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High Prevalence of Chronic Conditions Among Vulnerable Populations: A Literature Review and Methodological Proposal

Angelika Ptak BSN

St. Thomas University

NUR: 611 Advanced Practice Nursing Integration Practicum

Professor Corzo-Sanchez PhD

July 11, 2024

Abstract

This paper examines the high prevalence of chronic conditions, such as cardiovascular disease, diabetes, hypertension, and obesity, among vulnerable populations including those in poverty, underserved areas, and individuals lacking health insurance. A comprehensive review of relevant literature identifies significant gaps in current knowledge and proposes a mixed-methods approach to address these issues, emphasizing the roles of social determinants of health, housing stability, and integrated care models. This methodology aims to incorporate preventive measures, to enhance health outcomes for those at-risk populations suffering from chronic conditions.

Introduction

Chronic conditions such as cardiovascular disease, diabetes, hypertension, and obesity are prevalent among vulnerable populations, including individuals living in poverty, underserved areas, and those without health insurance (Khunti et al., 2023). These populations face significant barriers to accessing quality healthcare, leading to higher morbidity and mortality rates. Social determinants of health (SDOH), which include socioeconomic status, neighborhood environment, and access to healthcare, play a critical role in shaping health outcomes (Kim et al., 2023). This paper aims to synthesize current literature to identify gaps in knowledge and propose a methodological framework to address these issues through primary, secondary, and tertiary preventive measures.

Literature Review

Social Determinants of Health and Diabetes

The article “Social Determinants of Health and Diabetes” by the American Diabetes Association (2021) delves into how socioeconomic status, neighborhood environment, and healthcare access impact diabetes risk and outcomes. The study emphasizes the critical need to address SDOH to improve health equity and manage diabetes effectively among disadvantaged groups (Hill-Briggs et al., 2021). This comprehensive review identifies key socioeconomic factors that exacerbate diabetes prevalence and outcomes, such as limited access to nutritious food, safe environments, and preventive healthcare services. However, the article’s focus on diabetes limits its broader application to other chronic conditions. This indicates a gap in the literature regarding intervention strategies targeting SDOH across multiple chronic diseases.

Federal Housing Assistance and Chronic Disease

The CDC’s study “Federal Housing Assistance and Chronic Disease” (2023) explores the relationship between housing assistance and the prevalence of chronic conditions. The findings suggest that individuals receiving federal housing assistance experience different health outcomes compared to low-income individuals not receiving such support, (Kim et al., 2023) The study underscores the pivotal role of stable housing in managing chronic diseases and highlights how housing stability can mitigate health disparities (NIH, 2023). Despite providing robust evidence linking housing stability to improved health outcomes, the study does not fully account for other forms of social support, indicating a need for more comprehensive research that includes diverse social support mechanisms (Hill-Briggs et al.,2021).

Diabetes and Multiple Long-term Conditions

The article “Diabetes and Multiple Long-term Conditions” by the American Diabetes Association (2023) discusses the global health challenges posed by diabetes in conjunction with multiple long-term conditions (MLTC). The review highlights the complexities faced by healthcare systems designed around single-disease models and advocates for integrated care approaches to manage comorbidities effectively. This is particularly relevant for vulnerable populations who often suffer from multiple chronic conditions simultaneously. While the article provides valuable insights into the necessity for integrated care, its focus on diabetes-specific challenges may not fully encompass the broader spectrum of chronic conditions prevalent among vulnerable populations (Khunti et al., 2023). However, there are notable gaps in the literature regarding the development of integrated care models, that cater specifically to the needs of these populations.

Comparative Analysis

The literature reviewed highlights the profound impact of SDOH, housing stability, and integrated care models on managing chronic conditions among vulnerable populations. Common themes across the articles include the critical influence of socioeconomic factors on health outcomes and the importance of comprehensive social support mechanisms. Differences in focus are evident, with one article primarily addressing diabetes, another exploring the role of housing stability, and the third discussing the management of multiple long-term conditions through integrated care. These findings underscore the necessity for targeted interventions but also reveal significant gaps in comprehensive strategies addressing these issues holistically.

Gaps in Knowledge

The literature review identifies several critical gaps in knowledge:

1. Intervention Strategies for SDOH: There is a lack of comprehensive intervention strategies specifically targeting SDOH in underserved populations.

