Perceived discrimination and health-related quality-of-life: gender differences among older African Americans

Racial/Ethnic Disparities: Discrimination's Impact on Health-Related Quality of Life-An All of Us Cancer Survivors' Cross-sectional Study

BACKGROUND

Discrimination is associated with worse mental and physical health outcomes. However, the associations among cancer survivors are limited.

OBJECTIVE

We examined whether discrimination is associated with HRQoL and whether adjusting for it reduces racial/ethnic disparities in HRQoL among cancer survivors.

METHODS

Cross-sectional data from adult cancer survivors who completed surveys on discrimination in the medical settings (DMS), everyday perceived discrimination (PD), and HRQoL in the "All of Us" Program from 2018 to 2022 were assessed. We created a binary indicator for fair-to-poor vs. good-to-excellent physical health and mental health. PD and DMS scores were a continuous measure with higher scores reflecting more discrimination. Multivariable logistic regression models tested whether DMS and PD are associated with HRQoL and whether they differently affect the association between race/ethnicity and HRQoL.

RESULTS

The sample (N = 16,664) of cancer survivors was predominantly White (86%) and female (59%), with a median age of 69. Every 5-unit increase in DMS and PD scores was associated with greater odds of fair-to-poor physical health (DMS: OR [95%CI] = 1.66 [1.55, 1.77], PD: 1.33 [1.27, 1.40]) and mental health (DMS: 1.57 [1.47, 1.69], PD: 1.33 [1.27, 1.39]). After adjusting for DMS or PD, Black and Hispanic survivors had a decreased likelihood of fair-to-poor physical health and mental health (decrease estimate range: - 6 to - 30%) compared to White survivors. This effect was greater for Black survivors when adjusting for PD, as the odds of fair-to-poor mental health compared to White survivors were no longer statistically significant (1.78 [1.32, 2.34] vs 1.22 [0.90, 1.64]).

CONCLUSION

Experiences of discrimination are associated with lower HRQoL and reducing it may mitigate racial/ethnic disparities in HRQoL.

Associations between experiences of discrimination and quality of life in Black breast cancer survivors

BACKGROUND

Racial discrimination has been associated with decreased health-related quality of life (QOL) in the general population; however, its impact on QOL in cancer survivors is unclear. This study aims to examine how experiences of discrimination (EOD) impact QOL in breast cancer survivors and whether these associations vary by individual- and structural-level factors.

METHODS

The association of EOD assessed at baseline (∼12 months post-diagnosis) was assessed in the Women's Circle of Health Follow-up Study, a population-based longitudinal cohort study of Black breast cancer survivors in New Jersey. QOL was assessed at follow-up (∼24 months postdiagnosis) using the Functional Assessment of Cancer Therapy - Breast (FACT-B). Multivariable linear regression models adjusted for confounders assessed the association of EOD (none, low, high) with QOL. We also examined statistical interaction by individual-level factors (coping and spirituality) and structural-level factors (neighborhood socioeconomic status and residential segregation).

RESULTS

Of 216 study participants, 74% reported experiencing discrimination. In fully adjusted models, women with high EOD had lower overall QOL (no discrimination, mean FACT-B: 114.8; 95% CI, 107.9-121.7; high discrimination, mean FACT-B: 101.1; 95% CI, 94.2-108.0). Although no evidence was observed of statistically significant interaction, women with high spirituality had better overall QOL, regardless of EOD (high spirituality/low discrimination: 128.2; 95% CI, 121.9-134.5; high spirituality/high discrimination: 115.4; 95% CI, 108.5-122.3; low spirituality/no discrimination: 103.5; 95% CI, 93.8-113.2).

CONCLUSIONS

Among Black breast cancer survivors, discrimination was associated with poorer QOL. Spirituality may mitigate the harmful effects, as women with high spirituality, even in the context of high discrimination, reported higher QOL.

Feeling discriminated means poor self-perceived health: a gender analysis using SHARE

Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women.

