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Palme C, Hafner FS, Hafner L, Peifer TP, Huber AL, Steger B. Artificial Intelligence (AI) Reveals Ethnic Disparities in Cataract Detection and Treatment. Ophthalmol Ther 2024; 13:1683-1692. [PMID: 38642283 DOI: 10.1007/s40123-024-00945-8] [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: 02/12/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The aim of this work is to identify patients at risk of limited access to healthcare through artificial intelligence using a name-ethnicity classifier (NEC) analyzing the clinical stage of cataract at diagnosis and preoperative visual acuity. METHODS This retrospective, cross-sectional study includes patients seen in the cataract clinic of a tertiary care hospital between September 2017 and February 2020 with subsequent cataract surgery in at least one eye. We analyzed 4971 patients and 8542 eyes undergoing surgery. RESULTS The NEC identified 360 patients with names classified as 'non-German' compared to 4611 classified as 'German'. Advanced cataract (7 vs. 5%; p = 0.025) was significantly associated with group 'non-German'. Mean best-corrected visual acuity in group 'non-German' was 0.464 ± 0.406 (LogMAR), and in group 'German' was 0.420 ± 0.334 (p = 0.009). This difference remained significant after exclusion of patients with non-lenticular ocular comorbidities. Surgical time and intraoperative complications did not differ between the groups. Retrobulbar or general anesthesia was chosen significantly more frequently over topical anesthesia in group 'non-German' compared to group 'German' (24 vs. 18% respectively; p < 0.001). CONCLUSIONS This study shows that artificial intelligence is able to uncover health disparities between people with German compared to non-German names using NECs. Patients with non-German names, possibly facing various social barriers to healthcare access such as language barriers, have more advanced cataracts and worse visual acuity upon presentation. Artificial intelligence may prove useful for healthcare providers to discover and counteract such inequalities and establish tailored preventive measures to decrease morbidity in vulnerable population subgroups.
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Affiliation(s)
- Christoph Palme
- Department of Ophthalmology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Lena Hafner
- Department of Politics and International Studies, University of Cambridge, Cambridge, UK
| | | | - Anna Lena Huber
- Department of Ophthalmology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Bernhard Steger
- Department of Ophthalmology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Hai AH, Batey DS, Lee CS, Li S, Schnall R. Examining the Intersection of Ethnoracial Disparities and HIV Status in Substance Use Risks among U.S. Adults. AIDS Behav 2024; 28:1621-1629. [PMID: 38294646 PMCID: PMC11069471 DOI: 10.1007/s10461-024-04277-3] [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] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
Black/African American and Hispanic Americans experience significant HIV-related disparities. Substance use might be a contributing factor to these disparities, but there is limited research on this topic. This study investigated various substance use risks by HIV status and race/ethnicity (Black, Hispanic, White) among U.S. adults. We used data from the 2005-2019 National Survey on Drug Use and Health (N = 541,921). In each racial/ethnic group, the prevalence rates of past-year and past-month tobacco, alcohol, cannabis, and cocaine use, and past-year alcohol and illicit drug use disorders were estimated by HIV status. A series of logistic regressions with the interaction term of HIV x race/ethnicity were performed to examine race/ethnicity's moderating effect on the HIV-substance use associations, while controlling for sociodemographic factors and survey year. Moderation analysis showed that HIV status's association with the risks of past-year tobacco use (AOR = 1.67, 95% CI = 1.01-2.75), past-year cocaine use (AOR = 3.80, 95% CI = 1.91-7.57), past-month cocaine use (AOR = 5.34, 95% CI = 2.10-13.60), and past-year alcohol use disorder (AOR = 2.52, 95% CI = 1.29-4.92) differed significantly between Black and White adults. Between the Hispanic and White groups, HIV status's association with the risks of past-year alcohol use (AOR = 2.00, 95% CI = 1.09-3.69), past-year cocaine use (AOR = 2.40, 95% CI = 1.06-5.39), and past-month cocaine use (AOR = 3.69, 95% CI = 1.36-10.02) also differed significantly. It is well-established that individuals with HIV face an elevated risk of substance use. Our study added valuable insights by highlighting that this phenomenon is particularly more significant among Black and Hispanic adults for several substances when compared to White adults. Implications for practice are discussed.
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Affiliation(s)
- Audrey Hang Hai
- School of Social Work, Tulane University, New Orleans, LA, USA.
| | | | | | - Stacey Li
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Ashouri K, Ginosyan AA, Chu M, Hom B, Hwang J, Resnick K, Rahimi Y, Chaudhary P, Woan K, Siddiqi I, Ladha A, Ali A, Tam EL, Yaghmour G. Donor matters: Donor selection impact on hematopoietic stem cell transplantation outcomes in Hispanic patients with B-cell acute lymphocytic leukemia: Insights from a myeloablative HSCT study. Leuk Res 2024; 141:107501. [PMID: 38631149 DOI: 10.1016/j.leukres.2024.107501] [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: 01/17/2024] [Revised: 03/17/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a pivotal treatment for high-risk acute lymphocytic leukemia (ALL), although limited by suitable human leukocyte antigen (HLA)-matched sibling donors (MSD). This study evaluates the impact of donor selection on outcomes in post-HSCT Hispanic B-cell ALL patients. METHODOLOGY This single-center retrospective study evaluates outcomes in 88 adult Hispanic B-cell ALL patients who underwent haploidentical, MSD, or MUD myeloablative HSCT between 2013 and 2023. RESULTS Compared to Haploidentical transplants, MSD exhibited worse cumulative incidence of relapse (CIR) (HR = 3.39; P = 0.014) and disease-free survival (DFS) (HR = 2.44; P = 0.048) whereas MUD outcomes did not differ. This effect persisted even when controlling for pre-HSCT stage and Minimal residual disease (MRD) status. In addition, Ph-like was a significant predictor of worse DFS (HR = 3.60; P=0.014) and CIR (HR = 2.97; P=0.035) on multivariate analysis. Older donor age correlated with worse GVHD-free, relapse-free survival (GRFS) in haploidentical transplants (HR = 1.05; P=0.036). CONCLUSION Our data highlights improved outcomes with younger, haploidentical donors among Hispanic B-cell ALL patients undergoing myeloablative HSCT. This underscores the importance of donor selection in optimizing outcomes for ALL patients.
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Affiliation(s)
- Karam Ashouri
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anush A Ginosyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mollee Chu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Hom
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Hwang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Karen Resnick
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yekta Rahimi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Preet Chaudhary
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Karrune Woan
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Imran Siddiqi
- Division of Pathology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Abdullah Ladha
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Amir Ali
- Department of Pharmacy, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Eric Leon Tam
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
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Chidiac C, Phan P, Rhee DS, Garcia AV. Access to Laparoscopic Pediatric Surgery: Do Ethnic and Racial Disparities Exist? J Surg Res 2024; 296:265-272. [PMID: 38295714 DOI: 10.1016/j.jss.2023.12.041] [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: 07/14/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Disparate access to laparoscopic surgery may contribute to poorer health outcomes among racial and ethnic minorities, especially among children. We investigated whether racial and ethnic disparities in laparoscopic procedures existed among four common surgical operations in the pediatric population in the United States. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatrics, we conducted a retrospective review of pediatric patients, aged less than 18 y old, undergoing appendectomy, fundoplication, cholecystectomy, and colectomy from 2012 to 2021. To compare the surgical approach (laparoscopy or open), a propensity score matching algorithm was used to compare laparoscopic and open procedures between non-Hispanic Black with non-Hispanic White children and Hispanic with non-Hispanic White children. RESULTS 143,205, 9,907, 4,581, and 26,064 children underwent appendectomy, fundoplication, colectomy, and cholecystectomy, respectively. After propensity score matching, non-Hispanic Black children undergoing appendectomy were found to be treated laparoscopically less than non-Hispanic White children (93.5% versus 94.4%, P = 0.007). With fundoplication, Hispanic children were more likely to be treated laparoscopically than White ones (86.7% versus 80.9%, P < 0.0001). There were no statistically significant differences between Black or Hispanic children and White children in rates of laparoscopy for other procedures. CONCLUSIONS Though some racial and ethnic disparities exist with appendectomies and fundoplications, there is limited evidence to indicate that widespread inequities among common laparoscopic procedures exist in the pediatric population.
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Affiliation(s)
- Charbel Chidiac
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul Phan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Phillips A. Call to action on diabetes care: reaching communities facing health inequalities, health inequities and deprivation. Br J Nurs 2024; 33:16-20. [PMID: 38194328 DOI: 10.12968/bjon.2024.33.1.16] [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: 01/10/2024]
Abstract
This article presents evidence and policy on the importance of reaching out into local communities with inclusive approaches to try to reduce and prevent inequities and inequalities in diabetes care. The global emergency diabetes is causing and the risks and disproportionately high ethnic disparities are investigated. The article includes some suggestions on changing approaches to reduce health inequalities to enable diabetes care to become more accessible for those who need it the most.
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Affiliation(s)
- Anne Phillips
- Professor in Diabetes Care, Birmingham City University
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Silva Júnior AE, de Oliveira ADS, Praxedes DRS, da Costa Paula DT, de Lima Macena M, de Menezes Toledo Florêncio TM, Clemente APG, Bueno NB. Social and Racial Disparities in Food Consumption Among Brazilian College Students: a Nationwide Study. J Racial Ethn Health Disparities 2023; 10:2630-2640. [PMID: 36344748 DOI: 10.1007/s40615-022-01441-0] [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: 08/09/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
This study aims to assess the association between economic class, race/skin color, and food consumption among Brazilian college students. A cross-sectional web-based survey was conducted with college students from all over Brazil. Demographic data, economic class, self-reported race/skin color, anthropometry, and food consumption markers from the Brazilian Food and Nutrition Surveillance System were collected. The final sample comprised 5843 participants with a mean age of 24.1 (SD: 6.3) years, 4292 (73.5%) were female, and 810 (13.9%) in the highest economic stratum. We observed a progressive decrease in the frequency of fresh fruits and vegetables consumption from higher to lower economic classes (p < 0.01 for both). Contrarily, there was a progressive increase in the frequency of consumption of beans from higher to lower economic classes (p < 0.01). The frequency consumption of vegetables was also associated with race/skin color (p < 0.01), being lower in brown (PR: 0.94; CI 95%: 0.90; 0.98), and black (PR: 0.91; 95% CI: 0.85; 0.98) individuals, compared to white individuals. Brown individuals showed higher frequency consumption of beans (PR: 1.10; 95% CI: 1.05; 1.15) than whites. When compared to individuals of white race/skin color, brown (PR: 1.07; 95% CI: 1.01; 1.13) and black (PR: 1.15; 95% CI: 1.07; 1.23) individuals showed higher frequency consumption of sweetened beverages. Economic class and race/skin color were independent factors associated with the food consumption of Brazilian college students.