2. Social Support Mechanisms: More extensive studies are needed to explore the impact of various social support mechanisms beyond housing assistance.

3. Integrated Care Models: There is a significant gap in the development and implementation of integrated care models, tailored to manage multiple chronic conditions in vulnerable populations.

Addressing these gaps is essential for developing effective preventive measures and improving health outcomes for vulnerable populations.

Proposed Methodology

Study Design

This study will employ a mixed-methods approach, integrating quantitative and qualitative data. Randomized clinical trials (RCTs) will be conducted to test the effectiveness of various intervention strategies.

Participants

The study will focus on vulnerable populations, including those living in poverty, underserved areas, and individuals without health insurance.

Interventions

Interventions will be designed to address SDOH through community-based programs, provide stable housing and comprehensive social support, and implement integrated care models tailored to managing multiple chronic conditions.

Data Collection

Quantitative data will include health outcomes such as disease prevalence, hospitalization rates, and healthcare utilization. Qualitative data will capture patient experiences, barriers to care, and the effectiveness of intervention strategies.

Analysis

Statistical analysis will be used to evaluate quantitative data, while thematic analysis will be applied to qualitative data. This mixed-methods approach will provide a comprehensive understanding of the interventions’ impact on health outcomes.

Conclusion

Addressing the high prevalence of chronic conditions among vulnerable populations requires targeted interventions based on identified gaps in the literature. By focusing on SDOH, housing stability, and integrated care, this proposed study aims to enhance preventive measures and improve health outcomes and health equity for these populations.

References

Kim, C., Rossen, L. M., Stierman, B., Garrison, V., Hales, C. M. & Ogden, C. L. (2023). Federal

housing assistance and chronic disease among US adults, 2005–2018. Preventing Chronic Disease, 20, 230144. http://dx.doi.org/10.5888/pcd20.230144

Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A.,

Thornton, P. L., & Haire-Joshu, D. (2021). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258–279. Advanced online publication. https://doi.org/10.2337/dci20-0053

Khunti, K., Chudasama, Y. V., Gregg, E. W., Kamkuemah, M., Misra, S., Suls, J.,

Venkateshmurthy, N. S., & Valabhji, J. (2023). Diabetes and multiple long-term conditions: A review of our current global health challenge. Diabetes Care, 46(12), 2092–2101. https://doi.org/10.2337/dci23-0035

Health Care Models for Persons with Multiple Chronic Conditions from

Populations that Experience Health Disparities: Advancing Health Care towards Health Equity (R01 – Clinical Trials Optional); PAR-22-092. (2023). Department of Health and Human Services. National Institute of Health. https://grants.nih.gov/grants/guide/pa-files/PAR-22-092.html

