Milda R. Saunders
University of Chicago
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Featured researches published by Milda R. Saunders.
American Journal of Transplantation | 2010
Milda R. Saunders; K. A. Cagney; Lainie Friedman Ross; G. C. Alexander
To date, no study has characterized the association between neighborhood poverty, racial composition and deceased donor kidney waitlist. Using the United States Renal Data System data linked to 2000 U.S. Census Data, we examined Whites (n = 152 788) and Blacks (n = 130 300) initiating dialysis between January 2000 and December 2006. Subjects’ neighborhoods were divided into nine strata based on the percent of Black residents and percent poverty. Cox proportional hazards were used to determine the association between time to waitlist and neighborhood characteristics after adjusting for demographics and comorbid conditions. Individuals from poorer neighborhoods had a consistently lower likelihood of being waitlisted. This association was synergistic with neighborhood racial composition for Blacks, but not for Whites. Blacks in poor, predominantly Black neighborhoods (adjusted hazard ratio [HR] 0.57, 95% confidence intervals [CI] 0.53–0.62) were less likely to appear on transplant waitlist than those in wealthy, predominantly Black neighborhoods (HR 0.80, CI 0.67–0.96) and poor, predominantly White neighborhoods (HR 0.79, CI 0.70–0.89). All were all less likely to be waitlisted than their Black counterparts in wealthy, predominantly White or mixed neighborhoods (p < 0.05). Interventions targeted at individuals in poor and minority neighborhoods may represent an opportunity to improve equitable access to the deceased donor kidney waitlist.
Clinical Transplantation | 2015
Milda R. Saunders; Haena Lee; G. Caleb Alexander; Hyo Jung Tak; J. Richard Thistlethwaite; Lainie Friedman Ross
In the United States, African Americans and whites differ in access to the deceased donor renal transplant waitlist. The extent to which racial disparities in waitlisting differ between United Network for Organ Sharing (UNOS) regions is understudied.
Progress in Transplantation | 2013
Mark B. Lockwood; Milda R. Saunders; Christopher S. Lee; Yolanda T. Becker; Michelle A. Josephson; W. Chon
Context Barriers to kidney transplant for African Americans are well documented in the literature. Little information on ownership of information and communication technology and use of such technology in transplant populations has been published. Objective To characterize racial differences related to ownership and use of information and communication technology in kidney transplant patients. Design A single-center, cross-sectional survey study. Setting An urban Midwestern transplant center. Participants 78 pretransplant patients and 177 transplant recipients. Main Outcomes Measures The survey consisted of 6 demographic questions, 3 disease-related questions, and 9 technology-related questions. Dichotomous (yes/no) and Likert-scale items were the basis for the survey. Results Cell phone use was high and comparable between groups (94% in African Americans, 90% in whites, P = .22). A vast majority (75% of African Americans and 74% of whites) reported being “comfortable” sending and receiving text messages. Computer ownership (94.3% vs 79.3%) and Internet access (97.7% vs 80.7%) were greater among whites than African Americans (both P < .01). Fewer African Americans were frequent users of the Internet (27.1% vs 56.3%) and e-mail (61.6% vs 79.3%) than whites (both P < .01). More African Americans than whites preferred education in a classroom setting (77% vs 60%; P < .005) and educational DVDs (66% vs 46%; P < .002). Conclusion The use of cell phone technology and text messaging was ubiquitous and comparable between groups, but computer and Internet access and frequency of use were not. Reaching out to the African American community may best be accomplished by using cell phone/text messaging as opposed to Internet-based platforms.
