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Fagundes MLB, Junior OLDA, Hugo FN, Kassebaum NJ, Giordani JMDA. Distribution of edentulism by the Macro determinants of Health in 204 countries and territories: An Analysis of the Global Burden of Disease Study. J Dent 2024:105008. [PMID: 38685342 DOI: 10.1016/j.jdent.2024.105008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/27/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To carry out a comprehensive description of edentulism estimates by the macro determinants of health in 2000, 2010, and 2019 worldwide. METHODS This ecological study analyzed data from the Global Burden of Disease Study (GBD) to describe the incidence rate, prevalence rate and years lived with disability (YLDs) rate due to edentulism by macro determinants of health (governance, macroeconomic policy, social policy, public policies, societal values), for 204 countries and territories. The estimates were reported as rates (cases/100,000 people), for people of both sexes aged 55 years or older. RESULTS Countries belonging to the least privileged categories of the macro determinants showed the lowest prevalence rate, incidence rate, and YLD rate due to edentulism for all exposures. Countries with low government expenditure on health showed the lowest prevalence rate of edentulism in 2000 (18972.1; 95%CI 15960.0 - 21984.3) and 2010 (16646.8; 95%CI: 14218.3-19075.4) than those with high government expenditure on health in 2000 (25196.6; 95%CI: 23226.9 - 27166.2) and 2010 (21014.7; 95%CI: 19317.9 - 22711.5). Countries with low SDI showed the lowest YLDs in 2000 (321.0, 95%CI: 260.1- 381.9), 2010 (332.0; 95%CI: 267.7-396.3), and 2019 (331.6; 95%CI: 266.6-396.5). CONCLUSION The findings point to persistent inequalities in the distribution of edentulism between countries worldwide. The most privileged countries, with higher economic development, better governance, and better social and public policies, have shown higher rates of edentulism. CLINICAL SIGNIFICANCE This model must be reconsidered by advancing toward upstream and midstream strategies, beyond its conventional downstream clinical interventions.
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Affiliation(s)
| | | | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Linares Terrazas D, Luna Barrón B, Taboada López G. [Inequalities in time to diagnosis of Down Syndrome in Bolivia]. Salud Colect 2024; 20:e4710. [PMID: 38512123 DOI: 10.18294/sc.2024.4710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
Down Syndrome is the most common genetic condition and a leading cause of intellectual disability. Individuals in rural areas, particularly those with disabilities, often face disparities in healthcare access. Analyzing clinical records of patients diagnosed with Down Syndrome between 2013 and 2022 by the Institute of Genetics at the Universidad Mayor de San Andrés in La Paz, Bolivia, this study examined the time to diagnosis for 250 patients with Down Syndrome. The findings revealed that patients from rural areas with Down Syndrome take an average of five months to receive a diagnosis, compared to two months in urban areas (p<0.001). No significant differences were found in the time to diagnosis based on gender. However, a higher proportion of males from rural areas was observed (p=0.03). The results suggest that individuals in rural areas face challenges in receiving a timely diagnosis. On the other hand, women may not be brought to cities for proper diagnosis and treatment due to gender biases in certain communities. The importance of improving access to early diagnosis and treatment in rural areas is emphasized.
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Affiliation(s)
- Daniel Linares Terrazas
- Médico. Auxiliar de investigación, Unidad de Citogenética, Instituto de Genética, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Beatriz Luna Barrón
- Médica. Docente investigadora, Instituto de Genética, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Gonzalo Taboada López
- Médico. Docente investigador, Instituto de Genética, Universidad Mayor de San Andrés, La Paz, Bolivia
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Teruel Camargo J, Smith JT, Rodriquez EJ, Pérez-Stable EJ. Advancing Aging Research through a Health Disparities Perspective. J Gerontol A Biol Sci Med Sci 2024:glae082. [PMID: 38502828 DOI: 10.1093/gerona/glae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 03/21/2024] Open
Abstract
The proportion of older adults in the U.S. is growing, and the older adult population is also becoming increasingly diverse. However, there are limited data on the aging process and older adults in underserved populations. Equitable participation in research studies on aging, the research workforce, and the healthcare workforce is critical to improve health outcomes for the entire U.S. population. Health disparities frameworks offer researchers and healthcare professionals the tools to develop and evaluate aging research that addresses all levels of analysis and domains of influence. Although there have been efforts to diversify the healthcare and research workforce, significant disparities in representation remain. In this perspective, we discuss existing aging health disparities, health disparities frameworks to use as tools to better conduct aging research, methods to enhance the proportion of underrepresented populations in aging research, and the current gaps in as well as efforts to enhance the diversity of the healthcare and research workforces.
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Affiliation(s)
- Juliana Teruel Camargo
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jessica T Smith
- Division of Intramural Research, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Kouada R, Annabi K, Mosbahi A, Masmoudi T, Ben Dhiab M. L’accès aux soins des migrants en Tunisie en 2023-2024: Situation actuelle et enjeux éthiques. Tunis Med 2024; 102:65-69. [PMID: 38567469 DOI: 10.62438/tunismed.v102i2.4617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Transformed progressively into a transit country towards Europe but also as a host, Tunisia has seen a diversification of migratory movements since the 2011 revolution, as well as the profiles of migrants who face multiple difficulties that can have an impact on their health. AIM This update aimed to expose the situation of migrants in Tunisia regarding access to healthcare, and to raise the ethical issues that result from it. RESULTS Providing care to vulnerable individuals, especially migrants, compels us to reevaluate our practices and question ourselves. Ethical questioning is constant to determine how to do well and not harm. The reflection on this more humane "social medicine" comprehending the patient in its entirety, is only in its beginnings. The critical health status of the poorest populations and their extreme vulnerability do not only call for adapted and specific care measures but also a more comprehensive questioning of social ties and the place that our society grants to the weakest and excluded. CONCLUSION Migration must be considered as a central issue of the ethics of the health of a population in order to provide quality care without prejudice.
