Journal of Immigrant and Minority Health最新文献

The Haitian immigrant population in the United States is disproportionately affected by chronic kidney disease (CKD) yet underrepresented in research and policy discussions. While disparities in CKD care among Black Americans have been described, the unique barriers faced by Haitian immigrants in the U.S. remain insufficiently explored, including the lack of epidemiological data. In this article, we review environmental, social, institutional, and policy factors influencing kidney care for this community and discuss potential solutions[Fig.1]. This article aims to inform clinicians, educators, and policymakers seeking to advance equitable kidney care for Haitian immigrants in the United States.

Dyspepsia is among the most common gastrointestinal complaints, affecting nearly one in five adults annually. Guidelines diverge in their recommendations: the American College of Gastroenterology and Canadian Association of Gastroenterology endorse Helicobacter pylori "test-and-treat" for patients under 60 years, with upper endoscopy for those aged 60 and above or with alarm features. By contrast, the American Society for Gastrointestinal Endoscopy advises endoscopy for patients with new-onset dyspepsia beginning at age ≥ 50, even without alarm features. The British Society of Gastroenterology emphasizes risk context, recommending earlier endoscopy (age > 40 years) for individuals from regions with a high incidence of gastric cancer or with a family history of gastric cancer. These differences underscore uncertainty around age thresholds and the limitations of uniform, age-based strategies. In the United States, where several high-risk populations carry disproportionately elevated gastric cancer risk, a tailored, ethnicity- and life-course-informed approach is warranted. Embedding ancestry, nativity, and family history into dyspepsia evaluation would reframe H. pylori eradication as primary prevention and lower thresholds for endoscopy in high-risk groups. Such a strategy would rationalize endoscopy use, advance equity, and reduce preventable deaths. Reframing dyspepsia as an opportunity for prevention is both a clinical and equity imperative.

Non-US citizens often face financial barriers to receiving organ transplants in the US but less is known about their contributions as donors. We assessed participation of non-US citizens as kidney donors and the vulnerabilities that non-US citizens and their communities accept in order to donate. Using United Network for Organ Sharing and Organ Procurement and Transplant Network data (UNOS/OPTN), we performed cross-sectional analysis of 2,423 kidney living donors (LDs) and 8,965 deceased donors (DDs) in UNOS Region 11 between 2018 and 2022. Non-US citizens comprised 2.4% of LDs. Compared to US citizen LDs, non-US citizen LDs had 13.0 times the odds of lacking health insurance (95% CI 7.5, 22.7). Non-US citizens comprised 1.2% of DDs. Among DDs, 73.6% of non-US citizens lacked written documentation of donor intent, versus 41.2% of US citizens (X² 49.2, p < 0.001). 46% of non-US citizen DDs had not previously expressed donor intent to others, versus 27.1% of US citizen DDs (X² 21.7, p < 0.001). In summary, non-US citizens disproportionately accept donation-related financial burdens and vulnerabilities (i.e., having to make a donation decision while grieving a loved one) and contribute to an organ sharing system that their communities are often unable to access as recipients. This suggests lack of reciprocity that should be further evaluated to promote ethicality within the organ sharing system.

Refugee women in the United States face persistent barriers to maternal healthcare shaped by structural, sociocultural, and individual factors. Limited healthcare resources, transportation challenges, financial constraints, and complex health systems restrict timely and effective care. Sociocultural barriers such as limited cultural humility among providers, conflicts between medical and traditional practices, and miscommunication further deepen disparities. Trauma-related mental health conditions, language barriers, and fears of discrimination also hinder care at the individual level. Arizona's Refugee Women's Health Clinic exemplifies an effective, culturally grounded model for meeting refugee women's maternal health needs. Strong community networks, culturally responsive services, and targeted policy interventions serve as key facilitators to improve access. Recent policy shifts may further shape access to prenatal and postpartum care for lawfully present refugees and asylees. To close existing gaps, this commentary calls for extending Medicaid coverage beyond initial resettlement, strengthening provider cultural humility, investing in community-based infrastructure, and ensuring sustainable funding for community health workers. Advancing these strategies will promote equitable, culturally informed maternal care and improve outcomes for refugee women nationwide.

Australia's ageing population is increasingly culturally and linguistically diverse, yet the healthcare experiences and ageing preferences of specific subgroups remain underexplored. Older Arab migrants (OAMs) may face challenges related to language, cultural expectations, and transnational ties. To examine healthcare experiences, cultural and religious needs, and ageing preferences among OAMs in Australia, and identify predictors of preference to remain in Australia versus consider returning to the country of origin. A cross-sectional survey of 134 OAMs (aged ≥ 50 years) in New South Wales was conducted using a bilingual (Arabic/English) questionnaire. Descriptive statistics summarised participant characteristics, exploratory factor analysis identified domains, and logistic regression examined demographic and migration-related predictors. Six domains emerged: trust and satisfaction with healthcare, cultural and religious respect, healthcare communication, preferences for ageing in Australia, family involvement, and community connectedness. Participants generally trusted the healthcare system and were more satisfied with aged care in Australia than in their countries of origin. However, they reported limited confidence managing healthcare communication and low perceived provider efforts to address language barriers. Cultural and religious respect was valued and often recognised, yet many felt specific cultural and spiritual needs were insufficiently met. Preferences for ageing in Australia were associated with family involvement, migration pathway, and community ties. OAMs generally trust Australian healthcare but experience persistent communication and cultural barriers. Strengthening interpreter use and bilingual workforce capacity, embedding culturally safe care, and implementing inclusive aged care policies are needed to support equitable and dignified ageing for CALD populations.