applied EconomicsHealth EconomicsPopulation HealthPublic Health Policy
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Publications
Publications
Cost-Effectiveness of the Second COVID-19 Booster Vaccination in the USA
AbstractLi, R., Lu, P., Fairley, C. K., Pagán, J. A., Hu, W., Yang, Q., Zhuang, G., Shen, M., Li, Y., & Zhang, L. (n.d.).Publication year
2024Journal title
Applied Health Economics and Health PolicyVolume
22Issue
1Page(s)
85-95AbstractObjective: To assess the cost effectiveness of the second COVID-19 booster vaccination with different age groups. Methods: We developed a decision-analytic Susceptible-Exposed-Infected-Recovered (SEIR)-Markov model by five age groups (0–4 years, 5–11 years 12–17 years, 18–49 years, and 50+ years) and calibrated the model by actual mortality in each age group in the USA. We conducted five scenarios to evaluate the cost effectiveness of the second booster strategy and incremental benefits if the strategy would expand to 18–49 years and 12–17 years, from a health care system perspective. The analysis was reported according to the Consolidated Health Economic Evaluation Reporting Standards 2022 statement. Results: Implementing the second booster strategy for those aged ≥ 50 years cost $823 million but reduced direct medical costs by $1166 million, corresponding to a benefit-cost ratio of 1.42. Moreover, the strategy also resulted in a gain of 2596 quality-adjusted life-years (QALYs) during the 180-day evaluation period, indicating it was dominant. Further, vaccinating individuals aged 18–49 years with the second booster would result in an additional gain of $1592 million and 8790 QALYs. Similarly, expanding the vaccination to individuals aged 12–17 years would result in an additional gain of $16 million and 403 QALYs. However, if social interaction between all age groups was severed, vaccination expansion to ages 18–49 and 12–17 years would no longer be dominant but cost effective with an incremental cost-effectiveness ratio (ICER) of $37,572 and $26,705/QALY gained, respectively. Conclusion: The second booster strategy was likely to be dominant in reducing the disease burden of the COVID-19 pandemic. Expanding the second booster strategy to ages 18–49 and 12–17 years would remain dominant due to their social contacts with the older age group.Enrollment Patterns of Medicare Advantage Beneficiaries by Dental, Vision, and Hearing Benefits
AbstractGupta, A., Silver, D., Meyers, D. J., Murray, G., Glied, S., & Pagán, J. A. (n.d.).Publication year
2024Journal title
JAMA Health ForumVolume
5Issue
1Page(s)
E234936AbstractImportance: Most Medicare beneficiaries now choose to enroll in Medicare Advantage (MA) plans. Racial and ethnic minority group and low-income beneficiaries are increasingly enrolling in MA plans. Objective: To examine whether dental, vision, and hearing supplemental benefits offered in MA plans are associated with the plan choices of traditionally underserved Medicare beneficiaries. Design, Setting, and Participants: This exploratory observational cross-sectional study used data from the 2018 to 2020 Medicare Current Beneficiary Survey linked to MA plan benefits. The nationally representative sample comprised primarily community-dwelling MA beneficiaries enrolled in general enrollment MA plans. Data analysis was performed between April and October 2023. Exposures: Beneficiary self-identified race and ethnicity and combined individual and spouse income and educational attainment. Main Outcomes and Measures: Binary indicators were developed to determine whether beneficiaries were enrolled in a plan offering any dental, comprehensive dental, any vision, eyewear, any hearing, or hearing aid benefit. Mixed-effects logistic regression models were estimated to report average marginal effects adjusted for beneficiary-level demographic and health characteristics, plan attributes, and plan availability. Results: This study included 8139 (weighted N = 31 million) eligible MA beneficiaries, with a mean (SD) age of 77.7 (7.5) years. More than half of beneficiaries (54.9%) were women; 9.8% self-identified as Black, 2.0% as Hispanic, 83.9% as White, and 4.2% as other or multiple races or ethnicities. Plan choices by dental benefits were examined among 7516 beneficiaries who were not enrolled in any dental standalone plan, by vision benefits for 8026 beneficiaries not enrolled in any vision standalone plan, and by hearing benefits for 8131 beneficiaries not enrolled in any hearing standalone plan. Black beneficiaries were more likely to enroll in plans with any dental benefit (9.0 percentage points [95% CI, 3.4-14.4]; P <.001), any comprehensive dental benefit (11.2 percentage points [95% CI, 5.7-16.7]; P <.001), any eye benefit (3.0 percentage points [95% CI, 1.0 to 5.0]; P =.004), or any eyewear benefit (6.0 percentage points [95% CI, 0.6-11.5]; P =.03) compared with White beneficiaries. Lower-income individuals (earning ≤200% of the federal poverty level) were more likely to enroll in a plan with a comprehensive dental benefit (4.4 percentage-point difference [95% CI, 0.1-7.9]; P =.01) compared with higher-income beneficiaries. Beneficiaries without a college degree were more likely to enroll in a plan with a comprehensive dental benefit (4.7 percentage-point difference [95% CI, 1.4-8.0]; P =.005) compared with those with higher educational attainment. Conclusions and Relevance: The results of this study suggest that racial and ethnic minority individuals and those with lower income or educational attainment are more likely to choose MA plans with dental or vision benefits. As the federal government prepares to adjust MA plan star ratings for health equity, implements MA payment cuts, and allows increasing flexibility in supplemental benefit offerings, these findings may inform benefit monitoring for MA..Medical financial hardship between young adult cancer survivors and matched individuals without cancer in the United States