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Affiliation(s)
- Rihem Kouada
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Khaled Annabi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Amal Mosbahi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Tasnim Masmoudi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
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Woo H, Kim JS. Regional Disparities in the Infant Mortality Rate in Korea Between 2001 and 2021. J Korean Med Sci 2023; 38:e367. [PMID: 37967878 PMCID: PMC10643242 DOI: 10.3346/jkms.2023.38.e367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The infant mortality rate (IMR) has been considered an important indicator of the overall public health level. Despite improvements in recent decades, regional inequalities in the IMR have been reported worldwide. However, there are no Korean epidemiological studies on regional disparities in the IMR. METHODS We extracted causes of death data from the Statistics Korea through the Korean Statistical Information Service database between 2001 and 2021. The total and regional IMRs were calculated to determine regional disparities. Based on causes of death and using Seoul as a reference, the excess infant deaths and population attributable fractions (PAFs) were calculated for 15 other metropolitan cities and provinces. The average annual percent changes by region from 2001 to 2021 were obtained using a joinpoint regression program. To assess inequities in IMR trends, the rate ratios (RRs) and rate differences (RDs) of the 15 regions were calculated by dividing the study period into period 1 (2001-2007), period 2 (2008-2014), and period 3 (2015-2021). RESULTS The overall IMR in Korea was 3.64 per 1,000 live births, and the IMRs in the 14 regions were relatively higher than that in Seoul, with RRs ranging from 1.15 (95% confidence interval [CI], 1.04, 1.27) in Jeju-do to 1.62 (95% CI, 1.54, 1.71) in Daegu, over the total study period. Significant differences in infant deaths by region were observed for all causes of death, with PAFs ranging from 2.2% (95% CI, 1.7, 2.6) in Gyeonggi-do to 38.4% (95% CI, 38.1, 38.6) in Daegu. The leading cause of excess infant deaths was perinatal problems. The IMR disparities in the relative and absolute measures decreased from 1.44 (1.34, 1.54) to 1.21 (1.10, 1.31) for RRs and from 0.79 (0.63, 0.96) to 0.30 (0.15, 0.45) for RDs between periods 1 and 2, followed by an increase from 1.21 (1.10, 1.31) to 1.36 (1.21, 1.53) for RRs and from 0.30 (0.15, 0.45) to 0.51(0.36, 0.67) for RDs between period 2 and 3. CONCLUSION Infant death is associated with place of residence and regional gaps have recently widened again in Korea. An in-depth investigation of the causes of regional disparities in infant mortality is required for effective governmental policies to achieve equality in infant health.
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Affiliation(s)
- Hyeongtaek Woo
- Department of Preventive Medicine, School of Medicine, Keimyung University, Daegu, Korea
| | - Ji Sook Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea.
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Tobin-Tyler E, Boyd-Caine T, Genn H, Ries NM. Health Justice Partnerships: An International Comparison of Approaches to Employing Law to Promote Prevention and Health Equity. J Law Med Ethics 2023; 51:332-343. [PMID: 37655576 PMCID: PMC10881269 DOI: 10.1017/jme.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
This article traces the development and growth of health justice partnerships (HJPs) in three countries: the United States, Australia and the United Kingdom.
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Affiliation(s)
- Elizabeth Tobin-Tyler
- BROWN UNIVERSITY SCHOOL OF PUBLIC HEALTH AND ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY, PROVIDENCE, RI, USA
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7
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Kim E, Lee Y, Yoon JY. [Exploring Spatial Variations and Factors associated with Walking Practice in Korea: An Empirical Study based on Geographically Weighted Regression]. J Korean Acad Nurs 2023; 53:426-438. [PMID: 37673817 DOI: 10.4040/jkan.23045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Walking practice is a representative indicator of the level of physical activity of local residents. Although the world health organization addressed reduction in prevalence of insufficient physical activity as a global target, the rate of walking practice in Korea has not improved and there are large regional disparities. Therefore, this study aimed to explore the spatial variations of walking practice and its associated factors in Korea. METHODS A secondary analysis was conducted using Community Health Outcome and Health Determinants Database 1.3 from Korea Centers for Disease Control and Prevention. A total of 229 districts was included in the analysis. We compared the ordinary least squares (OLS) and the geographically weighted regression (GWR) to explore the associated factors of walking practice. MGWR 2.2.1 software was used to explore the spatial distribution of walking practice and modeling the GWR. RESULTS Walking practice had spatial variations across the country. The results showed that the GWR model had better accommodation of spatial autocorrelation than the OLS model. The GWR results indicated that different predictors of walking practice across regions of Korea. CONCLUSION The findings of this study may provide insight to nursing researchers, health professionals, and policy makers in planning health programs to promote walking practices in their respective communities.