The evaluation of clinical factors affecting oral health impacts on the quality of life of Iranian elderly patients visiting dental clinics: A cross-sectional study

BACKGROUND

Iran will soon have an aging population. Healthcare providers must consider factors affecting the quality of life for those 60 and older. Understanding oral health as one of these factors can improve the elderly's quality of life. Oral health-related quality of life (OHRQoL) is a crucial reflection of individuals' general well-being and their overall quality of life linked to health. This study aimed to evaluate the OHRQoL among elderly Iranians referring to Azad University of Medical Sciences in Tehran.

METHODS

In this cross-sectional study, 171 individuals over 65 (93 men and 78 women) were evaluated using OHIP-14 and GOHAI-12 questionnaires to analyze their quality of life. Gender, age, systemic diseases, using medications and dentures, the number of remaining teeth, and oral lesions were recorded. Salivary flow and xerostomia were analyzed with the spitting method and xerostomia index questionnaire, respectively. Also, four main flavor solutions were used to evaluate the taste perception. Data were analyzed using PASS11 and p value < .05 was the significance level.

RESULTS

Based on OHIP-14 and GOHAI-12, Iranian older people's quality of life can be affected by cardiovascular diseases, hypertension, xerostomia, and the number of remaining teeth (p < .05). The results also showed a significant correlation between the OHIP-14 and GOHAI-12 scores (p < .001). Both indexes revealed that the number of remaining teeth, xerostomia, salivary flow, and taste perception greatly influenced participants' quality of life. More remaining teeth, improved salivary flow, and better perception of sweetness and sourness were all linked to a higher quality of life, while increased xerostomia, reduced salivary flow, and bitter taste perception were linked to a decline in overall well-being. Cardiovascular diseases, hypertension, and medication use were also found to significantly impact quality of life.

CONCLUSION

This study's results indicate that cardiovascular diseases, hypertension, dry mouth, and tooth loss can negatively impact the elderly's quality of life. So, improving both systemic and oral health is vital for enhancing life quality in this age group.

Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions

OBJECTIVE

Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs.

METHOD

217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs.

RESULTS

: In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs.

CONCLUSIONS

: Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

Perceived racial/ethnic discrimination and cigarette smoking behaviors among a sample of people with HIV

This study was a secondary analysis of baseline data from a clinical trial of an intensive group-based smoking cessation treatment for people with HIV (PWH) who smoke. It examined the cross-sectional relationship between perceived ethnic discrimination (PED) and cigarette smoking variables (i.e., nicotine dependence, motivation to quit smoking, self-efficacy to quit smoking) among PWH and explored whether depressive symptoms mediated the relationship between PED and smoking variables. Participants (N = 442; Mage = 50.6; 52.8% Male; 56.3% Black, non-Hispanic; 6.3% White, non-Hispanic; 13.3% Hispanic; 87.7% unemployed; 81.6% single) completed measures of demographics, cigarette smoking, depressive symptoms, and PED. Greater PED was related to lower self-efficacy to quit smoking, greater perceived stress, and greater depressive symptoms. In addition, depressive symptoms mediated the relationship between PED and two cigarette smoking variables (i.e., nicotine dependence, self-efficacy to quit smoking). Findings highlight the need for smoking interventions to target PED, self-efficacy, and depressive symptoms to improve smoking cessation variables among PWH.

Creating havens for Black lesbian elders during COVID-19

Black lesbians experience more adverse health outcomes and economic insecurity in older age than their White counterparts due to enduring a lifetime of marginalization associated with the intersections of race, gender, and sexual orientation. Yet, there is a lack of organizations dedicated to empowering and supporting this population. ZAMI NOBLA (National Organization of Black Lesbians on Aging) is the only Black lesbian led national organization in the United States solely invested in improving the wellbeing of Black lesbian elders. Throughout the COVID-19 pandemic, they worked in solidarity with community partners across the country to leverage technological innovation and community solidarity to combat ageist ideology and elevate the spaces in which Black lesbians and their networks were able to learn, heal, thrive, and live. The organization's efforts fostered solidarity across generations of lesbians and the wider LGBTQ + community.

