Digital Commons Network^™

Northern Luzon In A Taiwan Flashpoint: The Philippines’ Place In U.S. Strategy, Carson Keller

Graduate Theses/Dissertations

While the defense of Taiwan from a potential invasion by the People’s Republic of China (PRC) has long been a topic of debate and scrutiny in U.S. strategic thinking, the role of its southern neighbor, the Philippines, has received far less attention. This thesis argues that northern Luzon would constitute key terrain in a cross-strait conflict and may become an early target of People’s Liberation Army (PLA) operations. Its proximity to Taiwan and position along the Luzon Strait, particularly the Bashi Channel, places it at the center of efforts to control access to the hypothetical battlespace. Drawing on PLA and …

Food Delivery Services For Enhancing Participation In The Special Supplemental Nutrition Program For Women, Infants, And Children (Wic) In The United States: Bridging The Wic-Eligible Access Gap, Jingjing Gao, Muinat Abolore Idris, Lilian O Ademu, Bryan Colby Griffin, Yue Zhang, Yun Hang, Gabriela A Gallegos

Faculty, Staff and Student Publications

Background: Diet-related health disparities among U.S. children persist despite the availability of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits to eligible women, infants, and children. Participation remains suboptimal: only 51.2% of eligible individuals were enrolled in 2021. Transportation and food-environment constraints pose salient barriers, especially for caregivers of infants in food deserts. Emerging online ordering and delivery options may reduce access frictions, but grocery delivery coverage is limited, and fees are often not covered by benefits.

Methods: We linked USDA Food and Nutrition Service state-level WIC participation data (November 2024 vs. September 2025) with demographic, …

Factors Associated With Opioid And Antibiotic Prescribing At Us Academic Dental Institutions: 2011 To 2020, S Tungare, A-I Yansane, S Gantela, K K Kookal, S Mccurdy, T M Krause, S Sharma, M Walji

Faculty, Staff and Student Publications

Introduction: In the United States, dentists are one of the leading prescribers of opioids and antibiotics. Because dental schools are the training grounds for future dentists, it is crucial to understand how prescribing has changed and why these medications are being prescribed in academic settings.

Objectives: The objective of this research was to describe the prescribing trends and factors associated with opioid and antibiotic medication prescribing at US academic dental institutions between 2011 and 2020.

Methods: Data from electronic dental records collected through the BigMouth data repository from 9 anonymized dental institutions between 2011 and 2020 were used. Prescribing rates …

The Role Of Home Visiting In Addressing Postpartum Care Gaps: Evidence From A Large Community Sample, Aishwarya Vijay, Allison Kemner, Karen Hoerchler, Abigail Edwards, Jeannie C Kelly, Rachel G Tabak, Mark D Huffman, Zainab Mahmoud

2020-Current year OA Pubs

BackgroundMaternal mortality in the United States has doubled over the last two decades, primarily due to cardiovascular disease, with more than half of deaths occurring postpartum. Despite national calls to action, attendance at postpartum clinic visits remains low. The role of alternative care delivery strategies, such as home visiting, remains insufficiently studied.ObjectiveTo describe postpartum clinic visit attendance among participants in a large national home visiting program, identify sociodemographic and clinical factors associated with attendance, and examine how timing and duration of enrollment relate to postpartum follow-up.DesignWe conducted a retrospective cohort study of pregnancy episodes among mothers enrolled in the Parents …

Updating The Epidemiology Of Blastomycosis And Histoplasmosis In The United States, Using National Electronic Health Record Data, 2013-2023., Juliana G E Bartels, Simon K. Camponuri, Theo T. Snow, Brittany L Morgan Bustamante, Natalie J. Kane, Rose Reynolds, Aidan Lee, Mark A. Hoffman, Theodore C. White, Justin V. Remais, Jennifer R. Head

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Where surveillance data are limited, nationally representative electronic health records allow for geographic, temporal, and demographic characterization of the fungal diseases blastomycosis and histoplasmosis.

METHODS: We identified incident blastomycosis and histoplasmosis cases from 2013 to 2023 within Oracle EHR Real-World Data, which comprises 1.6 billion healthcare encounters nationally. To characterize spatiotemporal incidence trends, we used generalized estimating equations weighted for nonrepresentativeness of electronic health record-reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates between regions, race/ethnicity, gender, and age subgroups and the national population.

