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Nanaw J, Sherchan JS, Fernandez JR, Strassle PD, Powell W, Forde AT. Racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19. BMC Public Health 2024; 24:1084. [PMID: 38641573 PMCID: PMC11027359 DOI: 10.1186/s12889-024-18526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Trust in the healthcare system may impact adherence to recommended healthcare practices, including willingness to test for and vaccinate against COVID-19. This study examined racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19 during the first year of the pandemic. METHODS This cross-sectional study used data from the REACH-US study, a nationally representative online survey conducted among a diverse sample of U.S. adults from January 26, 2021-March 3, 2021 (N = 5,121). Multivariable logistic regression estimated the associations between trust in the U.S. healthcare system (measured as "Always", "Most of the time", "Sometimes/Almost Never", and "Never") and willingness to test for COVID-19, and willingness to receive the COVID-19 vaccine. Racial/ethnic differences in these associations were examined using interaction terms and multigroup analyses. RESULTS Always trusting the U.S. healthcare system was highest among Hispanic/Latino Spanish Language Preference (24.9%) and Asian (16.7%) adults and lowest among Multiracial (8.7%) and Black/African American (10.7%) adults. Always trusting the U.S. healthcare system, compared to never, was associated with greater willingness to test for COVID-19 (AOR: 3.20, 95% CI: 2.38-4.30) and greater willingness to receive the COVID-19 vaccine (AOR: 2.68, 95% CI: 1.97-3.65). CONCLUSIONS Trust in the U.S. healthcare system was associated with greater willingness to test for COVID-19 and receive the COVID-19 vaccine, however, trust in the U.S. healthcare system was lower among most marginalized racial/ethnic groups. Efforts to establish a more equitable healthcare system that increases trust may encourage COVID-19 preventive behaviors.
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Affiliation(s)
- Judy Nanaw
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Juliana S Sherchan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jessica R Fernandez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | | | - Allana T Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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Xie Z, Chen G, Suk R, Dixon B, Jo A, Hong YR. Limited English Proficiency and Screening for Cervical, Breast, and Colorectal Cancers among Asian American Adults. J Racial Ethn Health Disparities 2023; 10:977-985. [PMID: 35297497 DOI: 10.1007/s40615-022-01285-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Literature shows that limited English proficiency (LEP) influences individual healthcare-seeking behaviors. The Asian population is the fastest-growing racial/ethnic group in the US, and approximately 50% of foreign-born Asians are estimated to live with LEP. OBJECTIVE To examine associations of LEP and patient-provider language concordance (PPLC) with evidence-based cancer screening utilization for cervical, breast, and colorectal cancers among Asian American adults. METHODS We obtained LEP, PPLC, and up-to-date status on the three types of cancer screening from a nationally representative sample of Asian Americans aged ≥ 18 years in the 2010-2016 and 2018 Medical Expenditure Panel Surveys. We used multivariable logistic regression models with recommended survey weighting to examine associations of LEP and PPLC with the cancer screening uptake based on USPSTF guidelines. RESULTS The study population comprised 8953 respondents, representing 8.17 million Asian American adults. Overall, 11.9% of respondents experienced LEP; of those with LEP, 20% were with PPLC. In multivariable models, compared to respondents without LEP, respondents with LEP and without PPLC were significantly less likely to report up-to-date status on breast (OR = 0.44; 95% CI: 0.26-0.76), cervical (OR = 0.44; 95% CI: 0.26-0.75), or colorectal cancer screening (OR = 0.46; 95% CI: 0.26-0.80). However, these differences were not detected in respondents with LEP and with PPLC. CONCLUSION LEP is associated with lower up-to-date status on cancer screening among Asian Americans, while PPLC seems to moderate this association. These findings suggest the enhancement for language-appropriate and culturally competent healthcare for Asian Americans with LEP, which helps accommodate their communication needs and promotes cancer screening.
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Affiliation(s)
- Zhigang Xie
- Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL, 32610-0195, USA
| | - Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Ryan Suk
- Center for Health Systems Research, Policy & Practice, Department of Management, Policy and Community Health School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Brittney Dixon
- Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL, 32610-0195, USA
| | - Ara Jo
- Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL, 32610-0195, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL, 32610-0195, USA. .,UFHealth Cancer Center, Gainesville, FL, USA.