Name: ____ Angelika Ptak BSN__ Date: 7/11/2024__________________

Author	Journal Name/ Year of Publication	Research Design	Sample Size	Outcome Variables Measured	Quality (A, B, C)	Results/Author’s Suggested Conclusion
Kamlesh Khunti ORCID et. al	Diabetes Care/2023 Volume 46 Issue 12	Systematic Review: Analysis of 566 studies on MLTC. Quantitative: Delphi method to define MLTC. Qualitative: Data from various populations and settings. Mixed Method: Evaluating system delivery, lifestyle, and therapeutic interventions	566 participants	Prevalence and Incidence: Tracking the occurrence of MLTC in diabetes patients. Healthcare Utilization: Assessing hospital admissions, emergency department visits, and primary care consultations. Health-Related Quality of Life: Evaluating the impact of MLTC on patients’ well-being. Mortality: Studying the association between MLTC and mortality risk. Healthcare Costs: Analyzing the economic burden of MLTC in diabetes management.	Prevalence and Incidence: I would assign this an “A” grade. The tracking of MLTC occurrence in diabetes patients is crucial and well-established. Healthcare Utilization: I’d give this a “B”. While important, it requires more nuanced analysis beyond basic tracking. Health-Related Quality of Life: This deserves an “A”. Understanding patient well-being is critical for holistic care. Mortality: I’d rate this as an “A-”. It’s significant, but complexities exist. –Healthcare Costs: I’d assign an “A” here. Analyzing economic burden is essential for policy decisions.	Rising Prevalence: The number of people with diabetes and MLTC is increasing globally, with significant implications for health care services and patient outcomes. Challenges: MLTC leads to fragmented care, polypharmacy, poor quality of life, and higher mortality rates12. Interventions Needed: Effective system delivery, care coordination, lifestyle interventions, and therapeutic interventions are crucial for managing MLTC. Research Directions: Future research should focus on developing robust evidence-based interventions to improve the lives of people with MLTC and build cost-effective health care systems
Christine Kim, PhD, MSPH, et. al	Federal Housing Assistance and Chronic Disease Among US Adults, 2005–2018 Volume 20 — November 30, 2023	The article uses a quantitative research design. It analyzes data from the National Health and Nutrition Examination Survey (NHANES) and US Department of Housing and Urban Development (HUD) administrative records to estimate the prevalence of chronic conditions and assess associations between housing assistance and these conditions among adults1. The study employs statistical methods, including propensity-score weighting, to control for potential confounders and ensure comparability between groups.	The study included 2,363 HUD-assisted adults and 13,755 HUD-unassisted adults with an income-to-poverty ratio (IPR) less than 21. This data was collected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018	The article measures the following outcome variables: Obesity: Defined as a body mass index (BMI) of 30.0 or more. Diabetes: Identified through self-reported diagnosis or a hemoglobin A1c level of 6.5% or more. Hypertension: Defined by systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or self-reported use of hypertension medication. These variables were assessed to understand the prevalence of chronic conditions among adults receiving HUD assistance compared to those eligible but not receiving assistance	The study found that adults receiving HUD assistance had a higher prevalence of obesity compared to those eligible but not receiving assistance. However, there were no significant differences for diabetes or hypertension. Given these mixed results, I would assign a “C” grade to the outcome variable measured. This reflects the study’s partial success in identifying significant associations, but also acknowledges the limitations and lack of significant findings for some conditions.	Higher Obesity Rates: Adults receiving HUD assistance had a higher prevalence of obesity (47.5%) compared to those not receiving assistance (42.1%). No Significant Differences: There were no significant differences in the prevalence of diabetes and hypertension between the two groups. Associations with Obesity: Housing assistance was significantly associated with higher odds of obesity, but not with diabetes or hypertension. Informing Future Research: The study’s findings can help inform future research on chronic disease prevalence among adults receiving housing assistance
Felicia Hill-Briggs et. al	SCIENTIFIC REVIEW NOVEMBER 2, 2020 Social Determinants of Health and Diabetes: A Scientific Revie	The research design of this study is a systematic review. It summarizes literature on the range of social determinants of health (SDOH) identified as having an impact on diabetes outcomes, drawing from systematic reviews, meta-analyses, and more recent published studies	The current page does not specify a single study with a sample size. Instead, it reviews multiple studies and frameworks related to social determinants of health (SDOH) and diabetes	The study measures several outcome variables related to diabetes and social determinants of health (SDOH): Diabetes Prevalence and Incidence: Rates of diabetes in different socioeconomic and demographic groups. Diabetes-Related Mortality: Risk of death due to diabetes across various income and education levels. Glycemic Control: HbA1c levels, indicating blood sugar control. Health Care Utilization: Frequency of emergency department visits, hospitalizations, and outpatient services for diabetes management. These variables help understand the impact of SDOH on diabetes outcomes	Prevalence and Incidence: I would assign this an “A”. Tracking MLTC occurrence in diabetes patients is crucial and well-established. Healthcare Utilization: I’d give this a “B”. While important, it requires more nuanced analysis beyond basic tracking. Health-Related Quality of Life: This deserves an “A”. Understanding patient well-being is critical for holistic care. Mortality: I’d rate this as an “A-”. It’s significant, but complexities exist. Healthcare Costs: I’d assign an “A” here. Analyzing economic burden is essential for policy decisions.	Here are the key takeaways from the commentary on diabetes and social determinants of health (SDOH): Disproportionate Impact: Diabetes disproportionately affects racial and ethnic minorities and low-income populations in the U.S., with higher risks and complications. SDOH Importance: Addressing SDOH is crucial for achieving health equity, especially in diabetes, due to its prevalence and economic costs. Frameworks and Definitions: Various frameworks, including WHO and Healthy People 2020, classify SDOH factors like socioeconomic status, neighborhood environment, food access, health care, and social context. –Recommendations: The article concludes with recommendations for linking health care and community sectors, and for further research to inform practice.
National Institutes of Health	Department of Health and Human Services November 29, 2023	Mixed method evaluating aimed at optimizing care for persons with multiple chronic conditions (MCCs) from populations experiencing health disparities.	The current page does not specify the sample size for the study. It focuses on the funding opportunity announcement and guidelines for research projects related to multiple chronic conditions (MCCs) in populations experiencing health disparities	Part of the current page talks about the outcome variables measured in the context of clinical trials and research projects. Here are the key points: –Primary and Secondary Outcome Variables: These should be clear, informative, and relevant to the hypothesis being tested. –Health Outcomes: Includes reduction of preventable complications, prevention of hospitalizations or readmissions, improved quality of life, and proactive health care delivery. –Patient-Centered Goals: Personal health outcomes that patients hope to achieve, such as physical/mental function, independence, well-being, and life expectancy. Cost and Quality of Care: Changes in outcomes such as cost, quality, access, or care coordination for people with multiple chronic conditions.	“A” The current page provides detailed information about a funding opportunity announcement (FOA) from the National Institutes of Health (NIH). It outlines the objectives, eligibility, application process, and specific areas of interest for research projects focused on optimizing care for persons with multiple chronic conditions (MCCs) from populations experiencing health disparities	The current page outlines a funding opportunity announcement (FOA) from the NIH, focusing on research to optimize care for individuals with multiple chronic conditions (MCCs) from populations experiencing health disparities. –Research Focus: The initiative supports innovative, multidisciplinary research to integrate and implement evidence-based care guidelines for MCCs. –Health Disparities: Emphasis on populations experiencing health disparities, including racial/ethnic minorities and socioeconomically disadvantaged groups. –Health Care Models: Encourages the use of existing or new health care models to achieve optimal health outcomes. –Funding and Eligibility: Details on application requirements, eligibility, and submission guidelines for potential applicants.