Medical Care | 2013
Milda R. Saunders; Marshall H. Chin
Background:We examined whether dialysis facility characteristics, neighborhood demographics, and region are associated with Centers for Medicare and Medicaid Services (CMS) dialysis facility quality measures in order to determine the most important targets for intervention. Methods:We linked US census data to the CMS Dialysis Compare File which contains information for facility outcomes for all CMS-certified dialysis facilities in 2007 (n=5616). We then used linear and logistic regression to characterize the association between dialysis facility quality—worse than expected patient survival, and the proportion of individuals in a facility achieving dialysis adequacy (urea reduction rate >65) or target hemoglobin (10<Hgb<12 g/dL)—and dialysis facility characteristics, neighborhood demographics, and region. Results:Only an increasing proportion of African Americans in the neighborhood is consistently associated with worse dialysis facility outcomes, even after controlling for neighborhood poverty. Facilities with the highest proportion of African Americans in the neighborhood had worse patient survival [odds ratio (OR) 4.6; 95% confidence interval (CI), 2.8–7.6], were less likely to have adequate dialysis (&bgr; −1.4; 95% CI, −2.3 to −0.6), and achieve targeted hemoglobin (&bgr; −3.1; 95% CI, −4.7 to −1.6) compared to those with the lowest proportion. No other predictor—facility, neighborhood, or region—was consistently associated with dialysis facility quality. Conclusions:The proportion of African Americans in the dialysis facility neighborhood is strongly and consistently associated with lower facility quality. Quality improvement efforts are particularly needed for dialysis facilities in minority communities.
JAMA | 2015
Milda R. Saunders; Adam S. Cifu; Monica B. Vela
of the Clinical Problem Chronic kidneydisease is an important health issue associatedwith increased morbidity, mortality, and health care costs. Chronic kidney disease is defined as greater than 3 months of decreased kidney function, identified by a reduced estimated glomerular filtration rate (eGFR) of less than 60mL/min/1.73 m2 or by blood orurinemarkers of kidneydamage regardless of eGFR.1 Using this definition, aboutwhich there remains some controversy,more than 14% of the US population has CKD and 6% have stage 3 CKD or higher.2,3 Stage 3CKDconfers a greater risk of CKD-related complications and progression to end-stage renal disease (ESRD).3 Because CKD has a long asymptomatic phase, there are acceptable screening tests, and the health consequences associated with the diseasearehigh, it is adisease that is amenable toscreening.Screening could also be beneficial because only 10% of people with CKD knowtheyhave thedisease, and treatmentsexist thatdelay theprogression of CKD.4
International Scholarly Research Notices | 2012
Kalycia Trishana Watson; Nehezi M. Roberts; Milda R. Saunders
Background. We examined factors associated with depression and anxiety in a cohort of low-income Baltimore women. Methods. We used Pathways to Adulthood data, a cohort of adults aged 27 to 33 who were born in Baltimore between 1960 and 1965. Our outcomes were a score of >4 on the General Health Questionnaire (GHQ-28) across the depression or anxiety domains. Linear regression clustered on census tract was used for multivariate analysis. Results. In multivariable analyses, unmarried women, White women, those with lower self-rated health, and younger mothers had higher depression scores. Only lower self-rated health and White race were associated with a higher anxiety score. Neither neighborhood poverty nor racial composition was a predictor for anxiety or depression; however, the significant risk factors cluster in disadvantaged neighborhoods. Conclusion. Our work highlights the importance of universal screening for depression or anxiety with more in-depth surveillance based on risk factors rather than on race.
Progress in Transplantation | 2015
Mark B. Lockwood; Milda R. Saunders; Michelle A. Josephson; Yolanda T. Becker; Christopher S. Lee
Context The Internet is a staple of electronic communication and is essential to the emerging telemonitoring and health information technology interventions for adults with chronic diseases. Objective To identify determinants of frequent Internet use in an urban kidney transplant population in the United States. Design A single center, cross-sectional survey study Setting An urban Midwestern transplant center Participants 78 pretransplant and 177 posttransplant patients Main Outcome Measures Frequent Internet use, defined as using the Internet more than 5 hours per week. Results Only 38% of participants reported being frequent Internet users. Non-Hispanic blacks and participants who reported their race/ethnicity as “other” were significantly less likely than whites to report being frequent Internet users. Women were 59% less likely than men to be frequent users of the Internet. Those who reported having kidney disease for more than 3 years were more likely to report being frequent Internet users. As education increased, Internet use increased. As age increased, Internet use decreased. Conclusion Alternatives to electronic information sources and/or additional resources should be considered for those who may fall in the so-called digital divide.