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Affiliation(s)
- Eunjoo Kim
- College of Nursing, Jeju National University, Jeju, Korea
- Health and Nursing Research Institute, Jeju National University, Jeju, Korea
| | - Yeongseo Lee
- College of Nursing, Seoul National University, Seoul, Korea
| | - Ju Young Yoon
- College of Nursing, Seoul National University, Seoul, Korea
- The Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
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Pool LR, Petito LC, Yang X, Krefman AE, Perak AM, Davis MM, Greenland P, Rosenman M, Zmora R, Wang Y, Hou L, Marino BS, Van Horn L, Wakschlag LS, Labarthe D, Lloyd-Jones DM, Allen NB. Cardiovascular health trajectories from age 2-12: a pediatric electronic health record study. Ann Epidemiol 2023; 83:40-46.e4. [PMID: 37084989 DOI: 10.1016/j.annepidem.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Many children have non-ideal cardiovascular health (CVH), but little is known about the course of CVH in early childhood. We identified CVH trajectories in children and assess the generalizability of these trajectories in an external sample. METHODS We used data spanning 2010-2018 from children aged 2-12 years within the Chicago Area Patient-Centered Outcomes Research Network-an electronic health record network. Four clinical systems comprised the derivation sample and a fifth the validation sample. Body mass index, blood pressure, cholesterol, and blood glucose were categorized as ideal, intermediate, and poor using clinical measurements, laboratory readings, and International Classification of Diseases diagnosis codes and summed for an overall CVH score. Group-based trajectory modeling was used to create CVH score trajectories which were assessed for classification accuracy in the validation sample. RESULTS Using data from 122,363 children (47% female, 47% non-Hispanic White) three trajectories were identified: 59.5% maintained high levels of clinical CVH, 23.4% had high levels of CVH that declined, and 17.1% had intermediate levels of CVH that further declined with age. A similar classification emerged when the trajectories were fitted in the validation sample. CONCLUSIONS Stratification of CVH was present by age 2, implicating the need for early life and preconception prevention strategies.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lucia C Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xiaoyun Yang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marc Rosenman
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Rachel Zmora
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Yaojie Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren S Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Wagner K, Wienke A, Gröger C, Klusmann JH, Führer A. Segregated by Wealth, Health, and Development: An Analysis of Pre-School Child Health in a Medium-Sized German City. Children (Basel) 2023; 10:children10050865. [PMID: 37238412 DOI: 10.3390/children10050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
The School Entry Examination (SEE) can be used to identify children with current health issues, developmental delays, and risk factors for later diseases. This study analyzes the health status of preschool children in a German city with considerable socio-economic differences among its quarters. We used secondary data from SEEs 2016-2019 from the entire city (8417 children), which we divided into quarters with low (LSEB), medium (MSEB), and high socioeconomic burden (HSEB). In HSEB quarters, 11.3% of children were overweight as opposed to 5.3% in LSEB quarters. In HSEB quarters, 17.2% of children had sub-par cognitive development in contrast to 1.5% in LSEB quarters. For overall sub-par development, LSEB quarters had a prevalence of 3.3%, whereas, in HSEB quarters, 35.8% of children received this result. Logistic regression was used to determine the influence of the city quarter on the outcome of overall sub-par development. Here, considerable disparities among HSEB and LSEB quarters remained after adjustment for parents' employment status and education. Pre-school children in HSEB quarters showed a higher risk for later disease than children in LSEB quarters. The city quarter had an association with child health and development that should be considered in the formulation of interventions.
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Affiliation(s)
- Karoline Wagner
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
| | | | | | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
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10
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Deal JA, Jiang K, Betz JF, Clemens GD, Zhu J, Reed NS, Garibaldi BT, Swenor BK. COVID-19 clinical outcomes by patient disability status: A retrospective cohort study. Disabil Health J 2023;:101441. [PMID: 36764842 DOI: 10.1016/j.dhjo.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND People with disabilities might experience worse clinical outcomes of SARS-CoV-2 infection, but evidence is limited. OBJECTIVE To investigate if people with disabilities requiring assistance are more likely to experience severe COVID-19 or death. METHODS Data from the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry (JH-CROWN) included 6494 adult patients diagnosed with COVID-19 and admitted between March 4, 2020-October 29, 2021. Severe COVID-19 and death were defined using the occurrence and timing of clinical events. Assistive needs due to disabilities were reported by patients or their proxies upon admission. Multivariable-adjusted Cox proportional hazards models were used to examine the associations between disability status and severe COVID-19 or death. Primary models adjusted for demographics and secondary models additionally adjusted for clinical covariates. RESULTS In this clinical cohort (47-73 years, 49% female, 39% Black), patients with disabilities requiring assistance had 1.35 times (95% confidence interval [CI]:1.01, 1.81) the hazard of severe COVID-19 among patients <65 years, but not among those ≥65 years, equating to an additional 17.5 severe COVID-19 cases (95% CI:7.7, 28.2) per 100 patients. A lower risk of mortality was found among patients <65 years, but this finding was not robust due to the small number of deaths. CONCLUSIONS People with disabilities requiring assistance aged <65 years are more likely to develop severe COVID-19. Although our study is limited by using a medical model of disability, these analyses intend to further our understanding of COVID-19 outcomes among people with disabilities. Also, standardized disability data collection within electronic health records is needed.
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Chung A, Zorbas C, Peeters A, Backholer K, Browne J. A Critical Analysis of Representations of Inequalities in Childhood Obesity in Australian Health Policy Documents. Int J Health Policy Manag 2022; 11:1767-1779. [PMID: 34380204 PMCID: PMC9808209 DOI: 10.34172/ijhpm.2021.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/10/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In Australia, childhood obesity follows a socioeconomic gradient whereby children with lower socioeconomic position are disproportionately burdened. To reduce these inequalities in childhood obesity requires a multi-component policy-driven response. Action to address health issues is underpinned by the ways in which they are represented as 'problems' in public policy. This study critically examines representations of inequalities in childhood obesity within Australian health policy documents published between 2000-2019. METHODS Australia's federal, state and territory government health department websites were searched for health policy documents including healthy weight, obesity, healthy eating, food and nutrition strategies; child and youth health strategies; and broader health and wellbeing, prevention and health promotion policies that proposed objectives or strategies for childhood obesity prevention. Thematic analysis of eligible documents was guided by a theoretical framework informed by problematization theory, ecological systems theory, and theoretical principles for equity in health policy. RESULTS Eighteen policy documents were eligible for inclusion. The dominant representation of inequalities in childhood obesity was one of individual responsibility. The social determinants of inequalities in childhood obesity were acknowledged, yet policy actions predominantly focused on individual determinants. Equity was positioned as a principle of policy documents but was seldom mentioned in policy actions. CONCLUSION Current representations of inequalities in childhood obesity in Australian health policy documents do not adequately address the underlying causes of health inequities. In order to reduce inequalities in childhood obesity future policies will need greater focus on health equity and the social determinants of health (SDoH).
