Papers by William Buckingham
BACKGROUND: The University of Wisconsin-Madison Department of Family Medicine is realizing the In... more BACKGROUND: The University of Wisconsin-Madison Department of Family Medicine is realizing the Institute of Medicine’s vision to integrate primary care and public health by incorporating community health in its missions of patient care, education, and research. Researchers developed Community Health Practice Profiles (CHPPs) using individual-level data from billing and electronic health records combined with community-level public health data to analyze and map health conditions and identify social determinants within local communities. METHODS: A HIPAA-compliant limited dataset was created using EHR data from UW-Health Primary Care clinics (2007-2012) for patients with known BMI in Dane County, aged 18+ (N=167,751), and diagnosed as obese (N=52,654; 31.4%). Patient-level data were geocoded by census block group, matched to community-level data, analyzed to look at the prevalence rates and associated risks, and mapped using advanced GIS techniques. RESULTS: Risk of obesity increased...
Alzheimer's & Dementia, 2021
Neighborhood disadvantage, a social exposome measure reflecting income, education, employment, an... more Neighborhood disadvantage, a social exposome measure reflecting income, education, employment, and housing in a census‐block group, is associated with markers of Alzheimer’s disease brain health such as brain volume and amyloid plaque presence. Yet it is not known whether this association extends to neurofibrillary degeneration, signaling a stronger link to neuropathology confirmed Alzheimer’s disease.
Alzheimer's & Dementia, 2021
The Journal of Community Informatics, 2012
Public Health decision makers face challenges in understanding the qualitative lived experiences ... more Public Health decision makers face challenges in understanding the qualitative lived experiences of populations, as well as capturing and understanding the geographic nature of public health. This paper describes a community information framework that captures both qualitative and geographic information about health and place from the population. The adoption of a ICT using principles of both participatory mapping and new spatial media opens new avenues for understanding public health – through community contributed data acquisition. This paper will describe the development and results of the ICT as well as potential to increase social equity with public health in Madison, Wisconsin, USA.
Mayo Clinic Proceedings, 2020
OBJECTIVE To determine whether neighborhood socioeconomic disadvantage, as determined by the Area... more OBJECTIVE To determine whether neighborhood socioeconomic disadvantage, as determined by the Area Deprivation Index, increases 30-day hospital re-observation risk. PARTICIPANTS AND METHODS This retrospective study of 20% Medicare fee-for-service beneficiary observation stays from January 1, 2014, to November 30, 2014, included 319,980 stays among 273,308 beneficiaries. We evaluated risk for a 30-day re-observation following an index observation stay for those living in the 15% most disadvantaged compared with the 85% least disadvantaged neighborhoods. RESULTS Overall, 4.5% (270,600 of 6,080,664) of beneficiaries had index observation stays, which varied by disadvantage (4.3% [232,568 of 5,398,311] in the least disadvantaged 85% compared with 5.6% [38,032 of 682,353] in the most disadvantaged 15%). Patients in the most disadvantaged neighborhoods had a higher 30-day re-observation rate (2857 of 41,975; 6.8%) compared with least disadvantaged neighborhoods (13,543 of 278,005; 4.9%); a 43% increased risk (unadjusted odds ratio [OR], 1.43; 95% CI, 1.31 to 1.55). After adjustment, this risk remained (adjusted OR, 1.13; 95% CI, 1.04 to 1.22). Discharge to a skilled nursing facility reduced 30-day re-observation risk (OR, 0.63; 95% CI, 0.57 to 0.69), whereas index observation length of stay of 4 or more days (3 midnights) conferred increased risk (OR, 1.29; 95% CI, 1.09 to 1.52); those living in disadvantaged neighborhoods were less likely to discharge to skilled nursing facilities and more likely to have long index stays. Beneficiaries with more than one 30-day re-observation (chronic re-observation) had progressively greater disadvantage by number of stays (adjusted incident rate ratio, 1.08; 95% CI, 1.02 to 1.14). Observation prevalence varied nationally. CONCLUSION Thirty-day re-observation, especially chronic re-observation, is highly associated with socioeconomic neighborhood disadvantage, even after accounting for factors such as race, disability, and Medicaid eligibility. Beneficiaries least able to pay are potentially most vulnerable to costs from serial re-observations and challenges of Medicare observation policy, which may discourage patients from seeking necessary care.
Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2020
Residence in a disadvantaged neighborhood associates with adverse health exposures and outcomes, ... more Residence in a disadvantaged neighborhood associates with adverse health exposures and outcomes, and may increase risk for cognitive impairment and dementia. Utilization of a publicly available, geocoded disadvantage metric could facilitate efficient integration of social determinants of health into models of cognitive aging.
