Journal of Racial and Ethnic Health Disparities最新文献

Living donor kidney transplantation (LDKT) offers the most favorable outcomes for patients with end-stage kidney disease, yet Black patients have disproportionately low LDKT rates. This multicenter randomized controlled trial tested whether Transplant House Calls (THC), a home-based education program that engages patients and social networks, with or without Peer Mentorship (PM), could increase LDKT access among Black patients. Between 2018 and 2020, 319 patients were randomized to Usual Care (UC), THC, or THC+PM. The primary outcome was LDKT within 1 year; secondary outcomes included living donor inquiries, donor evaluations, and patient-reported outcomes (PROs) related to knowledge, attitudes, and readiness. Overall, 5% of patients received LDKT, with no statistically significant differences among groups (UC: 0%; THC: 5%; THC+PM: 6%, P=0.07). However, both THC and THC+PM participants were significantly more likely than UC patients to have at least one living donor inquiry (P=0.04 and P=0.01, respectively) and evaluation (P=0.04 and P=0.01, respectively). Intervention participants also showed greater improvements in LDKT knowledge, reduced concerns, increased readiness to act, and higher self-efficacy compared with UC. Although PM uptake was incomplete, satisfaction was high, and exploratory analyses suggested a potential incremental benefit. The COVID-19 pandemic curtailed intervention delivery, delayed donor evaluations and surgeries, and likely contributed to the modest transplant rates observed. In conclusion, culturally tailored, home-based education that directly engages patients' social networks improves intermediate outcomes and patient preparedness for LDKT. Further evaluation with larger samples, longer follow-up, and full THC and PM implementation is warranted to assess potential impact on reducing racial disparities in LDKT.

Background: Primary care clinicians (PCCs) are tasked with communicating cardiovascular disease (CVD) risk to adults who are parents, including Black individuals. The impact of these discussions with parents is especially important because of the potential translation of lifestyle behaviors to their children. However, sparse research has examined Black parent's preferences on whether and how their PCCs should discuss parent's personal CVD risk and associated lifestyle behaviors. This study aimed to understand Black parent's perception of the role PCCs should play in communicating CVD risk and examined their preferences regarding how to communicate risk.

Methods: Qualitative focus groups (n = 10) were conducted with Medicaid-enrolled Black parents who have a school-aged child (6-11 years). Parents were recruited from primary care clinics affiliated with an academic medical center and community organizations in central Ohio. Focus group discussion questions were developed using two theoretical frameworks, including the Health Belief Model, to assess parent's desire and preferred approach to discussing CVD risk with their PCC. Focus groups were analyzed using thematic analysis to determine communication preferences.

Results: Forty-four parents (n = 40 female; median age 32 [range 24- 57] years) participated in the focus group discussions. Six major themes were identified including: 1) The desire to change health behaviors can be triggered by the recognition of risk factors, which can be highlighted by PCCs; 2) PCCs facilitate lifestyle behavior change by working with patients to develop a plan; and 3) Early communication about CVD risk factors is desired and expected, to prevent the onset of CVD. Other themes discussed the importance of the PCC-patient relationship along with facilitators and barriers to change.

Conclusions: Medicaid-enrolled Black parents indicated their desire for PCCs to discuss their personal CVD risk factors with them. This study highlights the importance of patient-provider communication when discussing CVD risk and risk factors.

Background: This qualitative study explored and assessed the relevance and usability of the Saving Mothers mPOWHER Mom's Kit to meet Black pregnant women's needs for information and knowledge of maternal health risks, building communication skills, and empowerment.

Methods: The study consisted of 24 in-depth interviews with women who had received and used the Kit.

Findings: The Kit was very well-received, with women appreciating the overall value of the tools and information. The blood pressure cuff and Fitbit were particularly valued for their role in the women's daily health monitoring. In many cases women were able to report specific blood pressure readings to their provider. Most of the women had gaps in their knowledge of the specific risks associated with, for example, high blood pressure. When asked about possible new tools for the Mom's Kit, women suggested two areas of improvement: 1) mental health/postpartum, and 2) a place/journal for personal reflection/inspiration and aspirations.