AbstractLi, L., Zhang, D., Li, Y., Jain, M., Lin, X., Hu, R., Liu, J., Thapa, J., Mu, L., Chen, Z., Liu, B., & Pagán, J. A. (n.d.).Publication year
2024Journal title
JNCI Cancer SpectrumVolume
8Issue
2AbstractBackground: Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties young adult cancer survivors in the United States experience in the post–Patient Protection and Affordable Care Act period. Method: We identified 1009 cancer survivors aged 18 to 39 years from the National Health Interview Survey (2015-2022) and matched 963 (95%) cancer survivors to 2733 control individuals using nearest-neighbor matching. We used conditional logistic regression to examine the association between cancer history and medical financial hardship and to assess whether this association varied by age, sex, race and ethnicity, and region of residence. Results: Compared with those who did not have a history of cancer, young adult cancer survivors were more likely to report material financial hardship (22.8% vs 15.2%; odds ratio ¼ 1.65, 95% confidence interval ¼ 1.50 to 1.81) and behavior-related financial hardship (34.3% vs 24.4%; odds ratio ¼ 1.62, 95% confidence interval ¼ 1.49 to 1.76) but not psychological financial hardship (52.6% vs 50.9%; odds ratio ¼ 1.07, 95% confidence interval ¼ 0.99 to 1.16). Young adult cancer survivors who were Hispanic or lived in the Midwest and South were more likely to report psychological financial hardship than their counterparts. Conclusions: We found that young adult cancer survivors were more likely to experience material and behavior-related financial hardship than young adults without a history of cancer. We also identified specific subgroups of young adult cancer survivors that may benefit from targeted policies and interventions to alleviate medical financial hardship.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.Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services: a cross sectional study
AbstractChang, J. E., Cronin, C. E., Lindenfeld, Z., Pagán, J. A., & Franz, B. (n.d.).Publication year
2023Journal title
BMC health services researchVolume
23Issue
1AbstractIntroduction: Opioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs. Methods: We conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association’s 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015–2018). Results: Controlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032–2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245–3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308–35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities. Conclusions: Medicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.Practical considerations for reinterpretation of individual genetic variants
Appelbaum, P. S., Berger, S. M., Brokamp, E., Brown, H. S., Burke, W., Clayton, E. W., Evans, B. J., Hamid, R., Marchant, G. E., Martin, D. M., O’Connor, B. C., Pagán, J. A., Parens, E., Roberts, J. L., Rowe, J., Schneider, J., Siegel, K., Veenstra, D. L., & Chung, W. K. (n.d.).Publication year
2023Journal title
Genetics in MedicineVolume
25Issue
5Social Determinants of Cardiovascular Health: A Longitudinal Analysis of Cardiovascular Disease Mortality in US Counties From 2009 to 2018
AbstractSon, H., Zhang, D., Shen, Y., Jaysing, A., Zhang, J., Chen, Z., Mu, L., Liu, J., Rajbhandari-Thapa, J., Li, Y., & Pagán, J. A. (n.d.).Publication year
2023Journal title
Journal of the American Heart AssociationVolume
12Issue
2AbstractBACKGROUND: Disparities in cardiovascular disease (CVD) outcomes persist across the United States. Social determinants of health play an important role in driving these disparities. The current study aims to identify the most important social determinants associated with CVD mortality over time in US counties. METHODS AND RESULTS: The authors used the Agency for Healthcare Research and Quality’s database on social determinants of health and linked it with CVD mortality data at the county level from 2009 to 2018. The age-standardized CVD mortality rate was measured as the number of deaths per 100 000 people. Penalized generalized estimating equations were used to select social determinants associated with county-level CVD mortality. The analytic sample included 3142 counties. The penalized generalized estimating equation identified 17 key social determinants of health including rural– urban status, county’s racial composition, income, food, and housing status. Over the 10-year period, CVD mortality declined at an annual rate of 1.08 (95% CI, 0.74–1.42) deaths per 100 000 people. Rural counties and counties with a higher percentage of Black residents had a consistently higher CVD mortality rate than urban counties and counties with a lower percentage of Black residents. The rural– urban CVD mortality gap did not change significantly over the past decade, whereas the association between the percentage of Black residents and CVD mortality showed a significant diminishing trend over time. CONCLUSIONS: County-level CVD mortality declined from 2009 through 2018. However, rural counties and counties with a higher percentage of Black residents continued to experience higher CVD mortality. Median income, food, and housing status consistently predicted higher CVD mortality.Spatiotemporal Optimization for the Placement of Automated External Defibrillators Using Mobile Phone Data