Neurology, 2021
ObjectiveTo test the hypothesis that neighborhood-level disadvantage is associated with longitudi... more ObjectiveTo test the hypothesis that neighborhood-level disadvantage is associated with longitudinal measures of neurodegeneration and cognitive decline in an unimpaired cohort.MethodsLongitudinal MRI and cognitive testing data were collected from 601 cognitively unimpaired participants in the Wisconsin Registry for Alzheimer's Prevention Study and the Wisconsin Alzheimer's Disease Research Center clinical cohort. Area Deprivation Index was geospatially determined based on participant residence geocode and ranked relative to state of residence. Linear regression models were fitted to test associations between neighborhood-level disadvantage and longitudinal change in cortical thickness and cognitive test performance. Mediation tests were used to assess whether neurodegeneration and cognitive decline were associated with neighborhood-level disadvantage along the same theoretical causal path.ResultsIn our middle- to older-aged study population (mean baseline age 59 years), liv...
Alzheimer's & Dementia, 2020
Social and economic conditions of an individual’s living environment constitute an important soci... more Social and economic conditions of an individual’s living environment constitute an important social determinant of health. Exposure to high neighborhood‐level socioeconomic disadvantage is associated with negative health outcomes. Recent cross‐sectional studies demonstrated that living in the most highly disadvantaged areas was associated with lower hippocampal volume, total brain volume1 and cognitive performance2 in an unimpaired older cohort. Using longitudinal data from a subset of the same cohort, we tested associations between high neighborhood‐level disadvantage, longitudinal cortical thickness and cognitive function.
Breastfeeding Medicine, 2021
Background: Disparities in breastfeeding persist placing a greater burden of disease on non-Hispa... more Background: Disparities in breastfeeding persist placing a greater burden of disease on non-Hispanic black and Hispanic women and infants. Targeted implementation of the Baby-Friendly Hospital Initiative (BFHI) in areas at risk for poor breastfeeding outcomes has been shown to improve disparities in breastfeeding. The area deprivation index (ADI), a measure of the relative socioeconomic disadvantage of a neighborhood, may be useful in exploring the accessibility of BFHI hospitals in highly deprived areas and the differences in exclusive breastfeeding (EBF) rates in hospitals with and without the BFHI designation across deprivation categories. Objective: To evaluate the geographical distribution of BFHI and non-BFHI hospitals across ADI categories and explore the differences in EBF rates in BFHI and non-BFHI hospitals across ADI categories. Methods: Hospital EBF rates obtained from the Joint Commission included 414 BFHI and 1,532 non-BFHI hospitals. State ADI rank scores were determined for each hospital's census block group. Descriptive statistics were used to describe the geographic distribution of BFHI hospitals across three ADI categories (low, medium, and high). EBF rates across ADI categories and BFHI designations were compared using multiway analysis of variance. Results: The distribution of BFHI was similar across all ADI categories, ranging from 18% to 24%. EBF rates were 4.9% lower in highly deprived areas compared to areas with lower deprivation (p < 0.01). BFHI was associated with significantly higher EBF rates across all ADI categories (6.9%-11.2%, p < 0.01). Conclusion: ADI may be a useful tool for targeting the implementation of BFHI in hospitals in highly deprived areas to reduce breastfeeding disparities.
Alzheimer's & Dementia, 2017
Background: By 2060 there will be 9.5 million individuals age 90+ in the United States and over o... more Background: By 2060 there will be 9.5 million individuals age 90+ in the United States and over one third will be NonWhite. In younger elderly, there are marked differences in rates of dementia by racial/ethnic groups, showing increased rates for Blacks and decreased rates for Asians. However, it is completely unknown if these discrepancies also occur in the oldest-old. Methods: We established a cohort of 2,351 members of Kaiser Permanente Northern California (KPNC) health-plan who, in 2010, were >age 90, with no diagnoses of dementia. Dementia diagnoses (ICD-9 codes 331.0, 290.0-290.4x, 294.1, 294.2x, and 294.8) made in primary care, neurology, memory clinics, and psychiatry were abstracted from electronic medical records from 1/1/201012/31/2015. We estimated dementia incidence rates standardized to the 2000 US Census 90+ year-old population by race/ethnicity. Cox proportional hazard models (age as time scale) evaluated the association between racial/ethnic groups and dementia risk. Participants were censored at dementia diagnosis, death, >90 day gap in health plan membership, or end of study. Results:The mean age in 2010 was 93.1 (range: 90-109). The cohort is 65% female, 72%White (N1⁄41,702), 16% Black (N1⁄4375), 4% Latino (N1⁄4105) and 7% Asian (N1⁄4169). 771 members (32.8%) were diagnosed with dementia during the 5-year follow-up period. The mean age of dementia diagnosis was 95.48 (SE1⁄40.10) and was similar across racial and ethnic groups: 95.56 (SE1⁄40.11) for Whites, 95.21 (SE1⁄40.23) for Blacks, 95.71 (SE1⁄40.66) for Latinos, 95.28 (SE1⁄40.31) for Asians. The overall age-adjusted incidence rate (aIR) was 100.5 per 1,000 person-years. Asians had the lowest incidence rates (aIR1⁄489.3), followed by Whites (aIR1⁄497.0), Latinos (aIR1⁄4105.8), and, lastly, Blacks who had the highest rates (aIR1⁄4121.5). In cox proportional hazard models adjusted for age as the time scale, education, sex, midlife and late-life vascular comorbidities, Blacks had significantly higher risk (aHR1⁄41.28; 95%CI: 1.05-1.51), compared to Whites. Conclusions: These are the first estimates of dementia incidence in a diverse cohort of 90+ individuals. Patterns of racial/ethnic disparities in dementia seen in younger elderly continue after age 90. These estimates provide an important foundation for understanding the burden of racial disparities in dementia in the oldest-old, the fastest growing segment of the population.