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Affiliation(s)
- Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Christina Zorbas
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Anna Peeters
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Marriott LK, Shugerman SR, Chavez A, Crocker Daniel L, Martinez A, Zebroski DJ, Mishalanie S, Zell A, Dest A, Pozhidayeva D, Wenzel ES, Omotoy HL, Druker BJ, Shannon J. Knight Scholars Program: A Tiered Three-Year Mentored Training Program for Urban and Rural High School High School Students Increases Interest and Self-Efficacy in Interprofessional Cancer Research. J STEM Outreach 2022; 5:10.15695/jstem/v5i2.06. [PMID: 37179900 PMCID: PMC10174623 DOI: 10.15695/jstem/v5i2.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Cancer research training programs build our future biomedical workforce. Training is often centered for students residing close to research institutions, making access more challenging for rural students. A cancer research training program was developed for high school students residing in five geographical regions across Oregon. Training was tiered in duration and intensity across the three years, including a one-week Introduction program and subsequent 10-week summer research training programs (Immersion and Intensive). A total of 60 students participated in in-person and/or virtual training, with Immersion students receiving mentored shadowing experiences in clinical care, public health, and outreach in their home communities. Laboratory rotations at a research-intensive institution enabled students to sample research environments before selecting an area of interest for Intensive training the following summer. Aligning with Self-Determination Theory, the Knight Scholars Program aims to build competence, relatedness, and autonomy of its trainees in biomedical sciences. The program exposed students to a wide range of interprofessional careers and collaborative teams, enabling scholars to envision themselves in various paths. Results show strong gains in interest and research self-efficacy for both Introduction and Immersion scholars, with findings highlighting the importance of representation within mentoring and training efforts.
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Affiliation(s)
- L K Marriott
- Oregon Health and Science University, Portland, OR
| | | | - A Chavez
- Oregon Health and Science University, Portland, OR
| | | | - A Martinez
- Oregon Health and Science University, Portland, OR
| | - D J Zebroski
- Oregon Health and Science University, Portland, OR
| | - S Mishalanie
- Oregon Health and Science University, Portland, OR
| | - A Zell
- Oregon Health and Science University, Portland, OR
| | - A Dest
- Oregon Health and Science University, Portland, OR
| | | | - E S Wenzel
- Oregon Health and Science University, Portland, OR
| | - H L Omotoy
- Oregon Health and Science University, Portland, OR
| | - B J Druker
- Oregon Health and Science University, Portland, OR
| | - J Shannon
- Oregon Health and Science University, Portland, OR
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13
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Mekinda MA, Chaudhary S, Vanderford NL, White KB, Kennedy LS, Marriott LK. Approaches for Measuring Inclusive Demographics Across Youth Enjoy Science Cancer Research Training Programs. J STEM Outreach 2022; 5:10.15695/jstem/v5i2.12. [PMID: 37840910 PMCID: PMC10575593 DOI: 10.15695/jstem/v5i2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
The National Cancer Institute's (NCI) Youth Enjoy Science Program (YES) funds initiatives to support the cancer research training and career ambitions of middle school through undergraduate students from populations underrepresented in the biomedical sciences. The program has funded 16 institutions nationally as of January 2022. Given the program's focus on increasing diversity within the cancer research workforce, demographic characteristics of YES trainees provide essential information about the populations being served and program effectiveness. Six programs formed an interest group focused on trainee demographics and surveyed all YES grantees about their demographic data practices. Fifteen programs (94%) completed the survey. Survey data were analyzed through descriptive statistics and thematic coding. Findings revealed considerable variability in programs' approach to demographic data, including which demographics were measured, how they were operationalized, and when and how the data were collected. Half of YES programs (53%) could report underrepresented populations in biomedical research among trainees using consistent definitions. Most programs described efforts to improve their demographic data practices; however, challenges remained for the vast majority. In consideration of these findings, we offer recommendations for inclusive demographic data practices to better define and retain underrepresented populations in biomedical sciences.