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Affiliation(s)
- André Eduardo Silva Júnior
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ana Debora Santos de Oliveira
- Faculdade de Nutrição, Universidade Federal de Alagoas, Avenida Lourival de Melo Mota S/N, Maceió-AL, 57072-970, Brazil
| | - Dafiny Rodrigues Silva Praxedes
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Mateus de Lima Macena
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Paula Grotti Clemente
- Faculdade de Nutrição, Universidade Federal de Alagoas, Avenida Lourival de Melo Mota S/N, Maceió-AL, 57072-970, Brazil
| | - Nassib Bezerra Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Avenida Lourival de Melo Mota S/N, Maceió-AL, 57072-970, Brazil.
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Beroukhim G, Seifer DB. Racial and Ethnic Disparities in Access to and Outcomes of Infertility Treatment and Assisted Reproductive Technology in the United States. Endocrinol Metab Clin North Am 2023; 52:659-675. [PMID: 37865480 DOI: 10.1016/j.ecl.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 10/23/2023]
Abstract
Infertility disproportionately affects the minority, non-White populace, with Black women having twofold higher odds than White women. Despite higher infertility rates, minority racial and ethnic groups access and utilize fertility care less frequently. Even once care is accessed, racial and ethnic disparities exist in infertility treatment and ART outcomes. Preliminary studies indicate that Asian and American Indian women have lower intrauterine insemination pregnancy rates. Many robust studies indicate significant racial and ethnic disparities in rates of clinical pregnancy, live birth, pregnancy loss, and obstetrical complications following in vitro fertilization, with lower favorable outcomes in Black, Asian, and Hispanic women.
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Affiliation(s)
- Gabriela Beroukhim
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - David B Seifer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
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Contreras J, Tinuoye EO, Folch A, Aguilar J, Free K, Ilonze O, Mazimba S, Rao R, Breathett K. Heart Failure with Reduced Ejection Fraction and COVID-19, when the Sick Get Sicker: Unmasking Racial and Ethnic Inequities During a Pandemic. Cardiol Clin 2023; 41:491-499. [PMID: 37743072 PMCID: PMC10267502 DOI: 10.1016/j.ccl.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Minoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias, and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID-19 pandemic and its interconnection between heart failure and SDOH. The pandemic presents a window of opportunity for achieving greater equity in the health care of all vulnerable populations.
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Affiliation(s)
- Johanna Contreras
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Elizabeth O Tinuoye
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Alejandro Folch
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Jose Aguilar
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Kendall Free
- Department of Biofunction Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Onyedika Ilonze
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908-0158, USA
| | - Roopa Rao
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA.
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Chander S, Luhana S, Sadarat F, Leys L, Parkash O, Kumari R. Gender and racial differences in first and senior authorship of high-impact critical care randomized controlled trial studies from 2000 to 2022. Ann Intensive Care 2023; 13:56. [PMID: 37368060 DOI: 10.1186/s13613-023-01157-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/04/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Females and ethnic minorities are underrepresented in the first and senior authorships positions of academic publications. This stems from various structural and systemic inequalities and discrimination in the journal peer-review process, as well as educational, institutional, and organizational cultures. METHODS A retrospective bibliometric study design was used to investigate the representation of gender and racial/ethnic groups in the authorship of critical care randomized controlled trials in 12 high-impact journals from 2000 to 2022. RESULTS In the 1398 randomized controlled trials included in this study, only 24.61% of the first authors and 16.6% of the senior authors were female. Although female authorship increased during the study period, authorship was significantly higher for males throughout (Chi-square for trend, p < 0.0001). The educational attainment [χ2(4) = 99.2, p < 0.0001] and the country of the author's affiliated institution [χ2(42) = 70.3, p = 0.0029] were significantly associated with gender. Male authorship was significantly more prevalent in 10 out of 12 journals analyzed in this study [χ2(11) = 110.1, p < 0.0001]. The most common race/ethnic group in our study population was White (85.1% women, 85.4% males), followed by Asians (14.3% females, 14.3% males). Although there was a significant increase in the number of non-White authors between 2000 and 2022 [χ2(22) = 77.3, p < 0.0001], the trend was driven by an increase in non-White male and not non-White female authors. Race/ethnicity was significantly associated with the country of the author's affiliated institution [χ2(41) = 1107, p < 0.0001] but not with gender or educational attainment. CONCLUSIONS Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.
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Affiliation(s)
- Subhash Chander
- Department of Internal Medicine, Mount Sinai Beth Israel, 281 1st Ave, New York, NY, 10003, USA.
| | - Sindhu Luhana
- Department of Medicine, AGA Khan University, Karachi, Pakistan
| | - Fnu Sadarat
- Department of Medicine, University at Buffalo, New York, USA
| | - Lorenzo Leys
- Department of Pulmonary and Critical Care, Mount Sinai West and Morningside, New York, USA
| | - Om Parkash
- Department of Medicine, Albert Einstein, Montefiore Medical Centre, New York, USA
| | - Roopa Kumari
- Department of Pathology, Mount Sinai Morningside and West, New York, USA
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Modi S, Norris MR, Nguyen V, Bower R, Craig TJ, Al-Shaikhly T. Racial and Ethnic Disparities in Allergen Immunotherapy Prescription for Allergic Rhinitis. J Allergy Clin Immunol Pract 2023; 11:1528-1535.e2. [PMID: 36736954 PMCID: PMC10164679 DOI: 10.1016/j.jaip.2023.01.034] [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] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Racial and ethnic differences exist in the severity of various atopic diseases including allergic rhinitis (AR). Patients of under-represented races and ethnicities may be subjected to disparate subcutaneous allergen immunotherapy (SCIT) prescription practices. OBJECTIVE To explore the racial and ethnic disparities in the use of SCIT among patients with AR. METHODS In this retrospective matched cohort study, we used the TriNetX US Collaborative Network, a multicenter electronic health record-based database to identify patients with AR 18 years and older. Patients were grouped according to their racial and ethnic identification. Study groups were matched for baseline demographics, atopic comorbidities, heart diseases and utilization of β-blockers, and angiotensin-converting enzyme inhibitors. The proportion of patients of under-represented racial and ethnic groups started on SCIT was contrasted to the non-Hispanic White cohort. RESULTS We identified 1,038,000 patients with AR; the mean age (±standard deviation) at the index was 49.7 (±16.1) years, and 64.6% were female. Ethnicity information was available from 87.3% of patients, and the majority (92.3%) were non-Hispanic. Over a 3-year observation period, fewer Black patients (relative risk [RR], 0.40; 95% confidence interval [CI], 0.33-0.48) and Hispanic patients (RR, 0.80; 95% CI, 0.64-0.99) were started on SCIT compared with non-Hispanic White patients. The proportions of Asian patients who were initiated on SCIT tended to be lower when compared with non-Hispanic White patients (RR, 0.69; 95% CI, 0.47-1.009). CONCLUSIONS In the United States, differences in SCIT prescription exist between Black and Hispanic patients relative to White patients. Barriers to treatment should be explored and mitigated.
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Affiliation(s)
- Sunjay Modi
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Matthew R. Norris
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Victoria Nguyen
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Robert Bower
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Timothy J. Craig
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Taha Al-Shaikhly
- Department of Medicine, Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania, United States
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Abdalla M, Abdalla M, Abdalla S, Saad M, Jones DS, Podolsky SH. The Under-representation and Stagnation of Female, Black, and Hispanic Authorship in the Journal of the American Medical Association and the New England Journal of Medicine. J Racial Ethn Health Disparities 2023; 10:920-9. [PMID: 35312972 DOI: 10.1007/s40615-022-01280-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
Abstract
Publication in leading medical journals is critical to knowledge dissemination and academic advancement alike. Leveraging a novel dataset comprised of nearly all articles published in JAMA and NEJM from 1990 to 2020, along with established reference works for name identification, we explore changing authorship demographics in two of the world's leading medical journals. Our main outcomes are the annual proportion of male and female authors and the proportion of racial/ethnic identities in junior and senior authorship positions for articles published in JAMA and NEJM since 1990. We found that women remain under-represented in research authorship in both JAMA (at its peak, 38.1% of articles had a female first author in 2011) and NEJM (peaking at 28.2% in 2002). The rate of increase is so slow that it will take more than a century for both journals to reach gender parity. Black and Hispanic researchers have likewise remained under-represented as first and last authors in both journals, even using the best-case scenario. Their appearance as authors has remained stagnant for three decades, despite attention to structural inequalities in medical academia. Thus, analysis of authorship demographics in JAMA and NEJM over the past three decades reveals the existence of inequalities in high-impact medical journal authorship. Gender and racial/ethnic disparities in authorship may both reflect and further contribute to disparities in academic advancement.
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Kapera O, Xie L, Marroquín EM, Ngenge S, Mathew MS, Almandoz JP, Schellinger J, Kukreja SS, Schneider B, McAdams C, Messiah SE. The Role of Body Appreciation in the Decision to Complete Metabolic and Bariatric Surgery Among Ethnically Diverse Patients. Obes Surg 2023; 33:879-89. [PMID: 36633761 DOI: 10.1007/s11695-023-06456-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/01/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE Metabolic and bariatric surgery (MBS) is an evidence-based safe, effective treatment for obesity. However, only half of referred or eligible persons complete the procedure for unknown reasons. The proposed study examined the association between the degree of body appreciation and the decision to complete MBS by ethnicity. METHODS This prospective cohort study included 409 participants who had been referred to a bariatric surgeon or an obesity medicine program between August 2019 and May 2022. Participants completed a survey about health behaviors and psychosocial characteristics, including body appreciation by MBS completion status (Y/N). Multivariate logistic regression models generated adjusted odd ratios (aOR) and 95% confidence intervals (CIs) of body appreciation among MBS completers vs. non-completers. RESULTS The sample mean age was 47.18 years (SD 11.63), 87% were female. 39.6% identified as non-Hispanic White (NHW), 38.5% as non-Hispanic Black (NHB), and 17.6% as Hispanic. Over a third of the sample (31.05%, n = 127) completed MBS. "Often" experiencing body appreciation was the most significant predictor of MBS completion (aOR: 28.19, 95% CI: 6.37-124.67, p-value < 0.001), followed by "Sometimes" (aOR: 20.47, 95% CI: 4.82-86.99, p-value < 0.001) and "Always" (aOR: 13.54, 95% CI: 2.55-71.87, p-value < 0.01) after controlling for sex, age, and race/ethnicity. There was not a significant interaction between body appreciation and race/ethnicity (p-value = 0.96). CONCLUSION Results showed a significant association between body appreciation and MBS completion, controlling for sex, age, and race/ethnicity. MBS clinical settings may want to assess body appreciation as a pre-operative screener among ethnically diverse patients.