Racial discrimination and 12-month and lifetime anxiety disorders among African American men and women: Findings from the National Survey of American Life

BACKGROUND

The purpose of this study was to assess the associations between racial discrimination and 12-month and lifetime DSM-IV anxiety disorders among African American men and women.

METHODS

Data was drawn from the African American sample of the National Survey of American Life (N = 3570). Racial discrimination was assessed with the Everyday Discrimination Scale. 12-month and lifetime DSM-IV outcomes were any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were utilized to assess the relationships between discrimination and anxiety disorders.

RESULTS

The data indicated that racial discrimination was associated with increased odds for 12-month and lifetime anxiety disorders, AG, and PD and lifetime SAD among men. Regarding 12-month disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, SAD, and PD. With respect to lifetime disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, GAD, SAD, and PD.

LIMITATIONS

The limitations of this study include the utilization of cross-sectional data, self-reported measures, and the exclusion of non-community dwelling individuals.

CONCLUSIONS

The current investigation showed that African American men and women are not impacted by racial discrimination in the same ways. These findings suggest that the mechanisms through which discrimination operates among men and women to influence anxiety disorders is potentially a relevant target for interventions to address gender disparities in anxiety disorders.

Experiences of discrimination and oral health-related quality of life among foreign-born older Chinese Americans: Does resilience play a mediating role?

OBJECTIVES

It is well-established that racial discrimination influences quality of life, but there is scarce evidence about how racial discrimination affects oral health-related quality of life (OHRQoL). Furthermore, the pathways linking racial discrimination and OHRQoL remain unknown. Guided by the integrative framework of immigration, ageing, and oral health, psychosocial stressors and resources exert influences on OHRQoL. In addition, according to the compensatory model of resilience, resilient resources could counteract risk exposures to stressors given specific outcomes. Hence, this study examined the relationship between experiences of discrimination and OHRQoL and investigated resilience as a mediator in such a relationship among older Chinese immigrants.

METHODS

Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3054 foreign-born older Chinese Americans aged 60 years or older. OHRQoL was measured by seven items from the Geriatric Oral Health Assessment Index. Experiences of discrimination (yes or no) were measured by the 9-item Experiences of Discrimination instrument. Resilience was measured by the 10-item Connor Davidson Resilience Scale. Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL.

RESULTS

Experiences of discrimination were directly associated with poorer OHRQoL (b = -0.98, P < .05). Resilience partially mediated the relationship between discrimination experiences and OHRQoL. Specifically, discrimination experiences were associated with weaker resilience (b = -1.58, P < .05), and weaker resilience was associated with poorer OHRQoL (b = 0.06, P < .05).

CONCLUSIONS

Findings illustrate the importance of studying racial discrimination and resilience in OHRQoL. Interventions need to consider individuals' discrimination experiences and stress coping abilities to promote OHRQoL.

Impact of Racial/Ethnic Discrimination on Quality of Life Among Breast Cancer Survivors

Although racial/ethnic disparities in health-care access, treatment, and cancer outcomes are well documented, the impact of racial/ethnic discrimination on cancer survivorship is unclear. We examined associations between quality of life (QoL) and self-reported discrimination among 3,991 women with breast cancer recruited during 2006-2013 from the Pathways Study in the Kaiser Permanente Northern California integrated health-care system, using linear regression models. Overall, 31% of women reported experiencing racial/ethnic discrimination, with differences by race/ethnicity (82% among non-Hispanic Black women vs. 19% among non-Hispanic White women) and nativity (40% among foreign-born Hispanic women vs. 76% among US-born Asian-American women). Experiencing racial/ethnic discrimination was associated with lower QoL in fully adjusted models. The mean QoL score was 119.6 (95% confidence interval (CI): 102.0, 137.1) for women who did not report discrimination, 115.5 (95% CI: 98.0, 133.0) for those who reported some discrimination/less than the median level, and 110.2 (95% CI: 92.7, 127.7) for those who reported more discrimination/greater than or equal to the median level. Discrimination was associated with lower QoL among women who used passive coping strategies or lived in neighborhoods with high neighborhood socioeconomic status, neighborhoods with high levels of segregation, or non-ethnic enclaves. Among breast cancer survivors, clinically meaningful differences in QoL scores were associated with racial/ethnic discrimination. Additional studies are needed to understand potential pathways through which these social factors affect survivorship outcomes.

