Doubly marginalized: the interplay of racism and disability in outcomes for minoritized people with Down syndrome.

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiology Pub Date : 2024-09-24 DOI:10.1097/EDE.0000000000001789
Salina Tewolde, Ashley Scott, Alianna Higgins, Jasmine Blake, Amy Michals, Matthew P Fox, Yorghos Tripodis, Eric Rubenstein
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Abstract

Background: Intersectionality, or the multidimensional influence of social identity and systems of power, may drive increased morbidity and mortality for adults of color with Down syndrome. We documented racial and ethnic differences in death and hospitalizations among Medicaid enrolled adults with Down syndrome and assessed interaction of racial-ethnic group and Down syndrome.

Methods: Our sample consisted of 119,325 adults with Down syndrome and >3.2 million adults without intellectual disability enrolled in Medicare at any point from 2011-2019. We calculated age-adjusted mortality and hospitalization rates by racial-ethnic group among those with Down syndrome. We examined additive interaction between Down syndrome and racial and ethnic group on mortality and hospitalization rates.

Results: Among those with Down syndrome, age-adjusted mortality rate did not differ between Black and White racial groups (rate ratio: 0.96, 95%CI: 0.92, 1.01) while mortality rate was lower for Pacific Islander (0.80), Asian (0.71), Native (0.77), and Mixed-race groups (0.50). Hospitalization rates were higher for all marginalized groups compared to the White group. When assessing the interaction between racial-ethnic group and Down syndrome, Black, Native Americans, and Mixed-race groups exhibited a negative additive interaction for mortality rate and all groups except Native Americans exhibited positive additive interaction for hospitalization.

Conclusions: Increased hospitalization rates for adults with Down syndrome from marginalized racial and ethnic groups suggest worse health and healthcare. Similar mortality rates across racial and ethnic groups may result from increased infant mortality rate in marginalized groups with Down syndrome leading to reduced mortality among those surviving to adulthood.

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双重边缘化:种族主义和残疾对少数族裔唐氏综合症患者的影响。
背景:交叉性,即社会身份和权力系统的多维影响,可能会导致患有唐氏综合症的有色人种成人的发病率和死亡率增加。我们记录了参加医疗补助计划(Medicaid)的唐氏综合症成人在死亡和住院方面的种族和民族差异,并评估了种族-民族群体与唐氏综合症之间的相互作用:我们的样本包括 119,325 名患有唐氏综合征的成人和超过 320 万名在 2011-2019 年间任何时间点加入医疗补助计划的非智障成人。我们计算了唐氏综合征患者中不同种族-人种群体的年龄调整后死亡率和住院率。我们研究了唐氏综合征与种族和民族群体在死亡率和住院率上的相加交互作用:在唐氏综合征患者中,黑人和白人种族群体的年龄调整后死亡率没有差异(比率:0.96,95%CI:0.92,1.01),而太平洋岛民(0.80)、亚裔(0.71)、土著(0.77)和混血群体(0.50)的死亡率较低。与白人群体相比,所有边缘化群体的住院率都较高。在评估种族-族裔群体与唐氏综合征之间的交互作用时,黑人、美国原住民和混血群体在死亡率方面表现出负相加的交互作用,而除美国原住民之外的所有群体在住院率方面表现出正相加的交互作用:结论:边缘化种族和民族群体中患有唐氏综合症的成人住院率增加,表明健康和医疗保健状况更差。不同种族和族裔群体的死亡率相似,这可能是因为边缘化群体中唐氏综合症患者的婴儿死亡率增加,导致存活至成年的患者死亡率降低。
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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
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