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13
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Braschi C, Liu JK, Moazzez A, Petrie BA. Presentation, Outcomes, and Non-elective Surgical Management of Diverticulitis: Is There an Ethnic Divide? J Gastrointest Surg 2023:10.1007/s11605-023-05638-4. [PMID: 36853521 PMCID: PMC10366017 DOI: 10.1007/s11605-023-05638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/18/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Caitlyn Braschi
- Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Jessica K Liu
- Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Ashkan Moazzez
- Division of General & Bariatric Surgery, Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson Street, Bldg F10, Torrance, CA, 90505, USA.
| | - Beverley A Petrie
- Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
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Bilaver LA, Galic I, Zaslavsky J, Anderson B, Catlin PA, Gupta RS. Achieving Racial Representation in Food Allergy Research: A Modified Delphi Study. J Allergy Clin Immunol Pract 2023; 11:281-291. [PMID: 36241153 DOI: 10.1016/j.jaip.2022.09.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The overrepresentation of White participants in food allergy research contributes to the development of research questions and interventions not driven by those disproportionately affected by the condition. This ultimately limits the generalizability of research findings and affects the development of knowledge about food allergy and food allergy management. OBJECTIVE To develop recommendations to combat inequitable research paradigms and increase participation of racially underrepresented populations in food allergy research. METHODS This study used a modified consensus development method, known as a Delphi method, to assemble the expertise of food allergy clinicians, advocacy leaders, community-engaged researchers, and patients. RESULTS Findings resulted in 18 recommendations within four domains: community partnership, intentional engagement and messaging, recruitment activities, and dissemination. CONCLUSIONS Findings from this study provide food allergy researchers with specific recommendations for examining their efforts more critically toward recruiting and engaging with racially underrepresented populations, effectively transitioning from a research-on to a research-with relationship with individuals and families living with food allergy.
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Affiliation(s)
- Lucy A Bilaver
- Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Isabel Galic
- Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Justin Zaslavsky
- Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Perry A Catlin
- Department of Psychology, Marquette University, Milwaukee, Wis
| | - Ruchi S Gupta
- Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of General Academic Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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15
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Mehta NK, Allam S, Mazimba S, Karim S. Racial, ethnic, and socioeconomic disparities in out-of-hospital cardiac arrest within the United States: Now is the time for change. Heart Rhythm O2 2022; 3:857-863. [PMID: 36588995 PMCID: PMC9795269 DOI: 10.1016/j.hroo.2022.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/23/2022] Open
Abstract
This review highlights the current evidence on racial, ethnic, and socioeconomic disparities in cardiac arrest outcomes within the United States. Several studies demonstrate that patients from Black, Hispanic, or lower socioeconomic status backgrounds suffer the most from disparities at multiple levels of the resuscitation pathway, including in the provision of bystander cardiopulmonary resuscitation, defibrillator usage, and postresuscitation therapies. These gaps in care may altogether lead to lower survival rates and worse neurological outcomes for these patients. A multisystem, culturally sensitive approach to improving cardiac arrest outcomes is suggested in this article.
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Affiliation(s)
- Nishaki K. Mehta
- Department of Cardiovascular Medicine, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, Michigan
- Division of Cardiovascular Medicine, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sahitya Allam
- Department of Internal Medicine, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, Maryland
- Address reprint requests and correspondence: Dr Sahitya Allam, 22 S Greene St, Room N3E09, Baltimore, MD 21201.
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Saima Karim
- Division of Cardiovascular Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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16
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Wong MS, Upchurch DM, Steers WN, Haderlein TP, Yuan AT, Washington DL. The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans. J Racial Ethn Health Disparities 2022; 9:1861-1872. [PMID: 34491563 PMCID: PMC8422953 DOI: 10.1007/s40615-021-01123-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES American Indian and Alaska Native (AI/AN) communities have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. This study examines whether neighborhood characteristics mediate AI/AN versus White-non-Hispanic Veteran COVID-19 infection disparities, and whether mediation differs based on proximity to reservations. METHODS Using Veteran Health Administration's (VHA) national database of VHA users evaluated for COVID-19 infection (3/1/2020-8/25/2020), we examined whether census tract neighborhood characteristics (percent households overcrowded, without complete plumbing, without kitchen plumbing, and neighborhood socioeconomic status [n-SES]) mediated racial disparities in COVID-19 infection, using inverse odds-weighted logistic models controlling for individual-level characteristics. Using moderated mediation analyses, we assessed whether neighborhood mediating effects on disparities differed for those residing in counties containing/near federally recognized tribal lands (i.e., Contract Health Service Delivery Area [CHSDA] counties) versus not. RESULTS The percent of households without complete plumbing, percent without kitchen plumbing, and n-SES partially mediated AI/AN-White-non-Hispanic COVID-19 infection disparities (accounting for 17-35% of disparity) to a similar extent in CHSDA and non-CHSDA counties. The percent of households without kitchen plumbing had stronger mediating effects for CHSDA than non-CHSDA residents. CONCLUSIONS Neighborhood-level social determinants of health may contribute to the disproportionate COVID-19 infection burden on AI/ANs; differences are exacerbated among AI/ANs living near reservations.
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Affiliation(s)
- Michelle S Wong
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - W Neil Steers
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Taona P Haderlein
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Anita T Yuan
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Donna L Washington
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA
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17
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Lusk JB, Xu H, Thomas LE, Cohen LW, Hernandez AF, Forrest CB, Michtalik HJ, Turner KB, O'Brien EC, Barrett NJ. Racial/ Ethnic Disparities in Healthcare Worker Experiences During the COVID-19 Pandemic: An Analysis of the HERO Registry. EClinicalMedicine 2022; 45:101314. [PMID: 35265822 PMCID: PMC8898082 DOI: 10.1016/j.eclinm.2022.101314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The extent to which healthcare worker (HCWs) experiences during the COVID-19 pandemic vary by race or ethnicity after adjustment for confounding factors is not currently known. METHODS We performed an observational prospective cohort study of 24,769 healthcare workers from 50 U.S. states and the District of Columbia, enrolled between April 10, 2020 and June 30, 2021, and evaluated participant experiences during the COVID-19 pandemic, including testing, diagnosis with COVID-19, emotional experiences, burnout, and interest in vaccines and vaccine clinical trials. FINDINGS After adjustment for professional role, medical history, and community characteristics, Black and Asian participants were less likely to receive SARS-CoV-2 viral testing (adjusted odds ratio (aOR) 0·82 [0·70, 0·96], p=0·012 and aOR 0·77 [0·67, 0·89], p<0·001 respectively) than White participants. Hispanic participants were more likely to have evidence of COVID-19 infection (aOR 1·23 (1·00, 1·50, p=0·048). Black and Asian participants were less likely to report interest in a COVID-19 vaccine (aOR 0·11 [0·05, 0·25], p<0·001 and aOR 0·48 [0·27, 0·85] p=0·012). Black participants were less likely to report interest in participating in a COVID-19 vaccine trial (aOR = 0·39 [0·28, 0·54], p<0·001). Black participants were also less likely to report 3 or more daily emotional impacts of COVID-19 (aOR = 0·66 [0·53, 0·82], p=<0·001). Black participants were additionally less likely to report burnout (aOR = 0·66 ([0·49, 0·95], p=0·025). INTERPRETATION In a large, national study of healthcare workers, after adjustment for individual and community characteristics, race/ethnicity disparities in COVID-19 outcomes persist. Future work is urgently needed to understand precise mechanisms behind these disparities and to develop and implement targeted interventions to improve health equity for healthcare workers. FUNDING This work was funded by the Patient-Centered Outcomes Research Institute (PCORI), Contract # COVID-19-2020-001.
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Affiliation(s)
- Jay B. Lusk
- Duke University School of Medicine, Durham, NC, USA
- Duke University Fuqua School of Business, Durham, NC, USA
- Correspondence: Jay B. Lusk, DUMC 3710, Durham, NC, USA 27710, 928-271-5557.
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Laine E. Thomas
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Lauren W. Cohen
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | | | | | | | - Emily C. O'Brien
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Nadine J. Barrett
- Department of Family Medicine and Community Health, Duke University, Durham, UA
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18
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Zhou X, Altice FL, Chandra D, Didomizio E, Copenhaver MM, Shrestha R. Use of Pre-exposure Prophylaxis Among People Who Inject Drugs: Exploratory Findings of the Interaction Between Race, Homelessness, and Trust. AIDS Behav 2021; 25:3743-3753. [PMID: 33751313 DOI: 10.1007/s10461-021-03227-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Scale-up of pre-exposure prophylaxis (PrEP) in people who inject drugs (PWID) remains suboptimal. Patient-level factors are often complex and may contribute to scale-up. Using cross-sectional data from 234 opioid-dependent patients on methadone who met eligibility criteria for PrEP, we conducted logistic regression analyses to assess potential moderators associated with being on PrEP (n = 60). Mean provider trust was significantly higher among Blacks vs Whites (39.4 vs 34.9; p = 0.002) and non-homeless vs homeless participants (37.5 vs 34.8; p = 0.008). Though race/ethnicity was not a significant moderator on provider trust and PrEP use, increased provider trust was marginally associated with increased PrEP use among Blacks (p = 0.058). Additionally, homelessness significantly moderated provider trust and PrEP use (p = 0.024). Provider trust among non-homeless participants was positively correlated with PrEP use (p = 0.013) but not among homeless participants. Strategies that promote provider trust in Blacks and non-homeless PWID on methadone may improve PrEP scale-up.
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Ikram M, Williams KA Sr. Socioeconomics of coronary artery calcium: Is it scored or ignored? J Cardiovasc Comput Tomogr 2021:S1934-5925(21)00448-2. [PMID: 34657819 DOI: 10.1016/j.jcct.2021.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/25/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022]
Abstract
IMPORTANCE Chicago is one of the most racially segregated cities in the US, with the largest mortality gap between neighborhoods. Computed tomographic coronary artery calcium scoring (CACS) is an excellent risk stratification tool, but costs about $200 out-of-pocket, making it inaccessible to some. OBJECTIVE To determine whether this ACC/AHA guideline-recommended screening tool is accessible to all populations and neighborhoods, we evaluated the price and availability of CACS in Chicago area hospitals. DESIGN We used the Illinois Department of Public Health list of area hospitals to inquire about CACS availability and price. We compared these results to US Census Bureau data for each hospital's service area's demographic, ethnic and socioeconomic population characteristics. RESULTS Out of the 40 hospitals in Chicagoland, 30 offered CACS. The 10 hospitals without CACS were smaller hospitals in zip codes with a higher population density (p < 0.01), higher poverty rates (22% vs. 13%, p < 0.01), lower percentage of white population (p < 0.02), lower frequency of higher education (35% vs. 51%, p < 0.05), and a trend toward more black residents (p < 0.10). Life expectancy was greater in areas with CACS available (78 vs. 75 years, p < 0.05). Even in areas with CACS, there was wide price variation, with higher prices in poorer areas (r = 0.57, p < 0.01). The highest vs. lowest quintile of income had higher education, larger white population (80% vs. 14%, p < 0.0001), and longer life expectancy (81 vs. 72 years, p < 0.0002), but tended to have a lower price of CACS ($86 vs. $487, p < 0.08). CONCLUSIONS AND RELEVANCE CACS is a powerful, evidenced-based clinical tool, but the availability and price vary widely in Chicagoland, and directly correlate with the socioeconomic and health care disparities that are known to exist. Removing these barriers to coronary artery disease screening may be one method to improve the poor cardiovascular outcomes in these areas.