Intersectional discrimination from black women, white women, black men, or white men impacts young adult black women's affective states and risky health cognitions

OBJECTIVE

Black women experience pronounced inequalities in alcohol use and sexual risk outcomes. Racial discrimination is a known contributor to health inequalities. However, Black women face unique and intersectional forms of discrimination beyond racial discrimination. The current study investigates how exclusion from four distinct social groups effects Black women's negative affect and risky health cognitions.

DESIGN

Black women (N = 124; ages 18-29) were randomly assigned to be excluded in Cyberball by Black women, Black men, White women, or White men.

MAIN OUTCOME MEASURES

Participants responded to measures of internalising (depressive, anxious) and externalising (anger) affect, heavy alcohol use willingness, and risky sex expectations.

RESULTS

Participants primarily attributed exclusion from White women to racial discrimination, exclusion from Black men to gender discrimination, and exclusion from White men to both gender and racial discrimination. When excluded by White women, participants reported the highest levels of anger, depressive affect, and anxiety. Exclusion by White men predicted the greatest heavy drinking willingness, though exclusion by Black men predicted the greatest risky sex expectations.

CONCLUSION

This study is the first to demonstrate that exclusion from different social groups leads to differing patterns of negative affect and risky health cognitions in young adult Black women.

Quality of life in older adults according to race/color: a cross-sectional study

BACKGROUND

Increased longevity is accompanied by new social and health demands, such as the race/color social construct, indicating the need to identify the specific needs of older adults to maintain and improve their quality of life.

OBJECTIVE

We aimed to verify the direct and indirect associations of demographic, economic, and biopsychosocial characteristics with self-assessed quality of life in older adults according to race/color.

DESIGN AND SETTING

This cross-sectional study included 941 older adults living in the urban area of a health microregion in Minas Gerais, Brazil.

METHODS

Older adults were divided into three groups: white (n = 585), brown (n = 238), and black (n = 102) race/color. Descriptive and trajectory analyses were performed (P < 0.05).

RESULTS

Among the three groups, worse self-assessed quality of life was directly associated with lower social support scores and greater numbers of depressive symptoms. Worse self-assessed quality of life was also directly associated with a higher number of functional disabilities in basic activities of daily living and the absence of a partner among older adults of brown and black race/color. Lower monthly income and higher numbers of morbidities and compromised components of the frailty phenotype were observed among participants of white race/color, as well as lower levels of education in the brown race/color group.

CONCLUSION

Factors associated with poorer self-assessed quality of life among older adults in the study community differed according to race/color.

Are cultural or psychosocial factors associated with patient-reported outcomes at the conclusion of kidney transplant evaluation?

BACKGROUND

Kidney transplant evaluation (KTE) is a period marked by many stressors for patients, which may lead to poorer patient-reported outcomes (PROs). Research on the association of cultural and psychosocial factors with PROs during KTE is lacking, even though cultural and psychosocial variables may mitigate the relationship between acceptance status and PROs.

METHODS

Using a prospective cohort study of 955 adults referred for KTE, we examined whether cultural factors and psychosocial characteristics, assessed at the initiation of KTE, are associated with PROs at KTE completion, controlling for demographics and medical factors. Also, we analyzed whether these factors moderate the relationship between transplant acceptance status and PROs.

RESULTS

In multivariable regression models, a stronger sense of mastery was associated with higher physical and mental QOL. A stronger sense of self-esteem was associated with higher kidney-specific QOL. Depression was associated with a lower mental QOL, but only in those who were accepted for transplant. Having low levels of external locus of control was associated with better mental QOL in those who were not accepted for transplant. Higher anxiety was associated with poorer kidney-specific QOL among those who were not accepted for KT, but trust in physician was only associated with greater satisfaction in transplant clinic service for those who were accepted for KT.

