Innovative Research at the Intersection of Medicine and Public Health

t is not difficult to recognize the significant opportunity that exists when medicine and public health collaborate to improve outcomes for patients and their communities. What can be difficult, however, is getting that work started and sustained, finding ways to break down the academic silos that exist between physicians and public health professionals, between those at the bedside and those out in the field or in the dataset.

As described by the National Academy of Medicine, “medical care is insufficient for ensuring better health outcomes,” when 80-90% of outcomes are driven by social determinants of health. By increasing research around some of the many factors that drive health outcomes for women, the Department of Obstetrics and Gynecology at Columbia University Irving Medical Center has expanded its purview for advancing women’s health. Through its Center for Women’s Population Health, co-led by Dr. Jason Wright and Dr. Ka Kahe, members of the department have published hundreds of articles on various topics over the last five years. Earlier this year, Dr. Xiao Xu, a health services researcher with expertise in health economics and outcomes research, joined the department to further expand this critical work.

Areas of interest for this team include outcomes and trends surrounding hospital volume, neighborhood conditions, policy changes, and environmental risk factors. Below are summaries of a few of the articles that the team published in 2024:

In Hospital Volume and Quality of Care for Emergency Gynecologic Care, published in Obstetrics & Gynecology, Kalinowska et al. sought to evaluate the association between hospital volume and the quality of gynecologic emergency care for tubal ectopic pregnancies, ovarian torsion, and pelvic inflammatory disease (PID). Looking at data from 602 hospitals, the team found that higher hospital volume is associated with use of conservative, fertility-preserving treatment of emergency gynecologic conditions, including ectopic pregnancy and ovarian torsion. They identified that “a strategy for regionalizing gynecologic emergency care to high-volume centers may be a lever to improve quality of care.” Read full article.

In Incidence of Induced Abortion Among Commercially Insured Pregnant Patients with Cancer, published in Contraception, Swartz et al. examined how pregnant people facing a new cancer diagnosis may balance a decision to pursue optimal cancer therapy, desire for pregnancy, and/or the well-being of the fetus. Looking at a dataset of women aged 12 to 55 years old with commercial insurance, it was found that the timing of diagnosis and the decision to begin treatment affected induced abortion rates. They found that “patients with cancer who received anticancer therapy had nearly double the incidence of induced abortion compared with those without a diagnosis of cancer.” For those patients who did not receive active therapy, the incidence of abortion was similar to patients without cancer. Read full article.

In Tubal Sterilization Rates by State Abortion Laws After the Dobbs Decision, published in the Journal of the American Medical Association, Xu et al. identified that the use of sterilization procedures changed after the Dobbs ruling by restrictedness of state abortion laws. Looking at claims data for 25.1 million individuals with employer-sponsored health insurance across all US states in 2021 to 2022, the study found an “increase in use of tubal sterilization in all included states after the Dobbs decision, followed by a further monthly increase in banned states and a similar but not significant tendency in limited states (but not in protected states). Read full article.

In Neighborhood Economic Vulnerability as a Predictor for Patterns of Care and Outcomes for Patients with Uterine Cancer, published in Gynecologic Oncology, Gamble et al. sought to qualify the effect of neighborhood socioeconomic vulnerability as it relates to racial disparities in uterine cancer treatment and survival. Looking at over 34,000 patients, the team found that neighborhood economic vulnerability is associated with poor outcomes for patients with uterine cancer. The authors noted that, “‘the greatest Black/White survival disparities are in the wealthiest neighborhoods,’ suggesting that affluence may not affect survival of Black patients with advanced stage endometrial cancer.” Read full article.

In Association of Urinary Cadmium Concentration with Cognitive Impairment in US Adults: A Longitudinal Cohort Study, published in Neurology, Lu et al. sought to build the research base looking at how cadmium exposure is associated with neurotoxicity. From this prospective cohort study, the authors found that urinary cadmium concentrations are associated with global cognitive impairment among White but not Black individuals. They noted that further studies were required to understand the racial disparity shown, looking at factors that may be involved, such as the role of smoking. Read full article.

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