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20
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Jeram M, Mohamed F, Coomarasamy C, MacCormick AD. Are There Ethnic Differences in Micronutrient Deficiencies in Preoperative Bariatric Patients? A Systematic Review and Meta-analysis. Obes Surg 2021. [PMID: 34383257 DOI: 10.1007/s11695-021-05625-1] [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] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this systematic review was to determine if in patients presenting for bariatric surgery, patients of different ethnicities, have different micronutrient deficiencies preoperatively. Databases searched were PubMed, Embase, MEDLINE and Cochrane Library. A meta-analysis of prevalence of vitamin D insufficiency (<20ng/ml) was carried out using a random effects model. Twenty-eight articles were included assessing preoperative micronutrient status across different ethnic groups. The most common micronutrient assessed was vitamin D, and the most assessed ethnicity was Caucasian. African Americans had the greatest prevalence of vitamin D insufficiency when compared to other ethnicities with a pooled prevalence and 95% confidence interval of 0.80 [0.74; 0.85]. There was a significant difference in vitamin D insufficiency when compared across ethnicities (p <0.01).
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21
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Davidovits M, Reisman L, Cleper R, Bar-Nathan N, Krause I, Dagan A, Zanhendler N, Chodick G, Hocherman O, Mor M, Aisner S, Mor E. Long-term outcomes during 37 years of pediatric kidney transplantation: a cohort study comparing ethnic groups. Pediatr Nephrol 2021; 36:1881-1888. [PMID: 33459932 DOI: 10.1007/s00467-020-04908-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to evaluate short- and long-term outcomes of kidney transplantation over 37 years in a national referral center and compare outcomes between Israeli Jewish and Arab children. METHODS Data on 599 pediatric transplantations performed in 545 children during 1981-2017, including demographic parameters, kidney failure disease profile, and pre-transplant dialysis duration, were retrieved from our computerized database and patient files. Patient and graft survival were estimated using the Kaplan-Meier method. RESULTS Twenty-year patient survival was 91.4% for live donor (LD) and 80.2% for deceased donor (DD) kidney recipients. Respective 10-year and 20-year graft survival rates for first kidney-only transplants were 75.2% and 47.0% for LD and 60.7% and 38.4% for DD grafts. Long-term graft survival improved significantly (p < 0.001) over the study period for recipients of both LD and DD allografts and reached 7-year graft survival of 92.0% and 71.3%, respectively. The proportion of DD transplantations was higher in the Arab subpopulation: 73.8% vs. 48.4% (p < 0.001). Graft survival was not associated with age at transplantation and did not differ between the Arab (N = 202) and Jewish children (N = 343). Median (IQR) waiting time on dialysis did not differ significantly between the Arab and Jewish children: 18 (10-30) and 15 (9-30) months, respectively (p Mann-Whitney = 0.312). CONCLUSIONS Good and progressively improving long-term results were obtained in pediatric kidney transplantation at our national referral center, apparently due to expertise gained over time and advances in immunosuppression. Equal access to DD kidney transplant and similar graft survival were found between ethnic groups.
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Affiliation(s)
- Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 49202, Petah Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Lewis Reisman
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 49202, Petah Tikva, Israel
| | - Roxana Cleper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Nephrology Unit, Dana-Dweq Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nathan Bar-Nathan
- Department of Transplantation, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Irit Krause
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 49202, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Dagan
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 49202, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neomi Zanhendler
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 49202, Petah Tikva, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Hocherman
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 49202, Petah Tikva, Israel
| | - Maya Mor
- Department of Transplantation, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Sigal Aisner
- Department of Transplantation, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Eytan Mor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Transplantation, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Pineros-Leano M, Grafft N. Racial and Ethnic Disparities in Childhood Growth Trajectories. J Racial Ethn Health Disparities 2021. [PMID: 34076865 DOI: 10.1007/s40615-021-01071-y] [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] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
Childhood overweight and obesity are a primary social and public health concern. Over the past 30 years, rates of childhood overweight and obesity in the United States of America (USA) have drastically increased, particularly among Black and Latino/a populations. However, they tend to be underrepresented in the childhood obesity literature. This study expands previous literature by identifying different BMI growth trajectories for Black, Latino/a, and White children from birth to age nine. This study found a high prevalence rate of overweight and obesity in a predominantly low-income minority group. Using growth-based trajectory modeling, this study also found different growth trajectories by racial/ethnic groups, with Latino/a children having the most concerning growth trajectories from birth to 9 years. These findings demonstrate that ethnic/racial disparities in childhood overweight and obesity start as early as birth, indicating the need to devote more attention from researchers and health policy-makers to address these disparities as early as possible.
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Bonett S, Meanley S, Elsesser S, Bauermeister J. State-Level Discrimination Policies And HIV Pre-Exposure Prophylaxis Adoption Efforts In The US. Health Aff (Millwood) 2021; 39:1575-1582. [PMID: 32897779 DOI: 10.1377/hlthaff.2020.00242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/05/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a drug regimen recommended for anyone at high risk of getting HIV to prevent them from being infected. Little research exists on how state-level policies might be related to differential PrEP uptake across the United States. To better understand the associations between state-level policies and PrEP uptake, we examined HIV criminalization, nondiscrimination laws for sexual and gender minorities, Medicaid expansion, Ryan White funding, and sociodemographic characteristics in relation to the PrEP-to-need ratio, a measure of PrEP uptake. Using a cross-sectional design, we analyzed data from all fifty states; Washington, D.C.; and Puerto Rico (all of which we categorize as states here) regarding policy, socioeconomic factors, and PrEP-to-need ratio in 2018. States with HIV criminalization laws had lower PrEP-to-need ratio, and states with more nondiscrimination laws for sexual and gender minorities had higher PrEP-to-need ratio. We found no association between Medicaid expansion, Ryan White funding, percentage Hispanic, percentage uninsured, median household income, percentage with high school education, or state population and PrEP uptake. Legislators should consider how laws concerning HIV and sexual and gender minorities might protect against discrimination and subvert fear and stigma, given the potential impact of these policies on HIV prevention.
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Affiliation(s)
- Stephen Bonett
- Stephen Bonett is a doctoral student in the School of Nursing at the University of Pennsylvania, in Philadelphia, Pennsylvania
| | - Steven Meanley
- Steven Meanley is a research associate in the School of Nursing at the University of Pennsylvania
| | - Steven Elsesser
- Steven Elsesser is a resident in the Department of Family Medicine and Community Health at the University of Pennsylvania
| | - José Bauermeister
- José Bauermeister is the Presidential Professor of Nursing in the School of Nursing at the University of Pennsylvania
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Summey RM, Pike J, Salazar C. Postoperative Risks for Hispanic Patients Undergoing Hysterectomy for Benign Indications. J Racial Ethn Health Disparities 2021; 9:684-690. [PMID: 33646554 DOI: 10.1007/s40615-021-01001-y] [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: 12/12/2020] [Revised: 01/28/2021] [Accepted: 02/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hispanic patients have previously been shown to have relatively lower odds of complication following hysterectomy compared with non-Hispanic white patients, but little is known about specific risks for this group. Our primary objective was to identify differences in proportions of specific complications experienced by Hispanic patients following hysterectomy for benign indications as compared with non-Hispanic white patients. DESIGN Retrospective cohort study examining differences in complication rates following benign hysterectomy between Hispanic and non-Hispanic white patients in NSQIP-participating hospitals from 2012 to 2016. MEASUREMENTS AND MAIN RESULTS A total of 102,051 women were included. A total of 15.0% were Hispanic and 85.0% were non-Hispanic white. Hispanic patients were more likely to have class 1 or 2 obesity (59.7 vs 49.8%), diabetes (10.9 vs 6.7%), and anemia (hematocrit < 33: 14.1 vs 6.5%); p < 0.01 for all. Hispanic patients were more likely to undergo abdominal hysterectomy (30.0 vs 19.1%, p < 0.01) and to remain inpatient for 2-6 days (38.8 vs 24.0%, p < 0.01). After adjustment for possible confounders including anemia, an increased odds of requiring blood transfusion persisted only in the laparoscopic and vaginal groups. Hispanic patients had a decreased or equal odds for all other examined complications. CONCLUSIONS Compared with non-Hispanic white patients, Hispanic women had a higher odds of requiring blood transfusion even when undergoing minimally invasive laparoscopic and vaginal approaches to hysterectomy. Despite a higher proportion of open surgery, Hispanic patients had a decreased or equal odds of postoperative complications.
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Affiliation(s)
- Rebekah M Summey
- Dell Medical School, University of Texas at Austin, 1301 W 38th St., Suite 705, Austin, TX, 78705, USA.
| | - Jordyn Pike
- Dell Medical School, University of Texas at Austin, 1301 W 38th St., Suite 705, Austin, TX, 78705, USA
| | - Christina Salazar
- Dell Medical School, University of Texas at Austin, 1301 W 38th St., Suite 705, Austin, TX, 78705, USA
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Pflugeisen BM, Mou J. Empiric evidence of ethnic disparities in coronavirus positivity in Washington State. Ethn Health 2021; 26:36-48. [PMID: 33428455 DOI: 10.1080/13557858.2020.1863922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/19/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Early reports from the initial months of the coronavirus pandemic reveal ethnic disparities in coronavirus incidence, severity, and mortality. This study aimed to evaluate the relationship between ethnicity and outcomes of coronavirus positivity and hospitalization. DESIGN An observational cohort study using electronic health record (EHR) data from a large community healthcare system in Washington State across the first phase of the pandemic (March 5 - June 7, 2020). RESULTS A total of 18,667 patients (65.9% of all tested) with EHR-documented ethnicity were included. Overall, 6.4% of patients tested positive for coronavirus. Among Latinx patients, 18.6% of those tested were positive, compared to only 4.0% of tested White patients. Multivariable logistic regression revealed significantly higher odds of positivity for Latinxs (aOR = 4.96, 95% CI 4.19-5.87), Asians (aOR = 2.33, 95% CI 1.74-3.08), Blacks (aOR = 1.82, 95% CI 1.43-2.31), and members of other ethnic minority groups (aOR = 2.34, 95% CI 1.80-2.95), compared to Whites in models adjusting for relevant confounders. Latinxs had a higher percentage of self-pay insurance (22.2%) compared to other ethnic groups (7.9-15.8%) and, among those who tested positive, were the only ethnic subpopulation with significantly higher odds than Whites to be hospitalized for COVID-19 (aOR = 2.19, 95% CI 1.45-3.33). We observed a positive correlation between infection and the percentage of Latinxs (r = 0.61, 95% CI 0.45-0.74), Blacks (r = 0.51, 95% CI 0.32-0.66), or Asians (r = 0.64, 95% CI 0.49-0.76) in a given zip-code. This correlationwas negative for Whites (r = -0.63, 95% CI -0.75, -0.45). CONCLUSIONS We present empirical evidence of higher rates of coronavirus positivity among People of Color compared to White people in Washington State. Social determinants of health, such as occupation, housing, healthcare access, and community structure, may contribute to health disparities in the coronavirus pandemic. Targeted capture of these variables in electronic health records is warranted to inform health equity analyses.