CONCLUSIONS

Targeting interventions to increase patient mastery and external locus of control, and reduce depression and anxiety in patients undergoing kidney transplant evaluation may be useful approaches to improve their experience during this stressful period.

Racial Discrimination and Health-Related Quality of Life: An Examination Among Asian American Immigrants

OBJECTIVES

We aimed to examine the relationship between everyday and major racial discrimination with health-related quality of life (HRQOL), which consists of self-rated health, days of poor physical health, mental health, and activity limitation.

DESIGN

In a cross-sectional analytic sample of 524 foreign-born Asian adults, aged 18 years and older, we conducted multivariable logistic regression and multivariable negative binomial regression to examine associations between discrimination and HRQOL. Furthermore, potential effect modification was tested by gender, ethnicity, and social support.

RESULTS

Associations were found between everyday racial discrimination and days of poor physical health (incidence rate ratio, IRR = 1.05), mental health (IRR = 1.03), and activity limitation (IRR = 1.05). Stronger significant associations were observed between major racial discrimination and days of poor physical health (IRR = 1.21), mental health (IRR = 1.16), and activity limitation (IRR = 1.53), adjusting for all covariates. Racial discrimination was not associated with poor self-rated health. In addition, gender significantly modified the relationship between continuous racial discrimination and activity limitation days with associations of greater magnitude among men, while social support significantly modified the association between categorized major racial discrimination and physically unhealthy days. When stratified, the association was only significant among those with low social support (IRR = 3.04; 95% CI: 1.60, 5.79) as opposed to high social support.

CONCLUSIONS

This study supports the association between racial discrimination and worse HRQOL among Asian Americans, which can inform future interventions, especially among men and those with low social support, aimed at improving the quality of life in this population.

Quality of Life and Community Wellbeing of Members Associated With Village Savings and Loans Associations as a Model of Sharing Economy in the Least Developing Countries: A Case of Mzuzu City in Northern Malawi, Southern Africa

This study was aimed at examining the impacts of the Sharing economy on the individual and community Quality of Life (QOL) and wellbeing by looking at their associated influencing factors using Village Savings and Loans Associations as a model of sharing economy in Malawi. An online community-based cross-sectional study design was conducted from November 2020 through January 2021. In the survey, 402 Village Savings and Loans Associations (VSLAs) members from the Mzuzu City area participated, recruited using snowball and respondent-driven sampling techniques. The sample size was computed using a single population proportion using the Yamane formula. Descriptive statistics and ordinal logistic regression model techniques were also employed. Additionally, we used the Chi-Square test, two-way ANOVA, and Ordinal regression model to determine statistical associations between socioeconomic data and QOL and wellbeing variables with a 5% level of significance. On the aspect of community wellbeing, the findings of our study indicated that income (levels and disposal) provided members with options to live a better QOL and wellbeing within the community by either facilitating payment for better education, eating healthier foods, acquiring assets, etc. Further, the absence of discrimination provided a platform for voice, inclusion, and social trust, enhancing freedom of expression. We also found that education facilitated better earnings and knowledge of public health-related issues. As for the contribution to the sharing economy, our study has emphasized the role played by trust in enhancing sharing economy. We recommend and encourage people to join these VSLAs so as to improve their QOL and wellbeing. However, there is a need to replicate the study on a larger scale to validate our study findings for effective policy formulation and implementation geared to improving the overall quality of people's lives. Based on these findings, we further recommend that authorities reinstate programs like National Strategy for Financial Inclusion 2016-2020 and Savings and Loan Groups Best Practice Guidelines (SLG BPGs) 2016-2017 that could further enhance the future of VSLAs, which are vital for QOL and community wellbeing of the people in developing countries like Malawi.