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Affiliation(s)
- Megan A. Mekinda
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, IL
| | - Sunita Chaudhary
- Rutgers Cancer Institute of New Jersey, Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nathan L. Vanderford
- Markey Cancer Center and the Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY
| | | | | | - Lisa K. Marriott
- OHSU-PSU School of Public Health; Oregon Health and Science University; Portland, OR
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14
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Huerta JJ, Figuracion MT, Vazquez-Cortes A, Hanna RR, Hernandez AC, Benitez SB, Sipelii MN, Brooks TC, ZuZero DT, Iopu FMRV, Romero CR, Chavez A, Zell A, Shugerman SR, Shannon JS, Marriott LK. Interprofessional Near-Peer Mentoring Teams Enhance Cancer Research Training: Sustainable Approaches for Biomedical Workforce Development of Historically Underrepresented Students. J STEM Outreach 2022; 5:10.15695/jstem/v5i2.10. [PMID: 37179901 PMCID: PMC10174597 DOI: 10.15695/jstem/v5i2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A cancer research training program explored different approaches for staffing their in-person and virtual programs for high school students. The inclusion of undergraduate near-peer mentors had a universal benefit when implemented across in-person and virtual training programs of one- and ten-week durations. Benefits are described for four stakeholder groups: the high school trainees, program staff, scientist partners, and peer mentors themselves. Peer mentors described that their involvement enhanced their own professional development and, for some, drove a new interest in cancer research. Scientist partners described that peer mentors helped translate their work in the virtual environment for high school students. High school trainees reported their sessions with peer mentors to be one of their favorite parts of the program. Interprofessional peer mentors were highly relatable to students and modeled communication and paths in biomedical research. Staff reported that peer mentors supported student engagement during community shadowing sessions, allowing staff to focus on developing the shadowing experiences with partners. The benefit of including peer mentors was substantial from all viewpoints explored. Their intensive inclusion in cancer research training programs supports sustainability and capacity building in biomedical workforce development.
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Affiliation(s)
- J J Huerta
- Oregon Health and Science University, Portland, OR
| | | | | | - R R Hanna
- Portland State University, Portland OR
| | | | | | - M N Sipelii
- Oregon Health and Science University, Portland, OR
- Portland State University, Portland OR
| | - T C Brooks
- Oregon Health and Science University, Portland, OR
| | - D T ZuZero
- National University of Natural Medicine, Portland, OR
| | | | | | - A Chavez
- Oregon Health and Science University, Portland, OR
| | - A Zell
- Oregon Health and Science University, Portland, OR
| | | | - J S Shannon
- Oregon Health and Science University, Portland, OR
| | - L K Marriott
- Oregon Health and Science University, Portland, OR
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15
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Bradford NJ, Amani B, Walker VP, Sharif MZ, Ford CL. Barely Tweeting and Rarely About Racism: Assessing US State Health Department Twitter Use During the COVID-19 Vaccine Rollout. Ethn Dis 2022; 32:257-264. [PMID: 35909637 PMCID: PMC9311300 DOI: 10.18865/ed.32.3.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introduction The general public was discussing racism and potential inequities in COVID-19 vaccinations among African Americans on Twitter before the first COVID-19 vaccine received emergency use authorization, but it is unclear how US state health departments (SHDs) were using Twitter to address the inequities. This study examines the frequency, content and timing of SHD tweets during the US rollout of the first SARS Co-V2 vaccine. Methods This was a prospective study of tweets posted from the official Twitter accounts of each of the 50 US SHDs and the DC health department from October 19, 2020 to February 28, 2021. We retrieved the content and metadata of 100% of their tweets; calculated frequencies and proportions of tweets containing key terms related to COVID-19 vaccines, equity and racism; stratified the data by region; and charted longitudinal trends. Results Overall, SHDs tweeted infrequently, and rarely tweeted about inequities, mistrust or racism. Though 55.48% of all SHD tweets were about COVID-19, hardly any tweets contained the terms: race/ethnicity (1.20%); equity (1.09); mistrust (.59%); or racism (.06%). Similar patterns existed among vaccination-related tweets, which accounted for 24.38% of all tweets. Only 21.64% of vaccination-related tweets containing any race/ethnicity, equity, mistrust, or racism terms were posted prior to the first Emergency Use Authorization (EUA). Those about African Americans (70.45%) were posted ≥8 weeks after EUA. Conclusions Concerns about racism and inequities in COVID-19 vaccination continue on Twitter, but SHDs rarely tweet about them. This strikes a worrisome chord of disconnection from the science linking health inequities to racism.
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Affiliation(s)
- Natalie J. Bradford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Bita Amani
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, Address correspondence to Bita Amani, PhD, MHS, Charles R. Drew University of Medicine and Science, Los Angeles, CA;
| | - Valencia P. Walker
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH,Nationwide Children’s Hospital, Columbus, OH
| | - Mienah Z. Sharif
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Chandra L. Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA
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16
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Martinez B, Huh J, Tsui J. Validating the Group-Based Medical Mistrust Scale with English and Spanish Speaking Latino Parents of Adolescents. J Am Board Fam Med 2022; 35:244-54. [PMID: 35379712 DOI: 10.3122/jabfm.2022.02.210307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Medical mistrust can be a barrier to health care utilization. While the Group-Based Medical Mistrust Scale (GBMMS) has been validated among diverse populations, we know little about its psychometric performance among English-Speaking (ES) and Spanish-Speaking (SS) Latinos. We aim to examine the factor structure of GBMMS among Latino parents and explore whether scale latent factor structures would be different across preferred languages. METHODS Parents of adolescents participating in an urban academic enrichment program for low-income students completed an online survey as part of a cross-sectional study about Human Papillomavirus (HPV) prevention. We tested the validity of the GBMMS in ES and SS respondents and performed exploratory factor analysis to identify latent factors. We examined scale scores, item means, item endorsement, and residual variance across language groups. RESULTS 2-factor latent structure was identified for both ES and SS groups; factors were labeled as 'Suspicion' and 'System-wide discrimination.' Scale validity was better among SS (α = 0.76). Medical mistrust scores did not vary across language groups, but variation emerged in item endorsement by language. DISCUSSION Our results suggest that the factor structures of the medical mistrust construct, measured by the GBMMS, are similar across ES and SS Latinos and that the GBMMS is valid for both populations. High factor pattern loading reflects a shared mistrust of how health care systems view and treat people of their racial/ethnic background, independent of their preferred languages. Measurement of medical mistrust and identifying its underlying causes are needed within diverse populations to fully address structural- and community-level influences on health inequities.