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Affiliation(s)
| | - Jin Mou
- MultiCare Health System, Institute for Research & Innovation, Tacoma, WA, USA
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Abstract
Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is genetically determined and minimally responsive to lifestyle or behavior changes. Mendelian randomization studies have suggested a causal link between elevated Lp(a) and heart disease, stroke, and aortic stenosis. There is substantial inter-ethnic variation in Lp(a) levels, with persons of African descent having the highest median values. Monitoring of Lp(a) has historically been limited by lack of standardization of assays. With the advent of novel therapeutic modalities to lower Lp(a) levels including proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors and targeted antisense oligonucleotides, it is increasingly important to screen patients who have family or personal history of atherosclerotic cardiovascular disease for elevations in Lp(a). Further study is needed to establish a causal relationship between elevated Lp(a) and cardiovascular disease across diverse ethnic populations.
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Affiliation(s)
- Keon Pearson
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, USA.
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Reddy S, Wu TC, Zhang J, Rahbar MH, Ankrom C, Zha A, Cossey TC, Aertker B, Vahidy F, Parsha K, Jones E, Sharrief A, Savitz SI, Jagolino-Cole A. Lack of Racial, Ethnic, and Sex Disparities in Ischemic Stroke Care Metrics within a Tele-Stroke Network. J Stroke Cerebrovasc Dis 2020; 30:105418. [PMID: 33152594 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105418] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/22/2020] [Revised: 09/03/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Differences in access to stroke care and compliance with standard of care stroke management among patients of varying racial and ethnic backgrounds and sex are well-characterized. However, little is known on the impact of telestroke in addressing disparities in acute ischemic stroke care. METHODS We conducted a retrospective review of acute ischemic stroke patients evaluated over our 17-hospital telestroke network in Texas from 2015-2018. Patients were described as Non-Hispanic White (NHW) male or female, Non-Hispanic Black (NHB) male or female, or Hispanic (HIS) male or female. We compared frequency of tPA and mechanical thrombectomy (MT) utilization, door-to-consultation times, door-to-tPA times, and time-to-transfer for patients who went on to MT evaluation at the hub after having been screened for suspected large vessel occlusion at the spoke. RESULTS Among 3873 patients (including 1146 NHW male (30%) and 1134 NHW female (29%), 405 NHB male (10%) and 491 NHB female (13%), and 358 HIS male (9%) and 339 HIS female (9%) patients), we did not find any differences in door-to consultation time, door-to-tPA time, time-to-transfer, frequency of tPA administration, or incidence of MT utilization. CONCLUSION We did not find racial, ethnic, and sex disparities in ischemic stroke care metrics within our telestroke network. In order to fully understand how telestroke alleviates disparities in stroke care, collaboration among networks is needed to formulate a multicenter telestroke database similar to the Get-With-The Guidelines.
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Affiliation(s)
- Sujan Reddy
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Tzu-Ching Wu
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Jing Zhang
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, United States; Department of Biostatistics and Data Science, The University of Texas Health Science Center (UTHealth), Houston, United States.
| | - Mohammad Hossein Rahbar
- Department of Biostatistics and Data Science, The University of Texas Health Science Center (UTHealth), Houston, United States.
| | - Christy Ankrom
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Alicia Zha
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - T C Cossey
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Benjamin Aertker
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist, United States.
| | - Kaushik Parsha
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Erica Jones
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Anjail Sharrief
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Sean I Savitz
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
| | - Amanda Jagolino-Cole
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center (UTHealth), 6431 Fannin Street, MSB 7.125, Houston, TX 77030, United States.
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Benitez J, Courtemanche C, Yelowitz A. Racial and Ethnic Disparities in COVID-19: Evidence from Six Large Cities. J Econ Race Policy 2020; 3:243-261. [PMID: 35300199 PMCID: PMC7584480 DOI: 10.1007/s41996-020-00068-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Received: 07/22/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
As of June 2020, the coronavirus pandemic has led to more than 2.3 million confirmed infections and 121 thousand fatalities in the USA, with starkly different incidence by race and ethnicity. Our study examines racial and ethnic disparities in confirmed COVID-19 cases across six diverse cities-Atlanta, Baltimore, Chicago, New York City, San Diego, and St. Louis-at the ZIP code level (covering 436 "neighborhoods" with a population of 17.7 million). Our analysis links these outcomes to six separate data sources to control for demographics; housing; socioeconomic status; occupation; transportation modes; health care access; long-run opportunity, as measured by income mobility and incarceration rates; human mobility; and underlying population health. We find that the proportions of Black and Hispanic residents in a ZIP code are both positively and statistically significantly associated with COVID-19 cases per capita. The magnitudes are sizeable for both Black and Hispanic, but even larger for Hispanic. Although some of these disparities can be explained by differences in long-run opportunity, human mobility, and demographics, most of the disparities remain unexplained even after including an extensive list of covariates related to possible mechanisms. For two cities-Chicago and New York-we also examine COVID-19 fatalities, finding that differences in confirmed COVID-19 cases explain the majority of the observed disparities in fatalities. In other words, the higher death toll of COVID-19 in predominantly Black and Hispanic communities mostly reflects higher case rates, rather than higher fatality rates for confirmed cases.
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Affiliation(s)
- Joseph Benitez
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY 40536 USA
| | - Charles Courtemanche
- Department of Economics, Gatton Business & Economics Building, University of Kentucky, Lexington, KY 40506-0034 USA
| | - Aaron Yelowitz
- Department of Economics, Gatton Business & Economics Building, University of Kentucky, Lexington, KY 40506-0034 USA
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Henning-Smith CE, Hernandez AM, Hardeman RR, Ramirez MR, Kozhimannil KB. Rural Counties With Majority Black Or Indigenous Populations Suffer The Highest Rates Of Premature Death In The US. Health Aff (Millwood) 2020; 38:2019-2026. [PMID: 31794313 DOI: 10.1377/hlthaff.2019.00847] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 11/05/2022]
Abstract
Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among US rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county's majority racial/ethnic group. Premature death rates were significantly higher in rural counties with a majority of non-Hispanic black or American Indian/Alaska Native (AI/AN) residents than in rural counties with a majority of non-Hispanic white residents. After we adjusted for community-level covariates, differences in premature death remained significant in counties with a majority of AI/AN residents but not those with a majority of non-Hispanic black residents. This study highlights the particular vulnerability of non-Hispanic black and AI/AN rural communities to high rates of premature mortality. Policies to improve rural health should focus on these racially diverse communities, addressing economic vitality and current and historical political context to mitigate health inequities and the harmful health effects of neglecting social determinants of health.
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Affiliation(s)
- Carrie E Henning-Smith
- Carrie E. Henning-Smith ( henn0329@umn. edu ) is an assistant professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis
| | - Ashley M Hernandez
- Ashley M. Hernandez is a PhD candidate in the Division of Environmental Health Sciences, University of Minnesota School of Public Health
| | - Rachel R Hardeman
- Rachel R. Hardeman is an assistant professor in the Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Marizen R Ramirez
- Marizen R. Ramirez is an associate professor in the Division of Environmental Health Sciences, University of Minnesota School of Public Health
| | - Katy Backes Kozhimannil
- Katy Backes Kozhimannil is an associate professor in the Division of Health Policy and Management, University of Minnesota School of Public Health
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Abstract
Virtual strategies for health care visits during a pandemic must not exclude marginalized patients.
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Affiliation(s)
- Kumara R Sundar
- Kumara R. Sundar is a family medicine physician in Seattle, Washington. This essay is part of a collection of reflections on the COVID-19 pandemic
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Abstract
We used data from the Medical Expenditure Panel Survey to explore potential explanations for racial/ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalizations and mortality. Black adults in every age group were more likely than White adults to have health risks associated with severe COVID-19 illness. However, Whites were older, on average, than Blacks. Thus, when all factors were considered, Whites tended to be at higher overall risk compared with Blacks, with Asians and Hispanics having much lower overall levels of risk compared with either Whites or Blacks. We explored additional explanations for COVID-19 disparities-namely, differences in job characteristics and how they interact with household composition. Blacks at high risk for severe illness were 1.6 times as likely as Whites to live in households containing health-sector workers. Among Hispanic adults at high risk for severe illness, 64.5 percent lived in households with at least one worker who was unable to work from home, versus 56.5 percent among Black adults and only 46.6 percent among White adults.
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Affiliation(s)
- Thomas M Selden
- Thomas M. Selden is director of the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Terceira A Berdahl
- Terceira A. Berdahl is a social science analyst in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality
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Azar KMJ, Shen Z, Romanelli RJ, Lockhart SH, Smits K, Robinson S, Brown S, Pressman AR. Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California. Health Aff (Millwood) 2020; 39:1253-1262. [PMID: 32437224 DOI: 10.1377/hlthaff.2020.00598] [Citation(s) in RCA: 405] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As the novel coronavirus disease (COVID-19) pandemic spreads throughout the United States, evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. We conducted a retrospective cohort analysis of COVID-19 patients at Sutter Health, a large integrated health system in northern California, to measure potential disparities. We used Sutter's integrated electronic health record to identify adults with suspected and confirmed COVID-19, and we used multivariable logistic regression to assess risk of hospitalization, adjusting for known risk factors, such as race/ethnicity, sex, age, health, and socioeconomic variables. We analyzed 1,052 confirmed cases of COVID-19 from the period January 1-April 8, 2020. Among our findings, we observed that compared with non-Hispanic white patients, non-Hispanic African American patients had 2.7 times the odds of hospitalization, after adjustment for age, sex, comorbidities, and income. We explore possible explanations for this, including societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option. Our study provides real-world evidence of racial and ethnic disparities in the presentation of COVID-19.