Racism and Older Black Americans' Health: a Systematic Review

We reviewed research that examines racism as an independent variable and one or more health outcomes as dependent variables in Black American adults aged 50 years and older in the USA. Of the 43 studies we reviewed, most measured perceived interpersonal racism, perceived institutional racism, or residential segregation. The only two measures of structural racism were birth and residence in a "Jim Crow state." Fourteen studies found associations between racism and mental health outcomes, five with cardiovascular outcomes, seven with cognition, two with physical function, two with telomere length, and five with general health/other health outcomes. Ten studies found no significant associations in older Black adults. All but six of the studies were cross-sectional. Research to understand the extent of structural and multilevel racism as a social determinant of health and the impact on older adults specifically is needed. Improved measurement tools could help address this gap in science.

Gender differences in African Americans' reactions to and coping with discrimination: Results from The National Study of American Life

The aim of this paper is to examine coping behaviors in the context of discrimination and possible gender-specific differences among a national sample of African American adults in the 2001-2003 National Survey of American Life (NSAL). Results show that in multivariable logistic regression models, African American women (vs. African American men) were less likely to accept discrimination as a fact of life but were more likely to get mad about experiences of discrimination, pray about it, and talk to someone. After adjusting for differences in the frequency of discrimination, African American women were also significantly more likely to try to do something about it. African American men were more likely to accept discrimination as a fact of life with higher frequency of day-to-day discrimination while women tended to talk to someone with a higher frequency of day-to-day discrimination and lifetime discrimination. These findings suggest gender differences in behavior concerning discrimination.

Self-reported experiences of discrimination in older black adults are associated with insula functional connectivity

Self-reported experiences of discrimination are associated with a number of negative health outcomes. However, the neurobiological correlates of discrimination remain elusive. Recent neuroimaging work suggests that the amygdala is sensitive to forms of social adversity and the insula is involved in assessments of trust. We hypothesized that functional connectivity (FC) of these brain regions may be associated with discrimination in older Black adults. One-hundred and twenty-four nondemented older Black adults participating in the Minority Aging Research Study or the Clinical Core study of the Rush Alzheimer's Disease Center completed a measure of self-reported experiences of discrimination and a 3T MRI brain scan including structural T1 and resting-state fMRI EPIBOLD sequences. The right and left amygdala and insula regions were anatomically delineated as ROIs according to the Harvard-Oxford Brain Atlas and whole-brain voxelwise FC analyses were conducted using default parameters in the CONN toolbox. In regression analyses controlling for demographics and global cognition, self-reported experiences of discrimination were associated with greater FC between the left insula and the bilateral intracalcarine cortex, weaker FC between the left insula and the left dorsolateral prefrontal cortex, and weaker FC between the right insula and the left supplementary motor area. Amygdala analyses yielded no significant findings. Greater self-reported experiences of discrimination are associated with differential insula functional connectivity in older adults. More specifically, results suggest that discrimination is associated with differential connectivity of a key region (the insula) involved in trust perception.

Socioeconomic determinants and disparities in sarcoidosis

PURPOSE OF REVIEW

The aim of this article is to describe the known health disparities that exist among patients with sarcoidosis by socioeconomic status, race, and gender, review potential contributors to health disparities in sarcoidosis, investigate the intersectionality among socioeconomic status, race, and gender in sarcoidosis, and outline a research agenda to address these disparities.

RECENT FINDINGS

Recent studies have reported the significant financial strain a diagnosis of sarcoidosis has on individuals and the disproportionate affect the strain has on low socioeconomic status individuals, Blacks, and females. Worse dyspnea, lower health-related quality of life, and higher rates of mortality and hospitalization are more common among those who are Black, female, or of low socioeconomic status.

SUMMARY

Health disparities in sarcoidosis by socioeconomic status, race, and gender have been described for decades. In this review, we describe potential contributors to health disparities including stress and propose interventions to address disparities including creating educational programs accessible for low-income patients and caregivers, targeting medication adherence and trust in physicians and the medical system, and ensuring access to high-quality care for all patients. As clinicians and researchers, we owe it to our patients to not only describe the health disparities that exist but also stimulate to achieve improvement in sarcoidosis.

Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies

RATIONALE

Quantitative health disparities research has increasingly employed intersectionality as a theoretical tool to investigate how social characteristics intersect to generate health inequality. Yet, intersectionality was not designed to quantify, predict, or identify health disparities, and, as a result, multiple criticisms against its misapplication in health disparities research have been made. As such, there is an emerging need to evaluate the growing body of quantitative research that aims to investigate health disparities through an intersectional lens.