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17
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Dineen KK, Pendo E. Engaging Disability Rights Law to Address the Distinct Harms at the Intersection of Race and Disability for People with Substance Use Disorder. J Law Med Ethics 2022; 50:38-51. [PMID: 35244002 DOI: 10.1017/jme.2022.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.
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18
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Lett E, Everhart A. Considerations for Transgender Population Health Research Based on US National Surveys. Ann Epidemiol 2021:S1047-2797(21)00317-3. [PMID: 34757013 DOI: 10.1016/j.annepidem.2021.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022]
Abstract
Transgender identities and health are highly politicized in the United States leading to restrictions on relevant data collection in national health surveillance systems. This has serious implications on transgender population health research; an urgent area of study given the systemic discrimination faced by transgender individuals and the resultant social and health inequities. In this precarious political climate, obtaining high-quality data for research is challenging and in recent years, two data sources have formed the foundation of transgender health research in the United States, namely the 2015 United States Transgender Study and the Behavioral Risk Factor Surveillance System (BRFSS) after the launch of the optional Sexual Orientation and Gender Identity Module in 2014. While useful, there are serious challenges to using these data to study transgender health, specifically related to survey weighting methodologies, ascertainment of gender identity, and study design. In this article, we detail these challenges and discuss the strengths and weaknesses of various methodological approaches that have been implemented as well as clarify several common errors that exist in the literature. We feel that this contribution is necessary to provide accurate interpretation of the evidence that currently informs policy and priority setting for transgender population health and will provide vital insights for future studies with these now ubiquitous sources of data in the field.
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19
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Bazan IS, Akgün KM. COVID-19 Healthcare Inequity: Lessons Learned from Annual Influenza Vaccination Rates to Mitigate COVID-19 Vaccine Disparities. Yale J Biol Med 2021; 94:509-515. [PMID: 34602888 PMCID: PMC8461587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The COVID-19 pandemic has infected 33 million Americans and resulted in more than 600,000 deaths as of late Spring 2021. Black, Indigenous, and Latinx (BIL) people are disproportionately infected, hospitalized, and dying. Effective vaccines were rapidly developed and have been widely available in the United States since their initial rollout in late 2020-early 2021 but vaccination rates in BIL communities have remained low compared with non-BIL communities. Limited access to the vaccine, lack of customized information, and mistrust of the medical system, all contribute to vaccine hesitancy and low vaccination rates. Regrettably, COVID-19 is not the only vaccine-preventable illness with racial/ethnic inequities. Similar inequities are seen with the seasonal influenza vaccine. We review the racial/ethnic health disparities in COVID-19 illness and vaccination rates and what inequities contribute to these disparities. We use evidence from the seasonal influenza vaccination efforts to inform potential strategies to attenuate these inequities. The development of effective and sustainable strategies to improve vaccination rates and reduce factors that result in health inequities is essential in managing current and future pandemics and promoting improved health for all communities.
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Affiliation(s)
- Isabel S. Bazan
- Section of Pulmonary, Critical Care, & Sleep
Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Akgün
- Section of Pulmonary, Critical Care, & Sleep
Medicine, Yale University School of Medicine, New Haven, CT, USA
- Pulmonary, Critical Care and Sleep Medicine, VA
Connecticut Healthcare System, West Haven, CT, USA
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20
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Abstract
Objectives Despite improvements in infant mortality rates (IMR) in the United States, racial gaps in IMR remain and may be driven by both structural racism and place. This study assesses the relationship between structural racism and race-specific IMR and the role of urban-rural classification on race-specific IMR and Black/White racial gaps in IMR. Methods We conducted an analysis of variance tests using 2019 County Health Rankings Data to determine differences in structural racism indicators, IMR and other co-variates by urban-rural classification. We used linear regressions to determine the associations between measures of structural racism and county-level health outcomes. Results Study results suggest that racial inequities in education, work, and homeownership negatively impact Black IMR, especially in large fringe, medium, and small metro counties, and positively impact White IMR. Structural racism is also associated with Black-White gaps in IMR. Conclusions Factors related to structural racism may not be homogenous or have the same impacts on overall IMR, race-specific IMR, and racial differences in IMR across places. Understanding these differential impacts can help public health professionals and policymakers improve Black infant health and eliminate racial inequities in IMR.
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Affiliation(s)
| | - Caryn N. Bell
- African American Studies, University of Maryland, College Park, College Park, MD
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21
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Labonté R. Neoliberalism 4.0: The Rise of Illiberal Capitalism Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention". Int J Health Policy Manag 2020; 9:175-178. [PMID: 32331498 PMCID: PMC7182151 DOI: 10.15171/ijhpm.2019.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/03/2019] [Indexed: 11/27/2022] Open
Abstract
Neoliberal logic and institutional lethargy may well explain part of the reason why governments pay little attention to how their economic and development policies negatively affect health outcomes associated with the global diffusion of unhealthy commodities. In calling attention to this the authors encourage health advocates to consider strategies other than just regulation to curb both the supply and demand for these commodities, by better understanding how neoliberal logic suffuses institutional regimes, and how it might be coopted to alternative ends. The argument is compelling as possible mid-level reform, but it omits the history of the development of neoliberalism, from its founding in liberal philosophy and ethics in the transition from feudalism to capitalism, to its hegemonic rise in global economics over the past four decades. This rise was as much due to elites (the 1% and now 0.001%) wanting to reverse the progressive compression in income and wealth distribution during the first three decades that followed World War Two. Through three phases of neoliberal policy (structural adjustment, financialization, austerity) wealth ceased trickling downwards, and spiralled upwards. Citizen discontent with stagnating or declining livelihoods became the fuel for illiberal leaders to take power in many countries, heralding a new, autocratic and nationalistic form of neoliberalism. With climate crises mounting and ecological limits rendering mid-level reform of coopting the neoliberal logic to incentivize production of healthier commodities, health advocates need to consider more profound idea of how to tame or erode (increasingly predatory) capitalism itself.