AbstractZhang, J., Mu, L., Zhang, D., Rajbhandari-Thapa, J., Chen, Z., Pagán, J. A., Li, Y., Son, H., & Liu, J. (n.d.).Publication year
2023Journal title
ISPRS International Journal of Geo-InformationVolume
12Issue
3AbstractWith over 350,000 cases occurring each year, out-of-hospital cardiac arrest (OHCA) remains a severe public health concern in the United States. The correct and timely use of automated external defibrillators (AEDs) has been widely acknowledged as an effective measure to improve the survival rate of OHCA. While general guidelines have been provided by the American Heart Association (AHA) for AED deployment, the lack of detailed instructions hindered the adoption of such guidelines under dynamic scenarios with various time and space distributions. Formulating the AED deployment as a location optimization problem under budget and resource constraints, we proposed an overlayed spatio-temporal optimization (OSTO) method, which accounted for the spatiotemporal heterogeneity of potential OHCAs. To highlight the effectiveness of the proposed model, we applied the proposed method to Washington DC using user-generated anonymized mobile device location data. The results demonstrated that optimization-based planning provided an improved AED coverage level. We further evaluated the effectiveness of adding additional AEDs by analyzing the cost-coverage increment curve. In general, our framework provides a systematic approach for municipalities to integrate inclusive planning and budget-limited efficiency into their final decision-making. Given the high practicality and adaptability of the framework, the OSTO is highly amenable to different healthcare facilities’ deployment tasks with flexible demand and resource restraints.Stakeholder Perspectives on Data-Driven Solutions to Address Cardiovascular Disease and Health Equity in New York City
AbstractLindenfeld, Z., Pagán, J. A., Silver, D., McNeill, E., Mostafa, L., Zein, D., & Chang, J. E. (n.d.).Publication year
2023Journal title
AJPM FocusVolume
2Issue
3AbstractIntroduction: There is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g., cardiovascular disease) closely mimic inequities in social factors such as income, education, and housing. Although there is a wealth of data on these social factors in New York City, little is known about how to rapidly use available data sources to address health disparities. Methods: Semistructured interviews were conducted with key stakeholders (N=11) from across the public health landscape in New York City (health departments, healthcare delivery systems, and community-based organizations) to assess perspectives on how social determinants of health data can be used to address cardiovascular disease and health equity, what data-driven tools would be useful, and challenges to using these data sources and developing tools. A matrix analysis approach was used to analyze the interview data. Results: Stakeholders were optimistic about using social determinants of health data to address health equity by delivering holistic care, connecting people with additional resources, and increasing investments in under-resourced communities. However, interviewees noted challenges related to the quality and timeliness of social determinants of health data, interoperability between data systems, and lack of consistent metrics related to cardiovascular disease and health equity. Conclusions: Future research on this topic should focus on mitigating the barriers to using social determinants of health data, which includes incorporating social determinants of health data from other sectors. There is also a need to assess how data-driven solutions can be implemented within and across communities and organizations.Substance Use Disorder Program Availability in Safety-Net and Non-Safety-Net Hospitals in the US
AbstractChang, J. E., Franz, B., Pagán, J. A., Lindenfeld, Z., & Cronin, C. E. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
8Page(s)
