This career-development award will fund the investigator's transition from executive leadership to intellectual leadership in the field of healh equity research. For over twenty years, the investigator has contributed to building the Morehouse School of Medicine, one of four historically-black medical schools in the nation and recently ranked #1 in the nation for achieving a social mission. He also led development of the National Center for Primary Care, a research, training, and resource center focused on achieving health equity. This mid-career award will allow him to transition from executive leadership to focus exclusively on research that seeks to build models of success toward achieving health equity in communities across the U.S. The proposed research will provide a roadmap to success in achieving more optimal and equitable asthma outcomes for all children, with broader application to a wide range of chronic disease outcome disparities across all age groups. In the proposed progression of research, we plan to build on our experience with Medicaid data by adding more sophisticated computer simulation models of health disparities at the community level, and also to add more sophisticated datasets, including clinical data from electronic health records and social determinant data with geospatial data links. We propose to first study the causes of local-area variation in asthma outcome disparities among millions of low-income, Medicaid enrolled children and youth across 29 states. These states hold over 80% of the entire U.S. Medicaid population, and over 90% of African American and Hispanic / Latino enrollees. Specifically, we will further refine our Monte Carlo simulations and Markov modeling to assess the impact of different treatment strategies filtered through real-world patient adherence. We will use multi-level modeling and geospatial analyses to quantify the effect of patient, provider, hospital, and community factors contributing to racial-ethnic and local-area variation in outcomes. We will engage in structural equation modeling to quantify conceptual models that include latent variables such as """"""""poverty"""""""" or """"""""quality of care"""""""". Finally, we will exploe agent- based modeling (overlaid on community-level geospatial topography) to simulate the complex dynamics of health disparities as they evolve in space over time. We will also refine these models using clinical data from electronic health records, and assess the applicability of these models to other chronic diseases and to overall health outcome disparities. Our ultimate goal is to save lives and decrease suffering by developing computer models that reveal community- specific intervention points most likely to reduce health disparities in each community.
Public Health Impact: This career-development award will fund the investigator's transition from executive leadership to intellectual leadership in the fiel of health equity research. The significance of the proposed research project is in its potential to provide a roadmap to success in achieving more optimal and equitable asthma outcomes for all children, with broader application to a wide range of chronic disease outcome disparities across all age groups. Our ultimate goal is to save lives and decrease suffering by developing computer models that reveal community-specific intervention points most likely to reduce health disparities in each community.
|Baltrus, Peter; Xu, Junjun; Immergluck, Lilly et al. (2017) Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach. J Asthma 54:53-61|
|Westney, Gloria; Foreman, Marilyn G; Xu, Junjun et al. (2017) Impact of Comorbidities Among Medicaid Enrollees With Chronic Obstructive Pulmonary Disease, United States, 2009. Prev Chronic Dis 14:E31|
|Adedinsewo, Demilade; Xu, Junjun; Agasthi, Pradyumna et al. (2017) Effect of Digoxin Use Among Medicaid Enrollees With Atrial Fibrillation. Circ Arrhythm Electrophysiol 10:e004573|
|Rust, George; Zhang, Shun; Yu, Zhongyuan et al. (2016) Counties eliminating racial disparities in colorectal cancer mortality. Cancer 122:1735-48|
|Cooke, Tiffany; Bastien, Gilberte; Xu, Junjun et al. (2016) Major Depressive Disorder and Condom Use in Young Adult Females. HSOA J Psychiatry Depress Anxiety 2:|
|Adedinsewo, Demilade; Taka, Nchang; Agasthi, Pradyumna et al. (2016) Prevalence and Factors Associated With Statin Use Among a Nationally Representative Sample of US Adults: National Health and Nutrition Examination Survey, 2011-2012. Clin Cardiol 39:491-6|
|Rust, George; Zhang, Shun; Malhotra, Khusdeep et al. (2015) Paths to health equity: Local area variation in progress toward eliminating breast cancer mortality disparities, 1990-2009. Cancer 121:2765-74|
|Wielen, Lynn M; Gilchrist, Emma C; Nowels, Molly A et al. (2015) Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care. J Health Care Poor Underserved 26:1032-47|
|Zhang, Shun; Rust, George; Cardarelli, Kathryn et al. (2015) Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection. AIDS Care 27:829-35|
|Rust, George; Zhang, Shun; McRoy, Luceta et al. (2015) Potential savings from increasing adherence to inhaled corticosteroid therapy in Medicaid-enrolled children. Am J Manag Care 21:173-80|
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