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Affiliation(s)
- Ronald Labonté
- Globalization and Health Equity, Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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22
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Abstract
Health inequities are well-documented, but their economic dimensions have received less attention. In this report, we describe four economic dimensions of health inequities in the United States. First, we describe an economic conceptual framework that connects poverty and health inequities at both individual and population levels and conveys the concept of reverse causality, where poverty worsens health inequities and health inequities worsen poverty. This framework can help us understand the key elements of health inequity and its drivers. Second, we describe economic measurements used for quantifying the economic burden of health inequalities and summarize the empirical findings from studies. Third, we review the evidence on the return-on-investment of economic interventions that are aimed at reducing health inequities. Finally, we highlight the importance of cross disciplinary perspectives from economics and implementation research in effectively delivering interventions that can mitigate health inequities.
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Affiliation(s)
- Michael M Engelgau
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Ping Zhang
- National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
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23
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Ofili EO, Tchounwou PB, Fernandez-Repollet E, Yanagihara R, Akintobi TH, Lee JE, Malouhi M, Garner ST, Hayes TT, Baker AR, Dent AL, Abdelrahim M, Rollins L, Chang SP, Sy A, Hernandez BY, Bullard PL, Noel RJ, Shiramizu B, Hedges JR, Berry MJ, Bond VC, Lima MF, Mokuau N, Kirken RA, Cruz-Correa M, Sarpong DF, Vadgama J, Yates C, Kahn SA, Soliman KF, Perry G, Pezzano M, Luciano CA, Barnett ME, Oyekan A, Kumar D, Norris KC. The Research Centers in Minority Institutions (RCMI) Translational Research Network: Building and Sustaining Capacity for Multi-Site Basic Biomedical, Clinical and Behavioral Research. Ethn Dis 2019; 29:135-144. [PMID: 30906162 PMCID: PMC6428183 DOI: 10.18865/ed.29.s1.135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Research Centers in Minority Institutions (RCMI) program was established by the US Congress to support the development of biomedical research infrastructure at minority-serving institutions granting doctoral degrees in the health professions or in a health-related science. RCMI institutions also conduct research on diseases that disproportionately affect racial and ethnic minorities (ie, African Americans/Blacks, American Indians and Alaska Natives, Hispanics, Native Hawaiians and Other Pacific Islanders), those of low socioeconomic status, and rural persons. Quantitative metrics, including the numbers of doctoral science degrees granted to underrepresented students, NIH peer-reviewed research funding, peer-reviewed publications, and numbers of racial and ethnic minorities participating in sponsored research, demonstrate that RCMI grantee institutions have made substantial progress toward the intent of the Congressional legislation, as well as the NIH/NIMHD-linked goals of addressing workforce diversity and health disparities. Despite this progress, nationally, many challenges remain, including persistent disparities in research and career development awards to minority investigators. The continuing underrepresentation of minority investigators in NIH-sponsored research across multiple disease areas is of concern, in the face of unrelenting national health inequities. With the collaborative network support by the RCMI Translational Research Network (RTRN), the RCMI community is uniquely positioned to address these challenges through its community engagement and strategic partnerships with non-RCMI institutions. Funding agencies can play an important role by incentivizing such collaborations, and incorporating metrics for research funding that address underrepresented populations, workforce diversity and health equity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Sy
- University of Hawaii at Manoa, Honolulu, HI
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jaydutt Vadgama
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | | | - RCMI Investigators and RTRN Team Members
- Morehouse School of Medicine, Atlanta, GA
- Jackson State University, Jackson, MS
- University of Puerto Rico Medical Sciences Campus, San Juan, PR
- University of Hawaii at Manoa, Honolulu, HI
- Ponce Health Sciences University, Ponce, PR
- Meharry Medical College, Nashville, TN
- University of Texas at El Paso, TX
- Xavier University, New Orleans, LA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
- Tuskegee University, Tuskegee, AL
- Clark Atlanta University, Atlanta, GA
- Florida Agriculture & Mechanical University, Tallahassee FL
- University of Texas at San Antonio, TX
- City College of New York, NY
- Texas Southern University, Houston, TX
- North Carolina Central University, Durham, NC
- University of California, Los Angeles, CA
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24
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Smith MJ, Weinstock D. Reducing Health Inequities Through Intersectoral Action: Balancing Equity in Health With Equity for Other Social Goods. Int J Health Policy Manag 2019; 8:1-3. [PMID: 30709097 PMCID: PMC6358644 DOI: 10.15171/ijhpm.2018.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022] Open
Abstract
Significant attention has been devoted to developing intersectoral strategies to reduce health inequities; however, these strategies have largely neglected to consider how equity in health ought to be weighted and balanced with the pursuit of equity for other social goods (eg, education equity). Research in this domain is crucial, as the health sector’s pursuit of health equity may be at odds with policies in other sectors, which may consider the reduction of health inequities to be peripheral to, if not incompatible with, their own equity-related aims. It is therefore critical that intersectoral strategies to reduce health inequities be guided by a more general account of social justice that is capable of carefully balancing equity in health against the pursuit of equity in other sectors.