e2331243AbstractImportance: Safety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown. Objective: To examine differences in the delivery of different SUD programs in SNHs vs non-SNHs across the US and to determine whether these differences are increased in certain types of SNHs depending on ownership. Design, Setting, and Participants: This cross-sectional analysis used data from the 2021 American Hospital Association Annual Survey of Hospitals to examine the associations of safety-net status and ownership with the availability of SUD services at acute care hospitals in the US. Data analysis was performed from January to March 2022. Main Outcomes and Measures: This study used 2 survey questions from the American Hospital Association survey to determine the delivery of 5 hospital-based SUD services: screening, consultation, inpatient treatment services, outpatient treatment services, and medications for opioid use disorder (MOUD). Results: A total of 2846 hospitals were included: 409 were SNHs and 2437 were non-SNHs. The lowest proportion of hospitals reported offering inpatient treatment services (791 hospitals [27%]), followed by MOUD (1055 hospitals [37%]), and outpatient treatment services (1087 hospitals [38%]). The majority of hospitals reported offering consultation (1704 hospitals [60%]) and screening (2240 hospitals [79%]). In multivariable models, SNHs were significantly less likely to offer SUD services across all 5 categories of services (screening odds ratio [OR], 0.62 [95% CI, 0.48-0.76]; consultation OR, 0.62 [95% CI, 0.47-0.83]; inpatient services OR, 0.73 [95% CI, 0.55-0.97]; outpatient services OR, 0.76 [95% CI, 0.59-0.99]; MOUD OR, 0.6 [95% CI, 0.46-0.78]). With the exception of MOUD, public or for-profit SNHs did not differ significantly from their non-SNH counterparts. However, nonprofit SNHs were significantly less likely to offer all 5 SUD services compared with their non-SNH counterparts (screening OR, 0.52 [95% CI, 0.41-0.66]; consultation OR, 0.56 [95% CI, 0.44-0.73]; inpatient services OR, 0.45 [95% CI, 0.33-0.61]; outpatient services OR, 0.58 [95% CI, 0.44-0.76]; MOUD OR, 0.61 [95% CI, 0.46-0.79]). Conclusions and Relevance: In this cross-sectional study of SNHs and non-SNHs, SNHs had significantly lower odds of offering the full range of SUD services. These findings add to a growing body of research suggesting that SNHs may face additional barriers to offering SUD programs. Further research is needed to understand these barriers and to identify strategies that support the adoption of evidence-based SUD programs in SNH settings.The Health and Economic Impact of Expanding Home Blood Pressure Monitoring
AbstractLi, Y., Zhang, D., Li, W., Chen, Z., Thapa, J., Mu, L., Zhu, H., Dong, Y., Li, L., & Pagán, J. A. (n.d.).Publication year
2023Journal title
American journal of preventive medicineVolume
65Issue
5Page(s)
775-782AbstractIntroduction: Home blood pressure monitoring is more convenient and effective than clinic-based monitoring in diagnosing and managing hypertension. Despite its effectiveness, there is limited evidence of the economic impact of home blood pressure monitoring. This study aims to fill this research gap by assessing the health and economic impact of adopting home blood pressure monitoring among adults with hypertension in the U.S. Methods: A previously developed microsimulation model of cardiovascular disease was used to estimate the long-term impact of adopting home blood pressure monitoring versus usual care on myocardial infarction, stroke, and healthcare costs. Data from the 2019 Behavioral Risk Factor Surveillance System and the published literature were used to estimate model parameters. The averted cases of myocardial infarction and stroke and healthcare cost savings were estimated among the U.S. adult population with hypertension and in subpopulations defined by sex, race, ethnicity, and rural/urban area. The simulation analyses were conducted between February and August 2022. Results: Compared with usual care, adopting home blood pressure monitoring was estimated to reduce myocardial infarction cases by 4.9% and stroke cases by 3.8% as well as saving an average of $7,794 in healthcare costs per person over 20 years. Non-Hispanic Blacks, women, and rural residents had more averted cardiovascular events and greater cost savings related to adopting home blood pressure monitoring compared with non-Hispanic Whites, men, and urban residents. Conclusions: Home blood pressure monitoring could substantially reduce the burden of cardiovascular disease and save healthcare costs in the long term, and the benefits could be more pronounced in racial and ethnic minority groups and those living in rural areas. These findings have important implications in expanding home blood pressure monitoring for improving population health and reducing health disparities.Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals: 2015-2021
AbstractChang, J. E., Cronin, C. E., Pagán, J. A., Simon, J., Lindenfeld, Z., & Franz, B. (n.d.).Publication year
2023Journal title
Journal of Addiction MedicineVolume
17Issue
4Page(s)
E217-E223AbstractObjectives Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs. Methods We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or χ2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave. Results Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital-and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates. Conclusions Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.Use of Telehealth to Address Depression and Anxiety in Low-income US Populations: A Narrative Review
AbstractSultana, S., & Pagán, J. A. (n.d.).Publication year
2023Journal title
Journal of Primary Care and Community HealthVolume