METHODS

We conducted a systematic review from earliest records to January 2020 to (i) describe the scope of limitations when applying intersectionality to quantitative health disparities research, and (ii) identify recommendations to improve the future integration of intersectionality with this scholarship. We identified relevant publications with electronic searches in PubMed and CA Web of Science. Studies eligible for inclusion were English-language publications that used quantitative methodologies to investigate health disparities among adults in the U.S. while explicitly claiming to adopt an intersectional perspective. Out of 1279 articles reviewed, 65 were eligible for inclusion.

RESULTS

Our review found that, while the value of intersectionality to the study of health disparities is evident, the existing research struggles with meeting intersectionality's fundamental assumptions. In particular, four limitations were found to be widespread: narrowing the measurements of intersectionality, intersectional groups, and health outcomes; placing primacy on the study of certain intersectional groups to the neglect of others; overlooking underlying explanatory mechanisms that contribute to the health disparities experienced by intersectional groups; and, lacking in the use of life-course perspectives to show how health disparities vary across different life stages.

CONCLUSION

If the goal of health equality is to be achieved among diverse intersectional groups, future research must be assisted by the collection and examination of data that overcomes these limitations.

Cross-sectional validation of the PROMIS-Preference scoring system by its association with social determinants of health

PURPOSE

PROMIS-Preference (PROPr) is a generic, societal, preference-based summary score that uses seven domains from the Patient-Reported Outcomes Measurement Information System (PROMIS). This report evaluates construct validity of PROPr by its association with social determinants of health (SDoH).

METHODS

An online panel survey of the US adult population included PROPr, SDoH, demographics, chronic conditions, and four other scores: the EuroQol-5D-5L (EQ-5D-5L), Health Utilities Index (HUI) Mark 2 and Mark 3, and the Short Form-6D (SF-6D). Each score was regressed on age, gender, health conditions, and a single SDoH. The SDoH coefficient represents the strength of its association to PROPr and was used to assess known-groups validity. Convergent validity was evaluated using Pearson correlations between different summary scores and Spearman correlations between SDoH coefficients from different summary scores.

RESULTS

From 4142 participants, all summary scores had statistically significant differences for variables related to education, income, food and financial insecurity, and social interactions. Of the 42 SDoH variables tested, the number of statistically significant variables was 27 for EQ-5D-5L, 17 for HUI Mark 2, 23 for HUI Mark 3, 27 for PROPr, and 27 for SF-6D. The average SDoH coefficients were - 0.086 for EQ-5D-5L, - 0.039 for HUI Mark 2, - 0.063 for HUI Mark 3, - 0.064 for PROPr, and - 0.037 for SF-6D. Despite the difference in magnitude across the measures, Pearson correlations were 0.60 to 0.76 and Spearman correlations were 0.74 to 0.87.

CONCLUSIONS

These results provide evidence of construct validity supporting the use of PROPr monitor population health in the general US population.

Informant-Reported Discrimination, Dementia, and Cognitive Impairment in Older Brazilians

BACKGROUND

Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia.

OBJECTIVE

Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians.

METHODS

We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer's and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales.

RESULTS

Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 -1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 -1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities.

CONCLUSION

Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.

Exploring health-related quality of life of Spanish domestic adult adoptees: sociodemographic characteristics, chronic medical conditions, and gender differences

PURPOSE

The main objective is to study the health-related quality of life (HRQoL) as a positive approach to health in adult adoptees. We will also consider comparison with population norms, relation to chronic medical conditions, the role of sociodemographic variables, and gender differences among the variables in this study.

METHODS

This was a cross-sectional study of 179 adult domestic adoptees from Spain aged between 18 and 44. They were recruited from a longitudinal study, which was on its third wave. They answered an interview and the self-report measure Health Survey Short Form (SF-12). ANOVAs and t test analyses to compare groups, and multiple regression to determine predictors of HRQoL, were performed.