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Affiliation(s)
- Kristen M J Azar
- Kristen M. J. Azar is a research scientist at the Sutter Health Center for Health Systems Research, in Walnut Creek, California, and a doctoral student in the Department of Epidemiology and Biostatistics at the University of California San Francisco (UCSF), in San Francisco, California
| | - Zijun Shen
- Zijun Shen is a statistical analyst at the Sutter Health Center for Health Systems Research
| | - Robert J Romanelli
- Robert J. Romanelli is a research scientist and director of Data and Analytics at the Sutter Health Center for Health Systems Research and an associate adjunct professor in the Department of Clinical Pharmacy at UCSF
| | - Stephen H Lockhart
- Stephen H. Lockhart is chief medical officer at Sutter Health in Sacramento, California
| | - Kelly Smits
- Kelly Smits is a communication specialist at Sutter Health in Sacramento
| | - Sarah Robinson
- Sarah Robinson is a statistical analyst at the Sutter Health Center for Health Systems Research
| | - Stephanie Brown
- Stephanie Brown is an emergency physician at Alta Bates Summit Medical Centers in Oakland and Berkeley, California, and the Physician Champion for Health Equity, Sutter Health
| | - Alice R Pressman
- Alice R. Pressman is a senior scientist and codirector of the Sutter Health Center for Health Systems Research and an associate adjunct professor in the Department of Epidemiology and Biostatistics at UCSF
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Hanna K, Zeeshan M, Hamidi M, Pandit V, Omesiete P, Cruz A, Ewongwo A, Joseph B, Nfonsam V. Colon cancer in the young: contributing factors and short-term surgical outcomes. Int J Colorectal Dis 2019; 34:1879-85. [PMID: 31624871 DOI: 10.1007/s00384-019-03402-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Accepted: 08/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The incidence in young patients has increased significantly over the last few decades. The aim of this study is to evaluate demographic and tumor characteristics of young patients and analyze the short-term surgical outcomes of patients undergoing surgery. METHODS We performed a 2-year review (2015-2016) of the ACS-NSQIP and included all patients with CC who underwent surgical management. Patients were stratified into two groups: early-onset CC (< 50 years old) and late-onset CC (≥ 50 years old). Outcome measures were hospital length of stay, 30-day complications, mortality, and readmission. RESULTS We included a total of 15,957 patients in the analysis. Mean age was 65 ± 13 years, and 52% were male. Overall 10% of the patients had early-onset CC. Patients with early-onset CC were more likely to be black (11% vs 7%, p = 0.04) and Hispanic (8% vs 4%, p = 0.02). Additionally, they presented with a more aggressive tumor and higher TNM staging. Patients with early onset CC had lower 30-day complications (18% vs 22%, p = 0.02), shorter hospital length of stay (6[3-8] vs 8[5-11], p = 0.03) and lower 30-day mortality (0.4% vs 1.8%, p = 0.04) compared to their counterparts. However, there was no difference between the two groups regarding 30-day readmission. On regression analysis, there was no difference between the two groups regarding study outcomes. CONCLUSIONS Racial disparity does exist in the incidence of colon cancer in the young with higher incidence in blacks. Younger patients with CC tend to have better surgical outcomes on univariate analysis. On regression analysis, the surgical outcomes between the two groups are comparable.
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Park JJ, Sommers BD, Humble S, Epstein AM, Colditz GA, Koh HK. Medicaid And Private Insurance Coverage For Low-Income Asian Americans, Native Hawaiians, And Pacific Islanders, 2010-16. Health Aff (Millwood) 2019; 38:1911-1917. [PMID: 31682495 DOI: 10.1377/hlthaff.2019.00316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 11/05/2022]
Abstract
To determine how low-income Asian American, Native Hawaiian, and Pacific Islander (AANHPI) adults gained health insurance coverage-specifically, via Medicaid or private insurance-under the Affordable Care Act, we used a difference-in-differences approach to compare uninsurance rates in 2010-13 and 2015-16. In Medicaid expansion states, adjusted Medicaid coverage gains were 9.67 percentage points larger than in nonexpansion states; however, adjusted private coverage gains in expansion states were 10.19 percentage points lower. These results indicate that, in contrast to the case for other racial/ethnic groups, for AANHPI the Medicaid coverage increases in expansion states were of similar magnitude to the private insurance coverage increases in nonexpansion states. Reasons for this may include differences in willingness to enroll in public versus private coverage, barriers related to language or citizenship status, or other factors. Future studies are needed to understand these patterns and promote health equity for this population.
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Affiliation(s)
- John J Park
- John J. Park ( john. park@mail. harvard. edu ) is a Knox Fellow in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Benjamin D Sommers
- Benjamin D. Sommers is a professor of health policy and economics in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, and a professor of medicine at Brigham and Women's Hospital, in Boston
| | - Sarah Humble
- Sarah Humble is a senior statistical data analyst in the Public Health Sciences Division, Washington University School of Medicine, in St. Louis, Missouri
| | - Arnold M Epstein
- Arnold M. Epstein is the John H. Foster Professor of Health Policy and Management in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health
| | - Graham A Colditz
- Graham A. Colditz is the Neiss-Gain Professor in the Public Health Sciences Division, Washington University School of Medicine
| | - Howard K Koh
- Howard K. Koh is the Harvey V. Fineberg Professor of the Practice of Public Health Leadership in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health
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Franzoi MA, Schwartsmann G, de Azevedo SJ, Geib G, Zaffaroni F, Liedke PER. Differences in Breast Cancer Stage at Diagnosis by Ethnicity, Insurance Status, and Family Income in Young Women in the USA. J Racial Ethn Health Disparities 2019; 6:909-16. [PMID: 31102102 DOI: 10.1007/s40615-019-00591-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Describe the clinical and epidemiological data from young women with breast cancer and determine the association between ethnicity, insurance status, family income, and breast cancer stage at the diagnosis in this population. METHODS Women under the age of 40 diagnosed with invasive breast cancer from 2010 to 2014 and identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database were included. Binary logistic regression was applied in order to estimate the odds ratios (ORs) for factors that were potentially predictive for receiving a breast cancer diagnosis at stage I. RESULTS Of 14,379 young women with invasive breast cancer, 70.9% of the patients were white, 15.9% black, and 13.2% classified as other ethnicity (American Indian, Asian, Pacific Islander). The initial clinical stage at diagnosis was stage I in 28.2%, II in 45.2%, III in 19.0%, and IV in 7.6%. The chi-square test showed a significant association between clinical stage at diagnosis and family income (p < 0.0001), insurance status (p < 0.0001), and ethnicity (p < 0.0001). The ORs for being diagnosed at stage I, regarding different factors, revealed that women with family income higher than US$ 85,000 were more likely to be diagnosed with stage I (OR [95%CI], 1.306 [1.173-1.454]; p value < 0.0001) when compared with patients with family income of less than US$ 60,000. Black women were less likely to be diagnosed with stage I (OR [95%CI], 0.676 [0.605-0.755]; p value < 0.0001), when compared with white women. Uninsured women were less likely to be diagnosed with stage I (OR [95%CI], 0.586 [0.529-0.648]; p value < 0.0001) when compared with women with insurance coverage. CONCLUSION Among young US women diagnosed with invasive breast cancer, most of them presented early stage disease. Women with black ethnicity, low income, and uninsured are at risk for late-stage presentation. Improvements in strategies to allow earlier breast cancer diagnosis in these at risk population are urged.
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Santos-Lozada AR, Martinez MJ. How Have You Been? or ¿Como estás?: Does Language of Interview Influences Self-Rated Health Among Hispanic Subgroups? J Immigr Minor Health 2018; 20:766-75. [PMID: 28597233 DOI: 10.1007/s10903-017-0606-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper reports language differences in poor/fair self-rated health (SRH) among adults from six Hispanic groups in the United States. Data are from the cross-sectional 1997-2013 National Health Interview Survey (NHIS). The total sample of Hispanic adults with valid information for the variables considered in the study (n = 156,374) included Mexican-Americans (Mex-Am; n = 43,628), Mexicans (n = 55,057), Puerto Ricans (n = 14,631), Cubans (n = 8,041), Dominicans (from Dominican Republican, n = 4,359) and Other Hispanics (n = 30,658). We compared percentage of the population that reported poor/fair SRH among Hispanic individuals by language of interview and across origins using bivariate tests of association. Multivariable logistic regression analysis was used to study the odds of reporting poor/fair SRH based on language among the overall population and each group. Among the six Hispanic origins Puerto Ricans (15.92%), Cubans (16.36%) and Dominicans (15.32%) reported poor/fair SRH at higher levels than the overall sample (12.32%). In the logistic regression model adjusting potential covariates, those interviewed in Spanish were at higher odds of reporting poor/fair SRH than those interviewed in English (OR = 1.47, p < 0.0001). In the stratified analysis, Mexican-Americans were the only group where language of interview did not affect the odds of reporting poor/fair SRH. There are differences by Hispanic origin for reporting poor/fair SRH, and also by language of interview. Achieving accurate measurement of health status among Hispanics is a concern for all researchers, in particular those who study differences in health status by race/ethnicity in the United States. Future, research should account for Hispanic background and language of interviews.
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Petersen TG, Forthun I, Lange T, Villadsen SF, Nybo Andersen AM, Uldall P, Strandberg-Larsen K. Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status. Eur J Paediatr Neurol 2019; 23:507-516. [PMID: 30777617 DOI: 10.1016/j.ejpn.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Children of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP). OBJECTIVES To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. METHODS A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. RESULTS In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR = 0.59 (95% CI:0.38-0.91) for Western and OR = 0.79 (95% CI:0.61-1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR = 1.27 (95% CI:1.05-1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99-1.14) for children of Non-Western immigrants. CONCLUSIONS While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.
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Affiliation(s)
- Tanja Gram Petersen
- Department of Public Health at University of Copenhagen, Oesterfarimagsgade 5, Postboks 2099, 1014 Copenhagen, Denmark.
| | - Ingeborg Forthun
- Department of Global Public Health and Primary Care at University of Bergen, Postboks 7804, N-5020 Bergen, Norway; Department of Pediatrics at Haukeland University Hospital, Post Office Box 1400, N-5021 Bergen, Norway
| | - Theis Lange
- Department of Public Health at University of Copenhagen, Oesterfarimagsgade 5, Postboks 2099, 1014 Copenhagen, Denmark
| | - Sarah Fredsted Villadsen
- Department of Public Health at University of Copenhagen, Oesterfarimagsgade 5, Postboks 2099, 1014 Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Department of Public Health at University of Copenhagen, Oesterfarimagsgade 5, Postboks 2099, 1014 Copenhagen, Denmark
| | - Peter Uldall
- Department of Pediatrics at University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Department of Public Health at University of Copenhagen, Oesterfarimagsgade 5, Postboks 2099, 1014 Copenhagen, Denmark
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Aarab R, Vijverberg SJH, Prins M, Snijder MB, van Ree R, Fokkens WJ, Zwinderman AH, Bel EHD, Maitland van der Zee AH. Prevalence of and factors associated with adult-onset asthma in different ethnic groups: The HELIUS study. Respir Med 2019; 150:113-9. [PMID: 30961936 DOI: 10.1016/j.rmed.2019.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 02/02/2023]
Abstract
Little is known about adult-onset asthma in different ethnic groups. The aim of this study was to examine ethnic differences in the prevalence of adult-onset asthma and factors associated with this phenotype. Cross-sectional data of 23,356 participants of the HELIUS study were used, including Dutch, South-Asian Surinamese, African Surinamese, Moroccan, Turkish and Ghanaian origin participants. Adult-onset asthma was defined as: self-reported asthma symptoms or start of asthma-medication at age ≥18 years combined with a smoking history <10 pack years. The prevalence of adult-onset asthma and its association with potential risk factors were assessed by logistic regression analyses. The adjusted prevalence of adult-onset asthma was higher in the Turkish, Moroccan and South-Asian Surinamese groups (4.9-6.0%) compared to the Dutch, Ghanaian and African Surinamese origin groups (2.4-2.6%). In addition to ethnicity, age, female sex, BMI, and doctors' diagnosis of nasal allergy/hay fever and chronic sinusitis/polyps were independently associated with adult-onset asthma. There are significant differences in the adjusted prevalence of adult-onset asthma among six ethnic groups.