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Affiliation(s)
- Maxwell J Smith
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Daniel Weinstock
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
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25
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Lee J, Schram A, Riley E, Harris P, Baum F, Fisher M, Freeman T, Friel S. Addressing Health Equity Through Action on the Social Determinants of Health: A Global Review of Policy Outcome Evaluation Methods. Int J Health Policy Manag 2018; 7:581-592. [PMID: 29996578 PMCID: PMC6037500 DOI: 10.15171/ijhpm.2018.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research.
Methods: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated.
Results: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated.
Conclusion: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.
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Affiliation(s)
- Janice Lee
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Ashley Schram
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Emily Riley
- Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Patrick Harris
- Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Fran Baum
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Matt Fisher
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toby Freeman
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Sharon Friel
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
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26
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Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review. Int J Health Policy Manag 2018. [PMID: 29524934 PMCID: PMC5819370 DOI: 10.15171/ijhpm.2017.130] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Despite decades of evidence gathering and calls for action, few countries have systematically attenuated health inequities (HI) through action on the social determinants of health (SDH). This is at least partly because doing so presents a significant political and policy challenge. This paper explores this challenge through a review of the empirical literature, asking: what factors have enabled and constrained the inclusion of the social determinants of health inequities (SDHI) in government policy agendas?
Methods: A narrative review method was adopted involving three steps: first, drawing upon political science theories on agenda-setting, an integrated theoretical framework was developed to guide the review; second, a systematic search of scholarly databases for relevant literature; and third, qualitative analysis of the data and thematic synthesis of the results. Studies were included if they were empirical, met specified quality criteria, and identified factors that enabled or constrained the inclusion of the SDHI in government policy agendas.
Results: A total of 48 studies were included in the final synthesis, with studies spanning a number of country-contexts and jurisdictional settings, and employing a diversity of theoretical frameworks. Influential factors included the ways in which the SDHI were framed in public, media and political discourse; emerging data and evidence describing health inequalities; limited supporting evidence and misalignment of proposed solutions with existing policy and institutional arrangements; institutionalised norms and ideologies (ie, belief systems) that are antithetical to a SDH approach including neoliberalism, the medicalisation of health and racism; civil society mobilization; leadership; and changes in government.
Conclusion: A complex set of interrelated, context-dependent and dynamic factors influence the inclusion or neglect of the SDHI in government policy agendas. It is better to think about these factors as increasing (or decreasing) the ‘probability’ of health equity reaching a government agenda, rather than in terms of ‘necessity’ or ‘sufficiency.’ Understanding these factors may help advocates develop strategies for generating political priority for attenuating HI in the future.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Sharon Friel
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, Australia
| | - Adrian Kay
- Institute of Policy Studies, University Brunei Darussalam, Gadong, Brunei Darussalam
| | - Fran Baum
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology and Population Health, College of Medicine, Biology & Environment, Australian National University, Canberra, Australia
| | - Tamara Mackean
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
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27
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Abstract
The gap in educational attainment separating underrepresented minorities from Whites and Asians remains wide. Such a gap has significant impact on workforce diversity and inclusion among cross-cutting Biomedical Data Science (BDS) research, which presents great opportunities as well as major challenges for addressing health disparities. This article provides a brief description of the newly established National Institutes of Health Big Data to Knowledge (BD2K) diversity initiatives at four universities: California State University, Monterey Bay; Fisk University; University of Puerto Rico, Río Piedras Campus; and California State University, Fullerton. We emphasize three main barriers to BDS careers (ie, preparation, exposure, and access to resources) experienced among those pioneer programs and recommendations for possible solutions (ie, early and proactive mentoring, enriched research experience, and data science curriculum development). The diversity disparities in BDS demonstrate the need for educators, researchers, and funding agencies to support evidence-based practices that will lead to the diversification of the BDS workforce.
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Affiliation(s)
| | | | | | | | - Xinzhi Zhang
- National Institutes of Health, National Institute on Minority Health and Health Disparities
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28
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Zhang X, Pérez-Stable EJ, Bourne PE, Peprah E, Duru OK, Breen N, Berrigan D, Wood F, Jackson JS, Wong DWS, Denny J. Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century. Ethn Dis 2017; 27:95-106. [PMID: 28439179 DOI: 10.18865/ed.27.2.95] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.
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Affiliation(s)
- Xinzhi Zhang
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | | | | | | | - Nancy Breen
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | | | | | - James S Jackson
- College of Literature, Science and the Arts, University of Michigan
| | - David W S Wong
- Department of Geography and GeoInformation Science, College of Science, George Mason University
| | - Joshua Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University Medical Center
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29
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Lopez-Class M, Peprah E, Zhang X, Kaufmann PG, Engelgau MM. A Strategic Framework for Utilizing Late-Stage (T4) Translation Research to Address Health Inequities. Ethn Dis 2016; 26:387-94. [PMID: 27440979 DOI: 10.18865/ed.26.3.387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Achieving health equity requires that every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Inequity experienced by populations of lower socioeconomic status is reflected in differences in health status and mortality rates, as well as in the distribution of disease, disability and illness across these population groups. This article gives an overview of the health inequities literature associated with heart, lung, blood and sleep (HLBS) disorders. We present an ecological framework that provides a theoretical foundation to study late-stage T4 translation research that studies implementation strategies for proven effective interventions to address health inequities.
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Affiliation(s)
- Maria Lopez-Class
- Center for Translation Research and Implementation, National Institutes of Health
| | - Emmanuel Peprah
- Center for Translation Research and Implementation, National Institutes of Health
| | - Xinzhi Zhang
- National Institute on Minority Health and Health Disparities, National Institutes of Health
| | - Peter G Kaufmann
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, National Institutes of Health
| | - Michael M Engelgau
- Center for Translation Research and Implementation, National Institutes of Health
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