RESULTS

Adoptees are not different from the general population in terms of perceived physical health (PH) and mental health (MH). Both PH and MH are related to different variables (e.g., current age is negatively associated with PH, as is the number of chronic medical conditions with MH). Despite the absence of gender differences in MH perception, there were common and different predictor variables for males and females. The number of chronic medical conditions predicts HRQoL regardless of gender. For women, employment is also a predictor, and for men, other variables are being in a romantic relationship, having children, and low income.

CONCLUSIONS

Adult adoptees are comparable to general population in terms of HRQoL, but there are associated variables (chronic medical conditions and gender) that should be considered. Post-adoption services should promote health and support in life transitions for this group.

An investigation of racial/ethnic and sex differences in the association between experiences of everyday discrimination and leukocyte telomere length among patients with coronary artery disease

Leukocyte telomere length (LTL) may be sensitive to psychosocial stressors such as discrimination. An inclusive examination of experiences of discrimination on LTL across racial/ethnic and sex groups is currently lacking. Baseline data were obtained from 369 White and African American patients with coronary artery disease (CAD) in the Mental Stress Ischemia Mechanisms and Prognosis Study. LTL was measured from peripheral blood leukocytes by quantitative polymerase chain reaction and calculated in kilobase pairs. Discrimination was measured using the 10-item Everyday Discrimination Scale (EDS). Responses were rated using 4-point Likert scales ranging from never = 1 to often = 4 and summed. Regression models were stratified by race/ethnicity and sex to estimate associations between discrimination and LTL. Each 10-unit increase in experiences of everyday discrimination was associated with an average of .20 fewer kilobase pairs (or 200 base pairs) among both African American women (β = -0.19; 95% CI: -0.35, -0.04; p-value: 0.02) and White women (β = -0.19; 95% CI: -0.37, -0.01; p-value: 0.04), after adjusting for basic demographic factors. Results were similar after further adjusting for behavioral, disease, and psychosocial risk factors (depression and stress). There were no significant associations between experiences of everyday discrimination and LTL for White men or African American men. Overall, experiences of discrimination were associated with shorter LTL among women and not in men. Discrimination may be a potential source of stress associated with shorter LTL among women with CAD. Future studies should explore longitudinal associations between everyday experiences of discrimination and telomere length and also with adverse cardiovascular outcomes.

Emotional and physical reactions to perceived discrimination, language preference, and health-related quality of life among Latinos and Whites

PURPOSE

To investigate whether emotional and physical reactions to perceived discrimination are associated with health-related quality of life (HRQOL) among whites and Latinos (by language preference) in Arizona.

METHODS

A cross-sectional analysis using the Arizona Behavioral Risk Factor Surveillance System (2012-2014) was restricted to non-Hispanic white and Latino (grouped by English- or Spanish-language preference) participants who completed the Reactions to Race optional module (N = 14,623). Four core items from the Centers for Disease Control and Prevention's Healthy Days Measures were included: self-rated health; physically unhealthy, mentally unhealthy; and functionally limited days. Poisson regression models estimated prevalence ratios and 95% confidence intervals (CIs) for poor self-rated health. Multinomial logistic models estimated odds ratios and 95% CI for poor mental, physical, and functionally limited days (defined as 14 + more days). Models were adjusted for sociodemographics, health behaviors, and multimorbidity.

RESULTS

Reports of emotional and physical reactions to perceived discrimination were highest among Spanish-language preference Latinos. Both Spanish- and English-language preference Latinos were more likely to report poor self-rated health in comparison to whites. In separate fully adjusted models, physical reactions were positively associated with each HRQOL measure. Emotional reactions were only associated with reporting 14 + mental unhealthy (aOR 3.16; 95% CI 1.82; 5.48) and functionally limited days (aOR 1.93; 95% CI 1.04, 3.58).

CONCLUSIONS

Findings from this study suggest that physical and emotional reactions to perceived discrimination can manifest as diminished HRQOL. Consistent collection of population-based measures of perceived discrimination is warranted to track and monitor differential health vulnerability that affect Latinos.