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Demmer E, Cifelli CJ, Houchins JA, Fulgoni VL. Ethnic disparities of beverage consumption in infants and children 0-5 years of age; National Health and Nutrition Examination Survey 2011 to 2014. Nutr J 2018; 17:78. [PMID: 30134909 PMCID: PMC6106834 DOI: 10.1186/s12937-018-0388-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 08/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dietary patterns, including beverage consumption, that are developed during a child's first few years of life have been shown to impact dietary choices made later in life. Authoritative sources provide beverage recommendations for infants and children; however, it is unclear if these guidelines are followed and what, if any, the differences are among races/ethnicities. The objective of this study was to examine beverage consumption to recommendations among children 0-5 months, 6-11 months, 12-23 months, 2-3 years, and 4-5 years. Additionally, examine how these beverage patterns associate with nutrient intake and to determine if differences exist in beverage consumption among race/ethnic groups (Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asian) in children aged 0-23 months, 2-3 years, and 4-5 years. METHODS Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) for children 0-5 years were analyzed (n = 2445). Beverages were classified as follows; milk, 100% juice, diet beverages, sugar sweetened beverages (SSB), and water. RESULTS Our results show that regardless of race/ethnicity, dietary recommendation were not always followed. Prior to 6 months, 10% of infants consumed any amount of 100% juice; from 6 to 11 months, 17% of young children were drinking any amount of milk. SSB consumption rapidly increased with age, whereas intake of milk and 100% juice declined after 2 to 3 years of age. Non-Hispanic Black young children consumed the most 100% juice from 2 to 3 years and up, exceeding recommended amounts, and throughout all age groups they consumed the least milk and most SSBs. The decreased intake of nutrient-rich beverages with age was associated with lower intakes of under-consumed nutrients of public health concern. By 4-5 years, 32.7% and 93.8% of children were consuming CONCLUSIONS Dietary recommendations for both the introduction of beverages and amounts consumed were not consistently followed for American infants and children 0-5 years. Race/ethnic disparities exist in beverage consumption with Non-Hispanic Black children consuming the least amount of milk and most SSBs. Improving beverage consumption patterns could help improve overall diet quality which directly contributes to overall childhood health.
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Affiliation(s)
- Elieke Demmer
- National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
| | | | - Jenny A. Houchins
- National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
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Hore P, Ahmed MS, Sedlar S, Saper RB, Nagin D, Clark N. Blood Lead Levels and Potential Risk Factors for Lead Exposures Among South Asians in New York City. J Immigr Minor Health 2017; 19:1322-9. [PMID: 27015835 DOI: 10.1007/s10903-016-0403-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
New York City’s South Asian children and pregnant women have a disproportionate burden of elevated blood lead levels. This study is the first to investigate blood lead levels and risk factors for lead exposures among South Asian New Yorkers. A survey and a finger-stick blood lead test using a portable analyzer were administered to 230 South Asian adults and children. Blood lead levels of 5 µg/dL or higher were found in 20 % of the adults and 15 % of the children, as compared to 5 % of adults and 2.5 % of children citywide. Factors associated with elevated blood lead levels were recent repair work at home, not speaking English, Bangladeshi or Indian ethnicity, and occupational risk factors. Public health professional should be aware that South Asians may be at an increased risk for elevated blood lead levels.
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Welton M, DeJoy D, Castellanos ME, Ebell M, Shen Y, Robb S. Ethnic Disparities of Perceived Safety Climate Among Construction Workers in Georgia, 2015. J Racial Ethn Health Disparities 2017. [PMID: 28643270 DOI: 10.1007/s40615-017-0394-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/19/2022]
Abstract
BACKGROUND Safety climate involves worker perception about the relative importance where they work and safety climate and has been shown to be a reliable predictor of safety-related outcomes. METHODS The primary objective of this study is to investigate ethnic differences in perceived safety climate among construction workers. Surveys (n = 179) that included a 10-item safety climate scale were administered in Athens, Georgia (GA), at local construction sites and home improvement stores during June-August, 2015. RESULTS The majority of respondents were carpenters or roofers (39%), followed by laborers (22%), painters and dry wall workers (14%), other skilled trades (14%), and supervisors (11%); 32% were Hispanic. Hispanic ethnicity (p < 0.0001), drinking two or more alcoholic beverages per day (p < 0.0001), working for a company that does not provide health insurance (p = 0.0022), and working for a company with fewer than ten employees (p < 0.0001) were significantly associated with lower perceived safety climate scores. CONCLUSION The lower perceived safety climate scores among Hispanic workers indicate that the perception of the importance of safety on the job site is lower among Hispanics construction workers than non-Hispanics construction workers.
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Affiliation(s)
- Michael Welton
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA.
| | - David DeJoy
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
| | | | - Mark Ebell
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
| | - Ye Shen
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
| | - Sara Robb
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
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Magaji BA, Moy FM, Roslani AC, Law CW. Survival rates and predictors of survival among colorectal cancer patients in a Malaysian tertiary hospital. BMC Cancer 2017; 17:339. [PMID: 28521746 PMCID: PMC5437641 DOI: 10.1186/s12885-017-3336-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 11/04/2015] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Background Colorectal cancer is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death globally. It is the second most common cancer among both males and females in Malaysia. The economic burden of colorectal cancer is likely to increase over time owing to its current trend and aging population. Cancer survival analysis is an essential indicator for early detection and improvement in cancer treatment. However, there was a scarcity of studies concerning survival of colorectal cancer patients as well as its predictors. Therefore, we aimed to determine the 1-, 3- and 5-year survival rates, compare survival rates among ethnic groups and determine the predictors of survival among colorectal cancer patients. Methods This was an ambidirectional cohort study conducted at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia. All Malaysian citizens or permanent residents with histologically confirmed diagnosis of colorectal cancer seen at UMMC from 1 January 2001 to 31 December 2010 were included in the study. Demographic and clinical characteristics were extracted from the medical records. Patients were followed-up until death or censored at the end of the study (31st December 2010). Censored patients’ vital status (whether alive or dead) were cross checked with the National Registration Department. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Log-rank test was used to compare the survival rates, while Cox proportional hazard regression analysis was carried out to determine the predictors of 5-year colorectal cancer survival. Results Among 1212 patients, the median survival for colorectal, colon and rectal cancers were 42.0, 42.0 and 41.0 months respectively; while the 1-, 3-, and 5-year relative survival rates ranged from 73.8 to 76.0%, 52.1 to 53.7% and 40.4 to 45.4% respectively. The Chinese patients had the lowest 5-year survival compared to Malay and Indian patients. Based on the 814 patients with data on their Duke’s staging, independent predictors of poor colorectal cancer (5-year) survival were male sex (Hazard Ratio [HR]: 1.41; 95% CI: 1.12, 1.76), Chinese ethnicity (HR: 1.41; 95% CI: 1.07,1.85), elevated (≥ 5.1 ng/ml) pre-operative carcino-embryonic antigen (CEA) level (HR: 2.13; 95% CI: 1.60, 2.83), Duke’s stage C (HR: 1.68; 95% CI: 1.28, 2.21), Duke’s stage D (HR: 4.61; 95% CI: 3.39, 6.28) and emergency surgery (HR: 1.52; 95% CI: 1.07, 2.15). Conclusions The survival rates of colorectal cancer among our patients were comparable with those of some Asian countries but lower than those found in more developed countries. Males and patients from the Chinese ethnic group had lower survival rates compared to their counterparts. More advanced staging and late presentation were important predictors of colorectal cancer survival. Health education programs targeting high risk groups and emphasizing the importance of screening and early diagnosis, as well as the recognition of symptoms and risk factors should be implemented. A nationwide colorectal cancer screening program should be designed and implemented to increase early detection and improve survival outcomes.
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Affiliation(s)
- Bello Arkilla Magaji
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,University of Malaya Cancer Research Institute (UMCRI), Kuala Lumpur, Malaysia.,Department of Community Health, College of Health Sciences, Usmanu Danfodiyo University, PMB, Sokoto, 2346, Nigeria
| | - Foong Ming Moy
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - April Camilla Roslani
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,University of Malaya Cancer Research Institute (UMCRI), Kuala Lumpur, Malaysia
| | - Chee Wei Law
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,University of Malaya Cancer Research Institute (UMCRI), Kuala Lumpur, Malaysia
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Wikaire E, Curtis E, Cormack D, Jiang Y, McMillan L, Loto R, Reid P. Predictors of academic success for Māori, Pacific and non-Māori non-Pacific students in health professional education: a quantitative analysis. Adv Health Sci Educ Theory Pract 2017; 22:299-326. [PMID: 28236125 DOI: 10.1007/s10459-017-9763-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/08/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health professional students by ethnic grouping. Kaupapa Māori and Pacific research methodologies were used to conduct a quantitative analysis using data for 2686 health professional students [150 Māori, 257 Pacific, 2279, non-Māori non-Pacific (nMnP)]. The predictive effect of admission variables: school decile; attending school in Auckland; type of admission; bridging programme; and first-year bachelor results on academic outcomes: year 2-4 grade point average (GPA); graduating; graduating in the minimum time; and optimal completion for the three ethnic groupings and the full cohort was explored using multiple regression analyses. After adjusting for admission variables, for every point increase in first year bachelor GPA: year 2-4 GPA increased by an average of 0.46 points for Māori (p = 0.0002, 95% CI 0.22, 0.69), 0.70 points for Pacific (p < 0.0001, CI 0.52, 0.87), and 0.55 points for nMnP (p < 0.0001, CI 0.51, 0.58) students. For the total cohort, ethnic grouping was consistently the most significant predictor of academic outcomes. This study demonstrated clear differences in academic outcomes between both Māori and Pacific students when compared to nMnP students. Some (but not all) of the disparities between ethnic groupings could be explained by controlling for admission variables.
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Affiliation(s)
- Erena Wikaire
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Elana Curtis
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Donna Cormack
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Louise McMillan
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Rob Loto
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Ha J, Chaudhri A, Avirineni A, Pan JJ. Burden of hepatocellular carcinoma among hispanics in South Texas: a systematic review. Biomark Res 2017; 5:15. [PMID: 28439416 PMCID: PMC5399820 DOI: 10.1186/s40364-017-0096-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 01/12/2017] [Accepted: 04/13/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the fastest rising causes of cancer-related mortality in the United States (U.S.). Despite improved HCC screening and surveillance guidelines, significant race/ethnicity-specific disparities in hepatocellular carcinoma remain, disproportionately affecting at risk racial minorities in the U.S. The current review aims to provide an updated analysis on race/ethnicity-specific disparities in HCC epidemiology with a focus on predisposing risk factors. CONCLUSION Among different race/ethnicities in the U.S., Hispanics experienced the greatest burden of HCC, particularly those residing in South Texas. It is important to understand that the underlying etiologies for these disparities are complex and multi-factorial. Some of these risk factors for developing chronic liver disease include non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and alcohol use. In addition, population genetics, acculturation of ethnic minorities, and access to healthcare may be further contributing to the observed disparities in HCC. By increasing awareness, improved modalities for screening and surveillance for HCC are important in guiding future research for targeted preventive and therapeutic interventions.
