Equity

Program in Health Equity Research Publications

Changes in HIV Pre-exposure Prophylaxis (PrEP) Coverage at State and County Level During the COVID-19 Pandemic in the United States

Mahdi Fallahi
Jenny Guadamuz
Dima Qato
2023

This study quantifies the prevalence and trends in weekly PrEP coverage at the national, state and county-level, before and during the COVID-19 pandemic in the United States.We estimated weekly PrEP coverage using longitudinal individual-level pharmacy claims from IQVIA LRx for a cohort of PrEP users (N = 287,493) ages 16 to 85 years between December 29th, 2019 and November 8th, 2020. Weekly PrEP coverage was defined as PrEP use among individuals at high risk for HIV. We conducted an interrupted time series analysis to quantify changes in weekly PrEP coverage before (December 29th,...

Induced Abortion and Out-of-State Travel Among Insured Women Before and After the Dobbs v. Jackson Women's Health Organization Decision

Ilina Odouard
Jenny Guadamuz
Apurba Chakraborty
G. Caleb Alexander
Dima Qato
2024

OBJECTIVE:

To quantify changes in abortion rates and out-of-state travel for abortion among insured women before and after the Dobbs v. Jackson decision.

METHODS:

This was a cross-sectional analysis of IQVIA's anonymized, patient-level preadjudicated medical claims on induced medication or procedural abortions among 43.1 million insured women of reproductive age (15–49 years) in the United States. We used information from the Guttmacher Institute to stratify states based on post-Dobbs abortion access policy: 1)...

Pandemic Telehealth Brought Benefit, But Not For Everyone

May 27, 2022

CHAMP faculty Jenny Guadamuz cites inequities and gaps in care that the expansion of telehealth in the COVID-19 pandemic brought about in this Bloomerg News article.

Jenny Gaudamuz heads CHAMP's Health Equity Research Program.

Mediators of racial/ethnic inequities in clinical trial participation among patients with cancer, 2011-2023

Jenny Guadamuz
Xiaoliang Wang
Ivy Altomare
Wendy Camelo Castillo
Somnath Sarkar
Ronac Mamtani
Gregory Calip
2024

Background: While minoritized populations are less likely to participate in cancer trials, it is unknown whether social determinants of health (SDOH) explain these inequities. Here we identify SDOH factors that contribute to racial/ethnic inequities in clinical trial participation among patients with 22 common cancers.

Methods: This retrospective cohort study used electronic health record data (2011-2023) linked to neighborhood (Census tract) data from multiple sources. Patients were followed from diagnosis to clinical study drug receipt (proxy for...

Racialized economic segregation and inequities in treatment initiation and survival among patients with metastatic breast cancer

Harlan Pittell
Gregory Calip
Amy Pierre
Cleo Ryals
Jenny Guadamuz
2024

Purpose: Racialized economic segregation, a form of structural racism, may drive persistent inequities among patients with breast cancer. We examined whether a composite area-level index of racialized economic segregation was associated with real-world treatment and survival in metastatic breast cancer (mBC).

Methods: We conducted a retrospective cohort study among adult women with mBC using a US nationwide electronic health record-derived de-identified database (2011–2022). Population-weighted quintiles of the index of concentration at the extremes...

Association Between Pharmacy Proximity With Cardiovascular Medication Use and Risk Factor Control in the United States

Alexander R. Zheutlin
Nasser Sharareh
Jenny Guadamuz
Ransmond O. Berchie
Catherine G. Derington
Joshua A. Jacobs
Favel L. Mondesir
G. Caleb Alexander
Emily B. Levitan
Monika Safford
Robert O. Vos
Dima Qato
Adam P. Bress
2024

Background: Poor neighborhood‐level access to health care, including community pharmacies, contributes to cardiovascular disparities in the United States. The authors quantified the association between pharmacy proximity, antihypertensive and statin use, and blood pressure (BP) and low‐density lipoprotein cholesterol (LDL‐C) among a large, diverse US cohort.

Methods and Results: A cross‐sectional analysis of Black and White participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study during 2013 to 2016 was conducted....

Citizenship Status and Mortality Among Young Latino Adults in the U.S., 1998‒2015

Jenny Guadamuz
Ramon A Durazo-Arvizu
Josefina Flores Morales
Dima Qato
2022

Introduction: Although Latino immigrants, especially noncitizens, endure structural factors that may increase their risk of death at younger ages, little is known about their risk of death in young adulthood. This study evaluates mortality differences across citizenship status among young Latino adults (aged 18-44 years) in the U.S.

Methods: This study used the National Health Interview Survey (1998-2014) with mortality follow-up through 2015. Cox regression models adjusted for age and sex were used to determine baseline differences in mortality....

Citizenship status and cost-related nonadherence in the United States, 2017–2021

Jenny Guadamuz
Dima Qato
2023

Objective:To assess inequities in prescription medication use and subsequent cost-related nonadherence (CRN) and cost-saving strategies by citizenship status in the United States.

Study Design: This cross-sectional study examined noncitizen (n = 8596), naturalized citizen (n = 12,800), and US-born citizen (n = 120,195) adults. We also examined older adults (≥65 years) separately, including noncitizens without Medicare (a group of importance given their immigration-related barriers to health care access). Multiple mediation analysis was used to...

Use of Oral and Emergency Contraceptives After the US Supreme Court’s Dobbs Decision

Dima Qato
Rebecca Myerson
Andrew Shooshtari
Jenny Guadamuz
2024

Question: What is the association between the US Supreme Court’s July 2022 Dobbs v Jackson Women’s Health Organization decision and fills for oral and emergency contraceptives?

Findings: In this cohort study of over 143 million prescriptions dispensed at US retail pharmacies from March 2021 through October 2023, the Dobbs decision was associated with declines in fills for oral contraceptives—both daily oral contraceptive pills and emergency contraceptives—in states that implemented the most restrictive policies with a full ban on...