RESULTS: National incidence rates in 2023 were …

A Comparative Analysis Of Domestic Violence Legislation In India And The United States: Understanding Protection Of Women Against Violence Act 2005 And Violence Against Women Act 1994, Deon Rodrigues

2025 Fall Honors Capstones Projects - Archive

Domestic violence continues to affect millions of individuals worldwide, yet legal systems respond to it in very different ways. This research compares how India’s Protection of Women from Domestic Violence Act (2005) and the United States’ Violence Against Women Act (1994; 2021) protect victims and hold offenders accountable. Using a comparative legal analysis, the study examines both laws’ language, enforcement mechanisms, and effectiveness through court cases, government reports, and statistical data. By identifying the strengths of the United States model such as mandatory arrest provisions and victim support systems, the study aims to propose practical reforms for India’s legal framework. …

Representation In Science And Trust In Scientists In The Usa, James Druckman, Katherine Ognyanova, Alauna Safarpour, Jonathan Schulman, Kristin Lunz Trujillo, Ata Aydin Uslu, Jon Green, Matthew Baum, Alexi Quintana Mathe, Hong Qu, Roy Perlis, David Lazer

Political Science Faculty Publications

Scientists provide important information to the public. Whether that information influences decision-making depends on trust. In the USA, gaps in trust in scientists have been stable for 50 years: women, Black people, rural residents, religious people, less educated people and people with lower economic status express less trust than their counterparts (who are more represented among scientists). Here the authors probe the factors that influence trust. They find that members of the less trusting groups exhibit greater trust in scientists who share their characteristics (for example, women trust women scientists more than men scientists). They view such scientists as having …

Knowing One's Place At The Table: Taste As A Means Of Othering In The American Colonies, 1700-1775, Nicholas Harp

Master's Theses or Doctor of Nursing Practice

This thesis began as an inquiry into a simple question. How did people in the American colonies talk about the food that they ate? This question led to a fascinating look into the social dynamics of the people living in eighteenth century America. Their own personal writings demonstrate how they understood their place in society through the food that they ate. Moreover, they often wrote about the way that other people ate in ways that alienated or discriminated against different ethnic groups. A look into the secondary historiography revealed that other historians had noticed this trend. However, very few addressed …

Type I Hybrid Effectiveness-Implementation Randomised Controlled Trial To Address Intergenerational Impact Of War Trauma And Resilience Among Second-Generation Refugee Children In The Usa: Resettled Refugee Families For Healing (Rrf4h) Study Protocol, Nhial T Tutlam, Tewodros W Liyew, Theresa S Betancourt, Byron J Powell, Shenyang Guo, Mary Mckay, Fred M Ssewamala

2020-Current year OA Pubs

INTRODUCTION: Children from refugee families resettled in the USA face higher risks of serious mental health challenges compared with their native-born peers. Research shows that refugee youth in high-income countries frequently suffer from trauma-associated disorders such as post-traumatic stress disorder (PTSD), depression and anxiety. The high prevalence of trauma-associated mental health problems among these youth may be attributed to their own trauma exposure, especially if born in conflict zones, and post-resettlement challenges like poverty, acculturation difficulties, racism and discrimination. However, they may also suffer from the effects of intergenerational trauma, where parental war trauma impacts them. This study aims to …

Promising Practices For Increasing The Number Of Equity-Owed Lifeguards In Canada And The United States Of America, Sofia Pantano, Audrey R. Giles

International Journal of Aquatic Research and Education

Currently a shortage of lifeguards exists in Canada and the United States (US) (Frommer, 2023; Santucci, 2024), and those who are working as lifeguards often do not reflect the diversity of the communities they serve (Martinez, 2020). Increasing the number of lifeguards from equity-owed groups is a potential way of increasing the lifeguard workforce and decreasing the shortage of workers in these important roles, as well as a moral imperative. In this paper I explore challenges to and promising practices aimed at increasing the representation of members equity-owed groups in lifeguarding. I begin with an overview of lifeguarding in Canada …

Acute Care Of Patients With Moderate Respiratory Distress: Recommendations From An American College Of Emergency Physicians Expert Panel., Christopher W Baugh, Jim F Neuenschwander, Jesslyn Lenox, Jennifer Hoh, Kara Ward, Sara Muramoto, John Casey, Antonio Anzueto, Hajirah Ishaq, Jared Mount, Peter M Deblieux

Ambulatory and Primary Care Articles

INTRODUCTION: Patients with respiratory distress are frequently encountered in the emergency department (ED). Efforts to assess, initiate treatments, and stabilize these patients require a systematic and rapid response. Emergency physicians need a comprehensive and efficient approach for evaluating, treating, and managing patients presenting to the ED with moderate respiratory distress.

