Erin R. McNeely, MD, FACP

All Publications

• Physician and healthcare partner engagement in the creation of healthfulness indices for West Michigan. Spatial and spatio-temporal epidemiology Sadler, R. C., Gailey, S., McNeely, E. R. 2025; 53: 100722

  Abstract

  Community participatory mapping can direct health research, offering opportunity to build spatial awareness and generate future research. Here we establish healthfulness indices by consulting healthcare system partners for their expert opinions on characteristics they felt influenced health. Partners started from 36 variables and narrowed to 16 in 4 simplified categories. The analytic hierarchy process was used to identify variable and category weights. Opinions were consolidated for each partner sub-group and overall. Map layers were assigned calculated weights and indices were created from weighted layers. Areas with more amenities scored higher, including in and around downtown areas and smaller towns. Lower scores were found in suburban and lower-income urban areas. Variation in maps among subgroups reflect differing priorities in tackling health equity issues. This work increases healthcare partner engagement in built environment work and generates future research pathways. Partners now have a tool for interrogating and communicating the environment's cumulative impact.

  View details for DOI 10.1016/j.sste.2025.100722

  View details for PubMedID 40490328

• Rural-Urban mild cognitive impairment comparison in West Michigan through EHR. Alzheimer's & dementia (New York, N. Y.) Zhang, X., Witteveen-Lane, M., Skovira, C., Dave, A. A., Jones, J. S., McNeely, E. R., Lawrence, M. R., Morgan, D. G., Chesla, D., Chen, B. 2024; 10 (3): e12495

  Abstract

  Mild cognitive impairment (MCI) is a significant public health concern and a potential precursor to Alzheimer's disease (AD). This study leverages electronic health record (EHR) data to explore rural-urban differences in MCI incidence, risk factors, and healthcare navigation in West Michigan.Analysis was conducted on 1,528,464 patients from Corewell Health West, using face-to-face encounters between 1/1/2015 and 7/31/2022. MCI cases were identified using International Classification of Diseases (ICD) codes, focusing on patients aged 45+ without prior MCI, dementia, or AD diagnoses. Incidence rates, cumulative incidences, primary care physicians (PCPs), and neuropsychology referral outcomes were examined across rural and urban areas. Risk factors were evaluated through univariate and multivariate Cox regression analyses. The geographic distribution of patient counts, hospital locations, and neurology department referrals were examined.Among 423,592 patients, a higher MCI incidence rate was observed in urban settings compared to rural settings (3.83 vs. 3.22 per 1,000 person-years). However, sensitivity analysis revealed higher incidence rates in rural areas when including patients who progressed directly to dementia. Urban patients demonstrated higher rates of referrals to and completion of neurological services. While the risk factors for MCI were largely similar across urban and rural populations, urban-specific factors for incident MCI are hearing loss, inflammatory bowel disease, obstructive sleep apnea, insomnia, being African American, and being underweight. Common risk factors include diabetes, intracranial injury, cerebrovascular disease, coronary artery disease, stroke, Parkinson's disease, epilepsy, chronic obstructive pulmonary disease, depression, and increased age. Lower risk was associated with being female, having a higher body mass index, and having a higher diastolic blood pressure.This study highlights rural-urban differences in MCI incidence and access to care, suggesting potential underdiagnosis in rural areas likely due to reduced access to specialists. Future research should explore socioeconomic, environmental, and lifestyle determinants of MCI to refine prevention and management strategies across geographic settings.Leveraged EHRs to explore rural-urban differences in MCI in West Michigan.Revealed a significant underdiagnosis of MCI, especially in rural areas.Observed lower rates of neurological referrals and completions for rural patients.Identified risk factors specific to rural and urban populations.

  View details for DOI 10.1002/trc2.12495

  View details for PubMedID 39135901

  View details for PubMedCentralID PMC11317927

• Increased disparities in waitlist and post-heart transplantation outcomes according to socioeconomic status with the new heart transplant allocation system. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Kelty, C. E., Dickinson, M. G., Leacche, M., Jani, M., Shrestha, N. K., Lee, S., Acharya, D., Rajapreyar, I., Sadler, R. C., McNeely, E., Loyaga-Rendon, R. Y. 2024; 43 (1): 134-147

  Abstract

  The study objective was to assess disparities in outcomes in the waitlist and post-heart transplantation (HT) according to socioeconomic status (SES) in the old and new U.S. HT allocation systems.Adult HT candidates in the United Network for Organ Sharing database from 2014 through 2021 were included. Old or new system classification was according to listing before or after October 18, 2018. SES was stratified by patient ZIP code and median household income via U.S. Census Bureau and classified into terciles. Competing waitlist outcomes and post-transplantation survival were compared between systems.In total, 26,450 patients were included. Waitlisted candidates with low SES were more frequently younger, female, African American, and with higher body mass index. Reduced cumulative incidence (CI) of HT in the old system occurred in low SES (53.5%) compared to middle (55.7%, p = 0.046), and high (57.9%, p < 0.001). In the new system, the CI of HT was 65.3% in the low SES vs middle (67.6%, p = 0.002) and high (70.2%, p < 0.001), and SES remained significant in the adjusted analysis. In the old system, CI of death/delisting was similar across SES. In the new system, low SES had increased CI of death/delisting (7.4%) vs middle (6%, p = 0.012) and high (5.4%, p = 0.002). The old system showed similar 1-year survival across SES. In the new system, recipients with low SES had decreased 1-year survival (p = 0.041).SES affects waitlist and post-transplant outcomes. In the new system, all SES had increased access to HT; however, low SES had increased death/delisting due to worsening clinical status and decreased post-transplant survival.

  View details for DOI 10.1016/j.healun.2023.08.016

  View details for PubMedID 37643656

  View details for PubMedCentralID PMC11152116