14AbstractSymptoms of anxiety and depressive disorders have been increasing substantially among adults in the United States (US) during the COVID-19 pandemic, particularly for low-income populations. Under-resourced communities have difficulties accessing optimal treatment for anxiety and depression due to costs as well as the result of limited access to health care providers. Telehealth has been growing as a digital strategy to treat anxiety and depression across the country but it is unclear how best to implement telehealth interventions to serve low-income populations. A narrative review was conducted to evaluate the role of telehealth in addressing anxiety and depression in low-income groups in the US. A PubMed database search identified a total of 14 studies published from 2012 to 2022 on telehealth interventions that focused on strengthening access to therapy, coordination of care, and medication and treatment adherence. Our findings suggest that telehealth increases patient engagement through virtual therapy and the use of primarily telephone communication to treat and monitor anxiety and depression. Telehealth seems to be a promising approach to improving anxiety and depressive symptoms but socioeconomic and technological barriers to accessing mental health services are substantial for low-income US populations.Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review
AbstractMcNeill, E., Lindenfeld, Z., Mostafa, L., Zein, D., Silver, D., Pagán, J., Weeks, W. B., Aerts, A., Rosiers, S. D., Boch, J., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of the American Heart AssociationVolume
12Issue
21AbstractBACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. METHODS AND RESULTS: After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geo-coded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. CONCLUSIONS: Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.Utilizing Publicly Available Community Data to Address Social Determinants of Health: A Compendium of Data Sources
AbstractLindenfeld, Z., Pagán, J. A., & Chang, J. (n.d.).Publication year
2023Journal title
Inquiry (United States)Volume
60AbstractTo compile a compendium of data sources representing different areas of social determinants of health (SDOH) in New York City. We conducted a PubMed search of the peer-reviewed and gray literature using the terms “social determinants of health” and “New York City,” with the Boolean operator “AND.” We then conducted a search of the “gray literature,” defined as sources outside of standard bibliographic databases, using similar terms. We extracted publicly available data sources containing NYC-based data. In defining SDOH, we used the framework outlined by the CDC’s Healthy People 2030, which uses a place-based framework to categorize 5 domains of SDOH: (1) healthcare access and quality; (2) education access and quality; (3) social and community context; (4) economic stability; and (5) neighborhood and built environment. We identified 29 datasets from the PubMed search, and 34 datasets from the gray literature, resulting in 63 datasets related to SDOH in NYC. Of these, 20 were available at the zip code level, 18 at the census tract-level, 12 at the community-district level, and 13 at the census block or specific address level. Community-level SDOH data are readily attainable from many public sources and can be linked with health data on local geographic-levels to assess the effect of social and community factors on individual health outcomes.COVID-19 vaccine inequality: A global perspective
AbstractTatar, M., Shoorekchali, J. M., Faraji, M. R., Seyyedkolaee, M. A., Pagán, J. A., & Wilson, F. A. (n.d.).Publication year
2022Journal title
Journal of Global HealthVolume
12AbstractBy the end of 2021, more than 12 billion COVID-19 vaccine doses have been globally distributed and administered [1]. However, nearly one million new daily cases and more than two thousand new daily deaths were reported by July 2022. The best way to slow the spread of the COVID-19 virus and the most effective way to prevent severe illness, hospitalizations, and death is to get vaccinated [2]. From the beginning of the global COVID-19 vaccination campaign, the World Health Organization (WHO) and the COVID-19 Vaccines Global Access (COVAX) initiative strived to guarantee fair and equitable vaccine rollouts worldwide. The WHO aims to achieve global access to the COVID-19 vaccines by mid-2022 with the goal of vaccinating 40% of the population of every country by the end of 2022 [3]. Nevertheless, substantial unequal COVID-19 vaccine distribution was reported a few months after the first public COVID-19 vaccination (March 31, 2021), and the emergence of new SARS-COV-2 variants has highlighted this issue [4]. We used Gini coefficients to measure the degree of COVID-19 vaccine inequality throughout the globe.Federal Paid Sick Leave Is Needed to Support Prevention and Public Health and Address Inequities
Pomeranz, J. L., Pagán, J. A., & Silver, D. (n.d.). In American journal of preventive medicine (1–).Publication year
2022Volume
63Issue
2Page(s)
e75Generational differences in beliefs about COVID-19 vaccines
AbstractWang, V. H. C., Silver, D., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Preventive MedicineVolume