METHODS: The American College of Emergency Physicians convened an expert panel of academic and community emergency physicians, critical care specialists, respiratory therapists, hospitalists, and pharmacists to develop and subsequently disseminate consensus recommendations regarding the diagnosis and treatment of patients with moderate respiratory distress presenting to the ED.

RESULTS: A digital …

Changes In Child Placement After Child Abuse Pediatrics Consultation For Suspected Physical Abuse., Kristine A. Campbell, Antoinette L. Laskey, Daniel M. Lindberg, M Katherine Henry, Porcia Vaughn, James Anderst, Megan M. Letson, Angela N. Bachim, Nancy S. Harper, Carmen M. Coombs, Lori D. Frasier, Joanne N. Wood

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The association between child abuse pediatric (CAP) assessments and child welfare outcomes is unknown.

OBJECTIVE: To determine the association between a CAP determination of the likelihood of physical abuse and change in child placement. We hypothesized that child race would be associated with CAP determination of abuse likelihood and child welfare outcomes.

PARTICIPANTS AND SETTING: Children under age ten years with in-person CAP consultation and referral to child protective services for suspected physical abuse at a U.S. pediatric referral center participating in CAPNET, a CAP research network, from 02/2021 to 01/2023.

METHODS: We created a series of generalized estimating …

A. Syllabus His 207 Comparative Twentieth Century South African And United States Civil Rights And Voting Rights Histories, Frankie Nicole Weaver

Frankie Nicole Weaver, Comparative Twentieth Century South African and United States Civil Rights and Voting Rights Histories

Originally shared as an in-person comparative upper-level undergraduate history course, this course was adapted for online, virtual use. It works well in either format; however, if you share it virtually, I strongly encourage at least one weekly synchronous class meeting and utilizing breakout rooms to promote discussion. Also, provide discussion questions and randomly enter breakout rooms to facilitate discussion --ensuring that engaging discussions occur. I recommend offering both in-person and virtual office hours, regardless.

Changes In Child Placement After Child Abuse Pediatrics Consultation For Suspected Physical Abuse, Kristine A Campbell, Antoinette L Laskey, Daniel M Lindberg, M Katherine Henry, Porcia Vaughn, James D Anderst, Megan M Letson, Angela N Bachim, Nancy S Harper, Carmen M Coombs, Lori D Frasier, Joanne N Wood

Faculty, Staff and Students Publications

Background: The association between child abuse pediatric (CAP) assessments and child welfare outcomes is unknown.

Objective: To determine the association between a CAP determination of the likelihood of physical abuse and change in child placement. We hypothesized that child race would be associated with CAP determination of abuse likelihood and child welfare outcomes.

Participants and setting: Children under age ten years with in-person CAP consultation and referral to child protective services for suspected physical abuse at a U.S. pediatric referral center participating in CAPNET, a CAP research network, from 02/2021 to 01/2023.

Methods: We created a series of generalized estimating …

Compensation, Horizontal Diffusion, And Bottom-Up Pathways: State Climate Policies In The United States And Australia, Ian Bailey, Roger Karapin

Publications and Research

Recent years have seen growing interest in subnational governments as arenas of climate governance, but limited systematic research exists on the extent, conditions, or pathways through which subnational climate policies can influence, or compensate for deficits in, national policies. This article addresses this gap by examining options for states to influence climate policy in the United States and Australia, two countries where federal governments have made limited progress in developing national climate policies. As an analytical framework, it conceives a typology of state government approaches to climate policy that distinguishes among compensating, horizontal diffusion, and bottom-up pathways. It then uses …

Organizational Climate And Decision Aid Sustainability In Lupus Care: Mixed Methods Study, Aizhan Karabukayeva, Larry R Hearld, Nathan W Carroll, Reena Kelly, Jasvinder A Singh