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Affiliation(s)
- John Ha
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fanin St, MSB 1.150, Houston, TX 77030 USA
| | - Aysha Chaudhri
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fanin St, MSB 1.150, Houston, TX 77030 USA
| | - Abhishek Avirineni
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fanin St, MSB 1.150, Houston, TX 77030 USA
| | - Jen-Jung Pan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fanin St, MSB 1.150, Houston, TX 77030 USA
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fanin St, MSB 4.234, Houston, TX 77030 USA
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Wehby GL, Trujillo AJ. Differences in early cognitive and receptive-expressive neurodevelopment by ancestry and underlying pathways in Brazil and Argentina. Infant Behav Dev 2017; 46:100-14. [PMID: 28068525 DOI: 10.1016/j.infbeh.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/22/2016] [Accepted: 12/03/2016] [Indexed: 12/21/2022]
Abstract
We examine disparities in early child cognitive and receptive-expressive skills by ethnic ancestry among infants aged 3-24 months from Brazil and Argentina. We employ unique data on the neurodevelopment of children who were seeking routine well-child care at a set of pediatric clinics in these countries. The sample included children who had normal birth outcomes and no major health complications, allowing us to focus on variation in neurodevelopment among children without major physical health limitations. The physicians attending the pediatric clinics were trained in administering the Bayley Infant Neurodevelopmental Screener, a standardized instrument used to screen an infant's risk of neurodevelopmental problems on various domains of abilities. We evaluate disparities in overall neurodevelopmental scores and risk for neurodevelopmental problems as well as in cognitive functioning and receptive-expressive neurodevelopment. We also examine the extent to which household demographic and socioeconomic characteristics and geographic location explain these disparities. We find large gaps in both cognitive and receptive-expressive neurodevelopment by ancestry. In Brazil, children of African ancestry have lower scores on both cognitive and receptive-expressive domains and on overall neurodevelopment than children of European ancestry. In Argentina, children of Native ancestry have lower scores on these outcomes than children of European ancestry. These gaps however are largely explained by differences in geographic location and household characteristics, highlighting the importance of policies that reduce socioeconomic and geographic disparities in social capital and economic development for eliminating ethnic disparities in infant neurodevelopment.
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Dickson KS, Zeedyk SM, Martinez J, Haine-Schlagel R. Examining ethnic disparities in provider and parent in-session participation engagement. J Child Serv 2017; 12:47-58. [PMID: 29151846 PMCID: PMC5690539 DOI: 10.1108/jcs-12-2016-0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Well-documented ethnic disparities exist in the identification and provision of quality services among children receiving community-based mental health services. These disparities extend to parent treatment engagement, an important component of effective mental health services. Currently, little is known about differences in how providers support parents' participation in treatment and the degree to which parents actively participate in it. The purpose of this paper is to examine potential differences in both provider and parent in-session participation behaviours. DESIGN/METHODOLOGY/APPROACH Participants included 17 providers providing standard community-based mental health treatment for 18 parent-child dyads, with 44 per cent of the dyads self-identifying as Hispanic/Latino. In-session participation was measured with the parent participation engagement in child psychotherapy and therapist alliance, collaboration, and empowerment strategies observational coding systems. FINDINGS Overall, results indicate significantly lower levels of parent participation behaviours among Hispanic/Latino families compared to their Non-Hispanic/Non-Latino counterparts. No significant differences were seen in providers' in-session behaviours to support parent participation across Hispanic/Latino and Non-Hispanic/Non-Latino families. RESEARCH LIMITATIONS/IMPLICATIONS These findings contribute to the literature on ethnic differences in parent treatment engagement by utilising measures of in-session provider and parent behaviours and suggest that further investigation is warranted to documenting and understanding ethnic disparities in parents' participation in community-based child mental health treatment. ORIGINALITY/VALUE This paper contributes to the evaluation of differences in parent treatment engagement through demonstrating the utility of an in-session observational coding system as a measure of treatment engagement.
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Affiliation(s)
- Kelsey S Dickson
- Postdoctoral Scholar at the Department of Psychiatry, University of California, San Diego, California, USA and Child and Adolescent Services Research Center, San Diego, California, USA
| | - Sasha M Zeedyk
- Assistant Professor at the Department of Child and Adolescent Studies, California State University, Fullerton, California, USA
| | - Jonathan Martinez
- Assistant Professor at the Department of Psychology, California State University, Northridge, Los Angeles, California, USA
| | - Rachel Haine-Schlagel
- Assistant Professor at the Department of Child and Family Development, San Diego State University, San Diego, California, USA and Child and Adolescent Services Research Center, San Diego, California, USA
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Becker DJ, Wisnivesky JP, Grossbard ML, Chachoua A, Camidge DR, Levy BP. Survival of Asian Females With Advanced Lung Cancer in the Era of Tyrosine Kinase Inhibitor Therapy. Clin Lung Cancer 2016; 18:e35-e40. [PMID: 28029530 DOI: 10.1016/j.cllc.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/23/2016] [Revised: 07/06/2016] [Accepted: 08/23/2016] [Indexed: 12/09/2022]
Abstract
INTRODUCTION We examined the effect of access to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy on survival for Asian female (AF) EGFR mutation-enriched patients with advanced lung adenocarcinoma. MATERIALS AND METHODS We used the Surveillance Epidemiology and End Results database to study patients with stage IV lung adenocarcinoma diagnosed from 1998 to 2012. We compared survival (lung cancer-specific survival [LCSS] and overall survival) between AFs and non-Asian males (NAMs), an EGFR mutation-enriched and EGFR mutation-unenriched population, respectively, with a diagnosis in the pre-EGFR TKI (1998-2004) and EGFR TKI (2005-2012) eras. We used Cox proportional hazards models to examine the interaction of access to TKI treatment and EGFR enrichment status. RESULTS Among 3029 AF and 35,352 NAM patients, we found that LCSS was best for AFs with a diagnosis in the TKI era (median, 14 months), followed by AFs with a diagnosis in the pre-TKI era (median, 8 months), NAMs with a diagnosis in the TKI era (median, 5 months), and NAMs with a diagnosis in the pre-TKI era (median, 4 months; log-rank P < .0001). In a multivariable model, the effect of a diagnosis in the TKI era on survival was greater for AFs than for NAMs (LCSS, P = .0020; overall survival, P = .0007). A lung cancer diagnosis in the TKI era was associated with an overall mortality decrease of 26% for AFs (hazard ratio, 0.740; 95% confidence interval, 0.682-0.80) and 15.9% for NAMs (hazard ratio, 0.841; 95% confidence interval, 0.822-0.860). CONCLUSIONS We found increased survival for lung adenocarcinoma diagnoses made after widespread access to EGFR TKIs, with the greatest increase among AF patients enriched for EGFR mutations. The present analysis eliminated the effect of crossover, which has complicated assessments of the survival advantage in EGFR TKI randomized trials.
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Affiliation(s)
- Daniel J Becker
- Section of Hematology Oncology, Veterans Affairs-New York Harbor Healthcare System, Manhattan Campus, New York, NY; Department of Medicine, New York University School of Medicine, New York, NY.
| | - Juan P Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael L Grossbard
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Abraham Chachoua
- Department of Medicine, New York University School of Medicine, New York, NY
| | - D Ross Camidge
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Benjamin P Levy
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Moreno-Black G, Stockard J. Two Worlds of Obesity: Ethnic Differences in Child Overweight/Obesity Prevalence and Trajectories. J Racial Ethn Health Disparities 2015; 3:331-9. [PMID: 27271074 DOI: 10.1007/s40615-015-0150-7] [Citation(s) in RCA: 7] [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] [Received: 01/21/2015] [Revised: 06/17/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Research on childhood obesity has examined the prevalence of overweight and obesity during childhood and developmental trajectories. This study focuses on the extent to which Hispanic and non-Hispanic white elementary students differ in prevalence of overweight and obesity by grade level, time, gender, and school setting. It also focuses on comparison of the trajectories in weight status for the Hispanic and non-Hispanic white students. METHODS BMI values were examined both using standard scores (z-scores) and as categorical variables. Cross-sectional data from 4 years were used to examine prevalence, and panel data across 2-year periods examined trajectories. Descriptive statistics and mixed models, controlling for school setting, were used. RESULTS Hispanic students began first grade with higher prevalence of obesity and overweight, and the differences were larger in higher grades and later years. The majority of students had stable weight status over the 2-year periods of the trajectory analysis, but Hispanic students began the panel with higher BMI-Z values and were more likely to increase and less likely to decrease BMI-Z. CONCLUSIONS The findings suggest that the degree of childhood overweight/obesity, especially among Hispanics, is substantial and will likely have profound impacts on adult obesity and other associated health issues in the future. Findings confirm the need for early childhood interventions to influence BMI.
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Affiliation(s)
| | - Jean Stockard
- Department of Planning, Public Policy and Management, University of Oregon, Eugene, Oregon, USA
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Sufrinko AM, Valrie CR, Lanzo L, Bond KE, Trout KL, Ladd RE, Everhart DE. Empirical validation of a short version of the Adolescent Sleep-Wake Scale using a sample of ethnically diverse adolescents from an economically disadvantage community. Sleep Med 2015; 16:1204-6. [PMID: 26429746 DOI: 10.1016/j.sleep.2015.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/22/2015] [Accepted: 07/03/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a need for brief, psychometrically sound instruments to assess adolescent sleep, particularly for ethnic minority and economically disadvantaged adolescents. A 10-item short version of the Adolescent Sleep-Wake Scale was recently proposed based upon exploratory factor analysis with primarily Caucasian healthy adolescents from middle- to high-income families. The aim of this study was to expand the utility of the short version of the Adolescent Sleep-Wake Scale by investigating the empirical and construct validity of the measure on an ethnically diverse sample of adolescents from an economically disadvantaged community. MATERIALS AND METHODS Participants included 467 adolescents (40% African American, 35.5% Caucasian, 16.5% Latino, and 7.9% multiethnic), aged 12-18 years (mean = 15.27 years, SD = 1.96 years), who completed the Adolescent Sleep-Wake Scale. A confirmatory factor analysis (CFA) was conducted with Mplus 7 based on the three-factor solution proposed by Essner et al. (2014). RESULTS CFA indicated that the three-factor structure was a good fit for the data (χ(2) (29) = 52.053, p = 0.005, root mean square error of approximation (RMSEA) = 0.04, CFI = 0.98, TLI = 0.96, standardized root mean residuals (SRMR) = 0.03), and factor loadings for each item were >0.40. Cronbach's alphas by ethnicity indicated that the scale has acceptable reliability (0.70 ≤ α ≤ 0.90) for African American, Caucasian, and multiethnic adolescents, but not for Latino adolescents. CONCLUSION Our results support the use of the Adolescent Sleep-Wake Scale short form for the majority of ethnic minority and economically disadvantaged adolescents.
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Affiliation(s)
- Alicia M Sufrinko
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA.
| | - Cecelia R Valrie
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA
| | - Lauren Lanzo
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA
| | - Kayzandra E Bond
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA
| | - Krystal L Trout
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA
| | - Rebecca E Ladd
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA
| | - D Erik Everhart
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA
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