157AbstractVaccine uptake variation across demographic groups remains a public health barrier to overcome the coronavirus pandemic despite substantial evidence demonstrating the effectiveness of COVID-19 vaccines against severe illness and death. Generational cohorts differ in their experience with historical and public health events, which may contribute to variation in beliefs about COVID-19 vaccines. Nationally representative longitudinal data (December 20, 2020 to July 23, 2021) from the Understanding America Study (UAS) COVID-19 tracking survey (N = 7279) and multilevel logistic regression were used to investigate whether generational cohorts differ in COVID-19 vaccine beliefs. Regression models adjusted for wave, socioeconomic and demographic characteristics, political affiliation, and trusted source of information about COVID-19. Birth-year cutoffs define the generational cohorts: Silent (1945 and earlier), Boomer (1946–1964), Gen X (1965–1980), Millennial (1981–1996), and Gen Z (1997–2012). Compared to Boomers, Silents had a lower likelihood of believing that COVID-19 vaccines have many known harmful side effects (OR = 0.52, 95%CI = 0.35–0.74) and that they may lead to illness and death (OR = 0.53, 95%CI = 0.37–0.77). Compared to Boomers, Silents had a higher likelihood of believing that the vaccines provide important benefits to society (OR = 2.27, 95%CI = 1.34–3.86) and that they are useful and effective (OR = 1.97, 95%CI = 1.17–3.30). Results for Gen Z are similar to those reported for Silents. Beliefs about COVID-19 vaccines markedly differ across generations. This is consistent with the idea of generational imprinting—the idea that some beliefs may be resistant to change through adulthood. Policy strategies other than vaccine education may be needed to overcome this pandemic and future public health challenges.Geographical and Temporal Analysis of Tweets Related to COVID-19 and Cardiovascular Disease in the US
AbstractZhang, X., Mu, L., Zhang, D., Mao, Y., Shi, L., Rajbhandari-Thapa, J., Chen, Z., Li, Y., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Annals of GISVolume
28Issue
4Page(s)
491-500AbstractThe COVID-19 pandemic has resulted in more than 600 million confirmed cases worldwide since December 2021. Cardiovascular disease (CVD) is both a risk factor for COVID-19 mortality and a complication that many COVID-19 patients develop. This study uses Twitter data to identify the spatiotemporal patterns and correlation of related tweets with daily COVID-19 cases and deaths at the national, regional, and state levels. We collected tweets mentioning both COVID-19 and CVD-related words from February to July 2020 (Eastern Time) and geocoded the tweets to the state level using GIScience techniques. We further proposed and validated that the Twitter user registration state can be a feasible proxy of geotags. We applied geographical and temporal analysis to investigate where and when people talked about COVID-19 and CVD. Our results indicated that the trend of COVID-19 and CVD-related tweets is correlated to the trend of COVID-19, especially the daily deaths. These social media messages revealed widespread recognition of CVD’s important role in the COVID-19 pandemic, even before the medical community started to develop consensus and theory supports about CVD aspects of COVID-19. The second wave of the pandemic caused another rise in the related tweets but not as much as the first one, as tweet frequency increased from February to April, decreased till June, and bounced back in July. At the regional level, four regions (Northeast, Midwest, North, and West) had the same trend of related tweets compared to the country as a whole. However, only the Northeast region had a high correlation (0.8–0.9) between the tweet count, new cases, and new deaths. For the second wave of confirmed new cases, the major contributing regions, South and West, did not ripple as many related tweets as the first wave. Our understanding is that the early news attracted more attention and discussion all over the U.S. in the first wave, even though some regions were not impacted as much as the Northeast at that time. The study can be expanded to more geographic and temporal scales, and with more physical and socioeconomic variables, with better data acquisition in the future.How Patient-Centered Medical Homes Integrate Dental Services Into Primary Care: A Scoping Review
AbstractGupta, A., Akiya, K., Glickman, R., Silver, D., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Medical Care Research and ReviewVolume
79Issue
4Page(s)
487-499AbstractIntegrated care delivery is at the core of patient-centered medical homes (PCMHs). The extent of integration of dental services in PCMHs for adults is largely unknown. We first identified dental–medical integrating processes from the literature and then conducted a scoping review using PRISMA guidelines to evaluate their implementation among PCMHs. Processes were categorized into workforce, information-sharing, evidence-based care, and measuring and monitoring. After screening, 16 articles describing 21 PCMHs fulfilled the inclusion criteria. Overall, the implementation of integrating processes was limited. Less than half of the PCMHs reported processes for information exchange across medical and dental teams, referral tracking, and standardized protocols for oral health assessments by medical providers. Results highlight significant gaps in current implementation of adult dental integration in PCMHs, despite an increasing policy-level recognition of and support for dental-medical integration in primary care. Understanding and addressing associated barriers is important to achieve comprehensive patient-centered primary care.Income inequality and the disease burden of COVID-19: Survival analysis of data from 74 countries