Faculty, Staff and Students Publications

Background: Digital decision aids (DAs) are increasingly used in health care to support shared decision-making and promote patient engagement. In the context of systemic lupus erythematosus (SLE), a complex autoimmune disease characterized by diverse symptoms and uncertain prognoses, DAs offer guidance to patients in navigating treatment risks and benefits. Although numerous studies have examined the initial implementation of evidence-based tools, there is limited evidence on the organizational factors that influence their long-term sustainability in clinical practice. This gap is particularly salient for digital interventions, where integration into routine workflows and ongoing use require alignment with clinic readiness and culture. This …

Master Protocol Design With Hybrid Control For Efficient Early-Phase Trial Consolidation, Alexander M Kaizer, Xiaojiang Zhan, Eric Baron, Rui Sammi Tang, David S Hong, Brian P Hobbs

Faculty, Staff and Student Publications

Purpose: Master protocols represent transformations, enabling multiple therapies or diseases under a single protocol. These designs streamline therapeutic development by reducing redundancies. Suited for evolving fields such as oncology and global emergencies such as the COVID-19 pandemic, master protocols have been exemplified by studies such as RECOVERY, Solidarity, and I-SPY 2, which accelerated effective treatment identification (with I-SPY 2 focused on molecular subtypes). Recent oncology examples, such as MORPHEUS, evaluate immunotherapy combinations with shared controls. Despite advantages, their application in early-phase oncology remains underutilized amid growing regulatory emphasis on randomization for robust evidence.

Methods: US Food and Drug Administration (FDA) …

Implementation Outcomes Of A Patient Decision-Aid In A Diverse Population With Systemic Lupus Erythematosus In 15 Us Rheumatology Clinics, Jasvinder A Singh, Larry R Hearld, Seth Eisen, W Winn Chatham, Sonali Narain, Narender Annapureddy, Diane L Kamen, Kimberly Trotter, Vikas Majithia, Cathy Lee Ching, Zineb Aouhab, Swamy Venuturupalli, Daniel J Wallace, Rosalind Ramsey-Goldman, Alfred Kim, Maureen Mcmahon, S Sam Lim, Kalpana Bhairavarasu, Alexa Meara, Kenneth Kalunian, T Mark Beasley

Faculty, Staff and Students Publications

Objective: The objective of this study was to examine the clinical outcomes during the implementation of a self-administered patient decision-aid (PtDA) for lupus.

Methods: We provided an effective computerized lupus PtDA in 15 rheumatology outpatient clinics 2019-2024 (including the COVID pandemic). We undertook Organizational Readiness to Implement Change Surveys (ORICs) and Team Learning and Psychological Safety Surveys (TLPSSs) at baseline. The primary study outcome objective measure, percent penetration/reach, was defined as the number of patients who viewed the lupus PtDA at the end of the study, divided by the total number of eligible patients (times 100). We used validated clinical …

Implementation Outcomes Of A Patient Decision-Aid In A Diverse Population With Systemic Lupus Erythematosus In 15 Us Rheumatology Clinics, Jasvinder A Singh, Seth Eisen, Alfred Kim, Et Al.

2020-Current year OA Pubs

OBJECTIVE: The objective of this study was to examine the clinical outcomes during the implementation of a self-administered patient decision-aid (PtDA) for lupus.

METHODS: We provided an effective computerized lupus PtDA in 15 rheumatology outpatient clinics 2019-2024 (including the COVID pandemic). We undertook Organizational Readiness to Implement Change Surveys (ORICs) and Team Learning and Psychological Safety Surveys (TLPSSs) at baseline. The primary study outcome objective measure, percent penetration/reach, was defined as the number of patients who viewed the lupus PtDA at the end of the study, divided by the total number of eligible patients (times 100). We used validated clinical …

Effects Of Long Covid On Healthcare Utilization, Michael Gottlieb, Erica S. Spatz, Huihui Yu, Imtiaz Ebna Mannan, Michelle Santangelo, Caitlin Malicki, Nicole L. Gentile, Rachel E. Geyer, Alex Charlton, Jonathan W. Dyal, Joann G. Elmore, Kristyn Gatling, Mandy J. Hill, Juan Carlos C. Montoy, Kelli N. O'Laughlin, Kristin L. Rising, Sharon Saydah, Kari A. Stephens, Ralph C. Wang, Lauren E. Wisk, Arjun K. Venkatesh, Robert A. Weinstein

Jefferson Center for Connected Care Faculty Papers

BACKGROUND: While most research on Long COVID (LC) has focused on symptoms and quality of life, there remains a critical need to better understand the effect of LC on resource utilization. This study sought to determine the type and amount of healthcare utilization among participants with versus without LC.