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Guan A, Kim-Mozeleski JE, Vyas P, Stewart SL, Gildengorin G, Burke NJ, Ma K, Pham AT, Tan J, Lu Q, McPhee SJ, Tsoh JY. Neighborhood Ethnic Composition and Self-rated Health Among Chinese and Vietnamese American Immigrants. J Immigr Minor Health 2021; 23:574-582. [PMID: 32617753 PMCID: PMC8208464 DOI: 10.1007/s10903-020-01041-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Immigrants tend to live in areas with higher co-ethnic density, and the effect of neighborhood ethnic composition could be particularly salient for health. This study explored associations between neighborhood ethnic composition and self-rated health among Asian immigrants. We analyzed data collected at baseline from 670 Chinese and Vietnamese immigrants enrolled in a lifestyle intervention trial. Residential addresses were geocoded and combined with neighborhood socio-demographic profiles based on census data. We used generalized estimating equations to examine neighborhood ethnic composition and self-rated health. Independent of individual-level factors, living in neighborhoods more densely populated by whites was associated with poor/fair self-rated health. Neighborhood household income and density of participants' own ethnic group were not associated with poor/fair self-rated health. More research is warranted to disentangle reasons why Chinese and Vietnamese immigrants living in white-concentrated neighborhoods reported poorer self-rated health, including investigating effects of discrimination, relative deprivation, and availability of social resources.
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Affiliation(s)
- Alice Guan
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jin E Kim-Mozeleski
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Priyanka Vyas
- Center for Tobacco Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Susan L Stewart
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA
| | - Ginny Gildengorin
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nancy J Burke
- Department of Public Health, University of California Merced, Merced, CA, USA.,Asian American Research Center on Health, San Francisco, CA, USA
| | - Kris Ma
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Amber T Pham
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Judy Tan
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J McPhee
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Janice Y Tsoh
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA. .,Asian American Research Center on Health, San Francisco, CA, USA.
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Joseph NP, Reid NJ, Som A, Li MD, Hyle EP, Dugdale CM, Lang M, Betancourt JR, Deng F, Mendoza DP, Little BP, Narayan AK, Flores EJ. Racial and Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed Coronavirus Disease 2019: A Retrospective Cohort Study. Radiology 2020; 297:E303-E312. [PMID: 32673191 PMCID: PMC7370353 DOI: 10.1148/radiol.2020202602] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Disease severity on chest radiographs has been associated with higher risk of disease progression and adverse outcomes from coronavirus disease 2019 (COVID-19). Few studies have evaluated COVID-19-related racial and/or ethnic disparities in radiology. Purpose To evaluate whether non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission chest radiographs compared with White or non-Hispanic patients. Materials and Methods This single-institution retrospective cohort study was approved by the institutional review board. Patients hospitalized with confirmed COVID-19 infection between March 17, 2020, and April 10, 2020, were identified by using the electronic medical record (n = 326; mean age, 59 years ±17 [standard deviation]; male-to-female ratio: 188:138). The primary outcome was the severity of lung disease on admission chest radiographs, measured by using the modified Radiographic Assessment of Lung Edema (mRALE) score. The secondary outcome was a composite adverse clinical outcome of intubation, intensive care unit admission, or death. The primary exposure was the racial and/or ethnic category: White or non-Hispanic versus non-White (ie, Hispanic, Black, Asian, or other). Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race and/or ethnicity. Results Non-White patients had significantly higher mRALE scores (median score, 6.1; 95% confidence interval [CI]: 5.4, 6.7) compared with White or non-Hispanic patients (median score, 4.2; 95% CI: 3.6, 4.9) (unadjusted average difference, 1.8; 95% CI: 0.9, 2.8; P < .01). For both White (adjusted hazard ratio, 1.3; 95% CI: 1.2, 1.4; P < .001) and non-White (adjusted hazard ratio, 1.2; 95% CI: 1.1, 1.3; P < .001) patients, increasing mRALE scores were associated with a higher likelihood of experiencing composite adverse outcome with no evidence of interaction (P = .16). Multivariable linear regression analyses demonstrated that non-White patients presented with higher mRALE scores at admission chest radiography compared with White or non-Hispanic patients (adjusted average difference, 1.6; 95% CI: 0.5, 2.7; P < .01). Adjustment for hypothesized mediators revealed that the association between race and/or ethnicity and mRALE scores was mediated by limited English proficiency (P < .01). Conclusion Non-White patients hospitalized with coronavirus disease 2019 infection were more likely to have a higher severity of disease on admission chest radiographs than White or non-Hispanic patients, and increased severity was associated with worse outcomes for all patients. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Avik Som
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Matthew D Li
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Emily P. Hyle
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Caitlin M. Dugdale
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Min Lang
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Joseph R. Betancourt
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Francis Deng
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Dexter P. Mendoza
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Brent P. Little
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Anand K. Narayan
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Efren J. Flores
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
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Tolisano AM, Schauwecker N, Baumgart B, Whitson J, Kutz JW, Isaacson B, Hunter JB. Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program. Ann Otol Rhinol Laryngol 2019; 129:347-354. [DOI: 10.1177/0003489419888232] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. Methods: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. Results: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). Conclusion: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.
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Affiliation(s)
- Anthony M. Tolisano
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Bethany Baumgart
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Johanna Whitson
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joe Walter Kutz
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brandon Isaacson
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacob B. Hunter
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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