AbstractSu, D., Alshehri, K., & Pagán, J. (n.d.).Publication year
2022Journal title
Preventive Medicine ReportsVolume
27AbstractThe COVID-19 pandemic presents a rare opportunity to assess national performance in responding to a historic crisis. It is not well understood how income inequality might be related to differential disease burden of COVID-19 across countries. Using recent data merged from Our World in Data 2020, the World Bank, and the Global Burden of Disease, we examined the association between income inequality (the Gini index) and COVID-19 infection and death rates among 74 countries with available data. After adjusting for differences in population size, age structure, longevity, population density, GDP per capita, health care expenditures, educational attainment, direct democracy index, stringency of implemented measures, and testing intensity for COVID-19, results from Cox Proportional Hazards regressions revealed that countries with more unequal income distribution carried a higher burden of COVID-19 infections and deaths in 2020. On average, each percentage point increase in the Gini index was associated with an 9% increase in the hazard of having a higher COVID-19 infection rate in the sample (AOR = 1.09, 95% CI 1.01, 1.18). The corresponding associated increase in the hazard of having a higher COVID-19 death rate was 14% (AOR = 1.14, 95% CI 1.06, 1.23). Countries with severe and persistent income inequality should develop national strategies to address this challenge to be better prepared for future pandemics.Racial/ethnic disparities in the availability of hospital based opioid use disorder treatment
AbstractChang, J. E., Franz, B., Cronin, C. E., Lindenfeld, Z., Lai, A. Y., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Journal of Substance Abuse TreatmentVolume
138AbstractIntroduction: While racial/ethnic disparities in the use of opioid use disorder (OUD) treatment in outpatient settings are well documented in the literature, little is known about racial/ethnic disparities in access to hospital-based OUD services. This study examines the relationship between hospital-based or initiated OUD services and the racial/ethnic composition of the surrounding community. Methods: We constructed a dataset marking the implementation of eight OUD strategies for a 20% random sample of nonprofit hospitals in the United States based on 2015–2018 community health needs assessments. We tested the significance of the relationship between each OUD strategy and the racial/ethnic composition of the surrounding county using two-level mixed effects logistic regression models that considered the hierarchical structure of the data of hospitals within states while controlling for hospital-level county-level, and state-level covariates. Results: In both unadjusted and adjusted models, we found that hospital adoption of several OUD services significantly varied based on the percentage of Black or Hispanic residents in their communities. Even after controlling for hospital size, the overdose burden in the community, community socioeconomic characteristics, and state funding, hospitals in communities with high percentage of Black or Hispanic residents had significantly lower odds of offering the most common hospital-based programs to address OUD – including programs that increase access to formal treatment services, prescriber guidelines, targeted risk education and harm reduction, and community coalitions to address opioid use. Conclusions: Hospital adoption of many OUD services varies based on the percentage of Black or Hispanic residents in their communities. More attention should be paid to the role, ability, and strategies that hospitals can assume to address disparities among OUD treatment and access needs, especially those that serve communities with a high concentration of Black and Hispanic residents.State Paid Sick Leave and Paid Sick-Leave Preemption Laws Across 50 U.S. States, 2009–2020
AbstractPomeranz, J. L., Silver, D., Lieff, S. A., & Pagán, J. A. (n.d.).Publication year
2022Journal title
American journal of preventive medicineVolume
62Issue
5Page(s)