METHODS: This was a secondary analysis of a prospective, longitudinal, multicenter U.S. study of adult participants with symptomatic COVID-19, confirmed with testing, who completed 3-month post-infection surveys and had electronic health record data for at least 180 days pre- and post-index testing. We excluded participants with any COVID-19 infections within the …

The Influence Of Human Presence And Footprint On Animal Space Use In Us National Parks, Kaitlyn M. Gaynor, Forest P. Hayes, Kezia Manlove, Nathan Galloway, John F. Benson, Michael J. Cherry, Rolf O. Peterson, Sarah Hoy, John Vucetich, Et Al.

Michigan Tech Publications

Given the importance of protected areas for biodiversity, the growth of visitation to many areas has raised concerns about the effects of humans on wildlife. In 2020, the COVID-19 pandemic led to temporary closure of national parks in the United States, offering a pseudonatural experiment to tease apart the effects of permanent infrastructure and transient human presence on animals. We compiled GPS tracking data from 229 individuals of 10 mammal species in 14 parks and used third-order hierarchical resource selection functions to evaluate the influence of the human footprint on animal space use in 2019 and 2020. Averaged across all …

Where Should The Cancer Control Interventions Target: A Geospatial Hotspot Analysis For Major Cancer Mortality 2018 To 2022 In The United States, Chongliang Luo, Saira Khan, Liyan Jin, Aimee S James, Graham A Colditz, Bettina F Drake

2020-Current year OA Pubs

BACKGROUND: Identifying changes in geographic disparities of cancer mortality reveals locations where cancer prevention and control efforts should be focused/targeted. We use recent cancer surveillance data to demonstrate the geographic disparity of major cancer mortality rates in the United States and its shift compared with previous data.

METHODS: This cross-sectional study used the 2018 to 2022 county-level mortality rates of colorectal, lung, breast, and prostate cancers from the Centers for Disease Control mortality data. Counties with suppressed death counts were imputed by spatial regression models. Getis-Ord Gi* statistics were used to evaluate the spatial clustering of county mortality. Identified hotspot …

Incident Depression After Breast Cancer Among Older Asian, Native Hawaiian, And Pacific Islander Women, Alzina Koric, Chun-Pin Esther Chang, Yuan-Chin Amy Lee, Mei Wei, Catherine Lee, Jing Wang, Mia Hashibe

2020-Current year OA Pubs

BACKGROUND: Longitudinal studies examining mental health outcomes among older (≥66 years) Asian, Native Hawaiian, and Pacific Islander (ANHPI) women diagnosed with breast cancer are limited. We evaluated incident depression after breast cancer among specific groups of older ANHPI compared with older non-Hispanic White (NHW) women. Predictors of depression and the risk of death following early onset of depression after breast cancer were also evaluated.

METHODS: A cohort of 26 776 older ANHPI women in the United States diagnosed with breast cancer between 2000 and 2017 was identified from the SEER-Medicare linked claims. There were 6694 older ANHPI and 20 082 …

Unfolding The Mystery Of Autoimmunity: The Environmental Determinants Of Diabetes In The Young (Teddy) Study, Marian Rewers, Daniel Agardh, Suzanne Bennett Johnson, Ezio Bonifacio, Helena Elding Larsson, Patricia Gesualdo, William Hagopian, Michael J Haller, Heikki Hyöty, Randi Johnson, Richard Mcindoe, Eoin Mckinney, Jessica Melin, Åke Lernmark, Richard E Lloyd, Kristian F Lynch, Jill M Norris, Stephen S Rich, Roswith Roth, Desmond Schatz, Jorma Toppari, Eric Triplett, Kendra Vehik, Suvi M Virtanen, Anette-G Ziegler, Beena Akolkar, Jeffrey P Krischer, Teddy Study Group

Faculty, Staff and Students Publications

In 2025, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health celebrates 75 years of leadership in diabetes research. The NIDDK serves people of the U.S. affected by or at risk for many chronic diseases, including diabetes and other endocrine, metabolic, and digestive disorders, by funding innovative research to develop better treatment and prevention and a cure for these conditions. Autoimmunity that leads to type 1 diabetes or celiac disease or thyroid autoimmunity affects 1 in 20 children and adolescents in the U.S. While treatments are available, prevention of these common autoimmune …

Our Lady Of Peace: John Joseph Lynch’S Pilgrimage To Niagara Falls, Amelia Gallagher

Vincentian Studies

This article relates how John Joseph Lynch established Niagara Falls as a pilgrimage site, which he envisioned as being the first such site in the United States. In the nineteenth century, Niagara was viewed as such a spectacular natural wonder that it frequently inspired religious devotion, a history that Lynch encouraged and continued. The evolution of nineteenth- and twentieth-century views of Niagara and of pilgrimage in general are discussed. Niagara's role in American history is also explored.