Health Services Research, 2018
New England Journal of Medicine, 2018
Innovation in Aging, 2017
WMJ : official publication of the State Medical Society of Wisconsin, 2012
Geocoding electronic health records (EHRs) provides novel insights for clinicians, but it is impo... more Geocoding electronic health records (EHRs) provides novel insights for clinicians, but it is important to understand and address key issues, including privacy and protection of patient records, in order to realize potential benefits. This paper discusses the issues surrounding geocoding and illustrates potential benefits through 3 case studies of no-shows to clinical appointments, patient analysis for a merged clinic site, and multi-clinic patient overlap. Geocoding EHRs provides a new contextual understanding for clinicians to understand patients and provide targeted interventions that patients can implement. While geocoding EHRs presents a need for high data security, the benefits outweigh the risks when proper protections are observed.
WMJ : official publication of the State Medical Society of Wisconsin, 2012
Electronic health records (EHRs) hold the promise of improving clinical quality and population he... more Electronic health records (EHRs) hold the promise of improving clinical quality and population health while reducing health care costs. However, it is not clear how these goals can be achieved in practice. Clinician-led teams developed EHR data extracts to support chronic disease use cases. EHRs were linked with community-level data to describe disease prevalence and health care quality at the patient, health care system, and community risk factor levels. Software was developed and statistical modeling included multivariate, mixed-model, longitudinal, data mining, and geographic information system (GIS)/spatial regression approaches. A HIPAA-compliant limited data set was created on 192,201 patients seen in University of Wisconsin Family Medicine clinics throughout Wisconsin in 2007-2009. It was linked to a commercially available database of approximately 6000 variables describing community-level risk factors at the census block group. Areas of increased asthma and diabetes prevalen...
Cartographic Perspectives, 2009
Over the course of the past twenty years, a social awareness to maps and the practice of mapping ... more Over the course of the past twenty years, a social awareness to maps and the practice of mapping has become a subject of acute interest both within the discipline of Geography and beyond. The rise of Google Maps, with its various "mashups" and "hacks" has produced an interest to use maps for understanding "non-mapped" phenomena (e.g. qualitative data or localized community information and knowledge). It is within this swirling of map interest that a potential avenue for Cartography can be seen-one that pushes the field forward while embracing the newfound enthusiasm of both the neo-geographer and the general public. This special digital issue of CP is intended to look at opportunities to share our craft. This sharing can come in many forms: a techniques piece, data or information. Our sharing focuses on inviting a group with specialized knowledge to participate in a mapping exercise. In situations like thissharing the practice of cartography-the cartographer plays the role of guide, more than map-maker, in the traditional sense of providing a finished product at the end of the production process. This role does not negate the
Journal of biomedical informatics, Jan 20, 2014
Geographically distributed environmental factors influence the burden of diseases such as asthma.... more Geographically distributed environmental factors influence the burden of diseases such as asthma. Our objective was to identify sparse environmental variables associated with asthma diagnosis gathered from a large electronic health record (EHR) dataset while controlling for spatial variation. An EHR dataset from the University of Wisconsin's Family Medicine, Internal Medicine and Pediatrics Departments was obtained for 199,220 patients aged 5-50years over a three-year period. Each patient's home address was geocoded to one of 3456 geographic census block groups. Over one thousand block group variables were obtained from a commercial database. We developed a Sparse Spatial Environmental Analysis (SASEA). Using this method, the environmental variables were first dimensionally reduced with sparse principal component analysis. Logistic thin plate regression spline modeling was then used to identify block group variables associated with asthma from sparse principal components. Th...
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Papers by William Buckingham