688-695AbstractIntroduction: Paid sick leave is associated with lower mortality risks and increased use of health services. Yet, the U.S. lacks a national law, and not all employers offer paid leave, especially to low-wage workers. States have enacted paid sick-leave laws or preemption laws that prohibit local governments from enacting paid sick-leave requirements. Methods: In 2019 and 2021, state paid sick-leave laws and preemption laws in effect in 2009–2020 were retrieved from Lexis+, coded, and analyzed for coverage and other features. Data from the U.S. Bureau of Economic Analysis were used to estimate the jobs covered by state paid sick-leave laws in 2009–2019. Results: In 2009, no state had a paid sick-leave law, and 1 state had preemption. By 2020, a total of 12 states had paid sick-leave laws, with a form of preemption (n=9) or no preemption (n=3), and 18 additional states solely preempted local laws without requiring coverage, creating a regulatory vacuum in those states. Although all state paid sick-leave laws covered private employers and required care for children and spouses, some laws exempted small or public employers or did not cover additional family members. The percentage of U.S. jobs covered by state-required paid sick leave grew from 0% in 2009 to 27.6% in 2019. Conclusions: Variation in state paid sick-leave laws, preemption, and lack of employer provision of paid sick leave to low-wage workers creates substantial inequities nationally. The federal government should enact a national paid sick-leave law.The Impact of Expanding Telehealth-Delivered Dietary Interventions on Long-Term Cardiometabolic Health
AbstractLi, Y., Zhang, D., Thapa, J., Li, W., Chen, Z., Mu, L., Liu, J., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Population Health ManagementVolume
25Issue
3Page(s)
317-322AbstractA healthy diet is an important protective factor to prevent cardiometabolic disease. Traditional face-to-face dietary interventions are often episodic, expensive, and may have limited effectiveness, particularly among older adults and people living in rural areas. Telehealth-delivered dietary interventions have proven to be a low-cost and effective alternative approach to improve dietary behaviors among adults with chronic health conditions. In this study, we developed a validated agent-based model of cardiometabolic health conditions to project the impact of expanding telehealth-delivered dietary interventions among older adults in the state of Georgia, a state with a large rural population. We projected the incidence of major cardiometabolic health conditions (type 2 diabetes, hypertension, and high cholesterol) with the implementation of telehealth-delivered dietary interventions versus no intervention among all older adults and 3 subpopulations (older adults with diabetes, hypertension, and high cholesterol, separately). The results showed that expanding telehealth-delivered dietary interventions could avert 22,774 (95% confidence interval [CI]: 22,091-23,457) cases of type 2 diabetes, 19,732 (19,145-20,329) cases of hypertension, and 18,219 (17,672-18,766) cases of high cholesterol for 5 years among older adults in Georgia. The intervention would have a similar effect in preventing cardiometabolic health conditions among the 3 selected subpopulations. Therefore, expanding telehealth-delivered dietary interventions could substantially reduce the burden of cardiometabolic health conditions in the long term among older adults and those with chronic health conditions.Transforming Primary Care in New York Through Patient-Centered Medical Homes: Findings From Qualitative Research
AbstractWeiss, L., Griffin, K., Wu, M., DeGarmo, E., Jasani, F., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Journal of Primary Care and Community HealthVolume
13AbstractBackground: The patient-centered medical home (PCMH) model, an important component of healthcare transformation in the United States, is an approach to primary care delivery with the goal of improving population health and the patient care experience while reducing costs. PCMH research most often focuses on system level indicators including healthcare use and cost; descriptions of patient and provider experience with PCMH are relatively sparse and commonly limited in scope. This study, part of a mixed-methods evaluation of a multi-year New York State initiative to refine and expand the PCMH model, describes patient and provider experience with New York State PCMH and its key components. Methods: The qualitative component of the evaluation included focus groups with patients of PCMH practices in 5 New York State counties (n = 9 groups and 67 participants) and interviews with providers and practice administrators at New York State PCMH practices (n = 9 interviews with 10 participants). Through these focus groups and interviews, we elicited first-person descriptions of experiences with, as well as perspectives on, key components of the New York State PCMH model, including accessibility, expanded use of electronic health records, integration of behavioral health care, and care coordination. Results: There was evident progress and some satisfaction with the PCMH model, particularly regarding integrated behavioral health and, to some extent, expanded use of electronic health records. There was less evident progress with respect to improved access and reasonable wait times, which caused patients to continue to use urgent care or the emergency department as substitutes for primary care. Conclusions: It is critical to understand the strengths and limitations of the PCMH model, so as to continue to improve upon and promote it. Strengths of the model were evident to participants in this study; however, challenges were also described. It is important to note that these challenges are difficult to separate from wider healthcare system issues, including inadequate incentives for value-based care, and carry implications for PCMH and other models of healthcare delivery.