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PICO Question and Introduction to the Research

Angelika Ptak BSN

St. Thomas University

NUR: 611 Advanced Practice Nursing Integration Practicum

Professor Corzo-Sanchez PhD

July 16, 2024

PICOT question.

I. Purpose of or rationale for the scholarly project:

1. Provide an evidence-based explanation of why it is necessary to complete a scholarly project and what benefit will be gained (health promotion, fiscal, and efficiency)

II. Background on the problem or population of interest:

1. Data and background needed for the project

III. Significance of the problem to nursing and health care:

1. The problem or population of interest aligns with the community’s larger interest in health care.

2. Context of importance

IV. Benefit of the project to nursing practice

1. Gained from your project.

2. Expected outcomes of a project to practice within your population and setting of interest

3. Relate the outcomes to evidence-based guidelines and outcomes.

4. Project influences on other populations or settings.

Abstract

As demonstrated by the recent trends of increased obesity and morbidity with mortality among the general population with the prevalence of chronic conditions such as cardiovascular, and diabetes, the numbers and statistical data are alarming to the public health and global arena. The chronic conditions that currently are on the rise and the age of developing them also is lower, as is manifested with pediatric and young adults suffering from metabolic syndrome and developing life-threatening conditions prematurely. Therefore, medical professionals have a responsibility to implement modalities that will improve the health and well-being of the general population. Especially the at-risk individuals with chronic conditions, the ones that are currently living with cardiovascular conditions, diabetes, and other major health conditions, to prevent further complications and increase life expectancy, by practicing preventive medicine, and interventions needed to lower chronic disease prevalence.

PICO Question

In vulnerable populations living in poverty or people who lack health insurance with no resources for health management, intervention with assistance and resource provision by healthcare providers and policy improvement, will lower the risk of chronic conditions in comparison to no assistance.

I. The purpose and rationale for the scholarly project

A physical and/or mental condition that leads to functional limitations, in results creating the need for frequent treatments with monitoring under medical providers. In addition, an individual with medication needs and management of the conditions for their alignment of those circumstances are categorized as a chronic disease. Therefore, chronic diseases are the most prevalent health conditions in the United States. Costing billions of dollars of he

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