International Scholarly Research Notices | 2012
Milda R. Saunders; Kalycia Trishana Watson; Hyo Jung Tak
Background. Few studies have examined how individual and neighborhood poverty in childhood and adulthood influence the likelihood of adult obesity. We used a longitudinal cohort to examine these associations. Methods. Our cohort consisted of children born in Baltimore, MD, USA with followup as adults from ages 27 to 33. We used logistic regression to examine the multivariate association between individual and neighborhood poverty in childhood and adulthood and adult obesity, (body mass index ≥30), based on self-reported height and weight. Results. Of the 986 female respondents, 82% were African American and 18% were White. Both groups had similar rates of adulthood obesity (African American 25% versus Whites 26% , 𝑃=0.91), and similar rates of poverty as children and adults. There was no statistically significant association between individual or neighborhood poverty during childhood and the likelihood of adult obesity. Adults at risk for overweight or overweight as children had significantly greater odds of adult obesity (OR 2.8 and 12.1, resp.). Conclusion. In this sample of women with high rates of childhood and adulthood poverty, obesity rates were high. Childhood risk for overweight and overweight were strongly associated with adult obesity. Individual and neighborhood poverty in childhood were not independently associated with adulthood obesity.
Progress in Transplantation | 2017
Mark B. Lockwood; Milda R. Saunders; Rachel Nass; Claire L. McGivern; Patrick N. Cunningham; W. James Chon; Michelle A. Josephson; Yolanda T. Becker; Christopher S. Lee
Background: Despite our knowledge of barriers to the early stages of the transplant process, we have limited insight into patient-reported barriers to the prekidney transplant medical evaluation in populations largely at-risk for evaluation failure. Methods: One-hundred consecutive adults were enrolled at an urban, Midwestern transplant center. Demographic, clinical, and quality of life data were collected prior to patients visit with a transplant surgeon/nephrologist (evaluation begins). Patient-reported barriers to evaluation completion were collected using the Subjective Barriers Questionnaire 90-days after the initial medical evaluation appointment (evaluation ends), our center targeted goal for transplant work-up completion. Results: At 90 days, 40% of participants had not completed the transplant evaluation. Five barrier categories were created from the 85 responses to the Subjective Barriers Questionnaire. Patient-reported barriers included poor communication, physical health, socioeconomics, psychosocial influences, and access to care. In addition, determinants for successful evaluation completion included being of white race, higher income, free of dialysis, a lower comorbid burden, and reporting higher scores on the Kidney Disease Quality of Life subscale role-emotional. Conclusion: Poor communication between patients and providers, and among providers, was the most prominent patient-reported barrier identified. Barriers were more prominent in marginalized groups such as ethnic minorities and people with low income. Understanding the prevalence of patient-reported barriers may aid in the development of patient-centered interventions to improve completion rates.
Journal of Heart and Lung Transplantation | 2017
Yuan Liu; Monica B. Vela; Tanya Rudakevych; Christopher H. Wigfield; Edward R. Garrity; Milda R. Saunders
BACKGROUND Since 2005, the Lung Allocation Score (LAS) has prioritized patient benefit and post-transplant survival, reducing waitlist to transplant time to <200 days and decreasing mortality on the waitlist. A current challenge is the wait for the waitlist-the time between the patients transplant-eligible diagnosis and waitlist registration. METHODS We investigated whether sociodemographic (age, sex, race, insurance, marital status, median household income) and clinical (forced expiratory volume in 1 second [FEV1] percent of predicted, body mass index, depression/anxiety, alcohol/substance misuse, absolute/relative contraindications) factors influenced referral and waitlist registration. We conducted a retrospective cohort study through chart review of hospitalized patients on the University of Chicago general medicine service from 2006 to 2014 who met transplant-eligible criteria and ICD-9 billing codes for cystic fibrosis (CF) and pulmonary fibrosis (PF). We analyzed the times from transplant eligibility to referral, work-up and waitlisting using Kaplan-Meier curves and log-rank tests. RESULTS Overall, the referral rate for transplant-eligible patients was 64%. Of those referred, approximately 36% reach the lung transplant waitlist. Referred CF patients were significantly more likely to reach the transplant waitlist than PF patients (CF 60% vs PF 22%, p < 0.05). In addition, CF patients had a shorter wait from transplant eligibility to waitlist than PF patients (329 vs 2,369 days, respectively [25th percentile], p < 0.05). Patients with PF and CF both faced delays from eligibility to referral and waitlist. CONCLUSIONS Quality improvement efforts are needed to better identify and refer appropriate patients for lung transplant evaluation. Targeted interventions may facilitate more efficient evaluation completion and waitlist appearance.