Review: My America: A Poetry Atlas Of The United States, Rachel Schwedt, Janice Delong

Ages 10-12

Appreciation of nature, Citizenship, Community, Diversity, Ethnic pride, Knowledge, Patriotism, Wonder

Cunning Commies, Dumb Democrats, And Exiled Germans: A Holistic Postmortem Of The 1948 Czechoslovak Coup D'État, Douglas Joys

Undergraduate Theses, Capstones, and Recitals

The role played by the post-WWII expulsion of ethnic Germans from Czechoslovakia in catalyzing the 1948 Czechoslovak coup d'état has been underexplored in favor of the traditional narrative of an East-West clash between Czechoslovak democratic and communist parties backed by the United States and Soviet Union, respectively. Scholarship on the expulsion and the coup has on occasion brought up connections between the two events, albeit briefly and only as a small part of larger examinations of one of the two. The Eastern and Western forces at play in Czechoslovakia were undoubtedly key factors in the coup’s outcome: the end of …

Impact Of Sociodemographic Determinants On Enrollment Into Contemporary Lymphoma Clinical Trials: A Systematic Review, Jun Yang Jiang, Ang Li, Alexis Romero, Christopher R Flowers, Chijioke Nze

Faculty, Staff and Students Publications

While the incidence and survival associated with lymphoma have improved in recent years, outcome disparities related to sociodemographic factors such as age, sex, race, ethnicity, socioeconomic status (SES), and other social determinants of health (SDOH) remain prevalent in the modern era. Clinical trials are crucial for further improving outcomes, yet not all sociodemographic groups are equally represented in contemporary lymphoma trials. We conducted a systematic review of the literature evaluating the impact of SDOH on enrollment into clinical trials in the United States and identified 21 relevant studies. We confirmed that Black and Hispanic individuals are underrepresented in lymphoma clinical …

The Burden Of Burnout: Understanding Its Prevalence And Organizational Drivers In Medical Physics, Deborah Schofield, C Lynn Chevalier, Laurence Court, William Harmsen, Akiva Turner

Faculty, Staff and Student Publications

Background: Burnout is a work-related syndrome characterized by increased levels of emotional exhaustion (EE) and depersonalization (DP) along with decreased levels of personal achievement. In the healthcare setting, higher burnout levels have been associated with negative impacts on personnel, an increased risk of errors, and a decrease in the quality of delivered care.

Purpose: The purpose of this study was to assess the prevalence of burnout among medical physicists working in the United States. Additionally, the impact of personal and organizational features on burnout risk was examined.

Methods: The anonymous survey was distributed to 1962 full members of the American …

One Cutoff Is Not Enough: Assessing Different Area Deprivation Index Cutoffs For Insurance Types On Surgical Desirability Of Outcome Ranking (Door), Susanne Schmidt, Michael A Jacobs, Daniel E Hall, Karyn B Stitzenberg, Lillian S Kao, Bradley B Brimhall, Chen-Pin Wang, Laura S Manuel, Hoah-Der Su, Jonathan C Silverstein, Paula K Shireman

Faculty, Staff and Student Publications

Background: Social Determinants of Health impact health outcomes. Area Deprivation Index (ADI) is used to risk-adjust for neighborhood affluence/deprivation but guidance on choosing deprivation cutoffs is lacking. We hypothesize that different ADI cutoffs are required for different insurance types.

Methods: National Surgical Quality Improvement Program data 2013-2019 merged with electronic health records from three academic healthcare systems. Desirability of Outcome Ranking (DOOR) assessed the association of ADI cutoffs for different insurance types, adjusted for operative stress, frailty, and case status (elective, urgent, emergent). Secondary analyses assessed the association of ADI with case status.

Results: Patients with Private insurance living in …