Interpretation: The mPOWHER Mom's Kit shows much promise in meeting the needs of Black pregnant women in the areas of maternal health literacy, provider communication, and empowerment. Limitations include that only English-speaking women were interviewed. Future iterations of the Kit will include additional resources on mental health and self-care, developed through a collaborative process with the target community. Overall, the findings provided Saving Mothers with clear and actionable next steps for refinements and enhancements of the mPOWHER Kit.

Background: Allostatic load (AL) reflects the cumulative dysregulation of physiological systems due to repeated stress responses. Early life exposure to adversity can increase AL, causing premature aging and heightened mortality risks, especially among Black adolescents. AL has potential to be a useful proxy measure of health risk. However, for it to be used in racially-diverse populations, measures of AL must be invariant across racial groups, particularly when comparisons are being made between the groups.

Purpose: This exploratory study examines whether AL displays properties of measurement invariance across Black and White adolescents.

Methods: We used a nationally representative sample drawn from the National Health and Nutrition Examination Survey dataset to establish the optimal model for this sample. We then tested for measurement invariance by conducting a multigroup model.

Results: The construct of AL displayed weak factorial invariance, such that the same biomarkers indexed AL for both groups (Likelihood Ratio Test: (χ²(3) = 7.02, p = .071). AL did not display strong factorial invariance, suggesting that mean comparisons are not valid between these two groups.

Conclusion: These initial results underscore the importance of testing assumptions about measurement invariance before comparing levels of AL between Black and White adolescents. Research assessing AL during adolescence may help clarify researchers' and clinicians' understanding of the interplay between early life adversity, puberty, and stress-related biomarkers that contribute to AL. This construct may facilitate more effective identification and prediction of adolescents' disease risk, but it remains critical to first establish how to accurately model and apply AL in racially-diverse populations.

Introduction: Substance use, such as alcohol and tobacco, is notably greater among tribal populations than among the general population, with their distinct socioeconomic and cultural factors influencing their substance use. Owing to their severe socioeconomic marginalization, the Koraga tribe, which is classified as a particularly vulnerable tribal group (PVTG), is reported to have a high prevalence of substance use. However, there have been no systematic efforts to document the extent of SUD within this community, mainly due to the challenges in establishing contact with them. This study aims to address this gap by conducting a household survey to systematically assess the prevalence of SUD among this tribal population.

Methodology: A cross-sectional population-based household survey was conducted among four taluks of the Udupi district, Karnataka, India. Twelve tribal hamlets from the four taluks were identified, and all the households in those colonies were visited for data collection. All the adults from each household were eligible, and 401 participated in the study. The modified BG Prasad scale; the alcohol, smoking, and substance involvement screening test (ASSIST); and the Patient Health Questionnaire screening tools were used for data collection. The data were analyzed via JAMOVI 2.6.19.

Results: Thirteen percent of the participants had used alcohol in their lifetime. Similarly, 16.7% of the participants used tobacco, and 5.2% used both substances. An increase in age, being male, and having a lower socioeconomic status increased the risk of substance use among the study population. Among all the participants, 2% were screened positive for moderate depressive symptoms, and 1.7% were screened positive for severe depressive symptoms. In addition, 1.2% reported having moderate anxiety symptoms, and 2.5% reported having medium levels of somatic symptoms.

Conclusion: Culturally sensitive and community-led documentation may provide a more accurate account of the level of substance use among this tribal population.

Objectives: Middle-aged Black adults occupy a distinct generational position, having come of age during the legal desegregation of healthcare facilities, yet continuing to face persistent disparities in treatment and access. Despite growing evidence, limited research explores how intersectional factors such as age, income, and education influence perceived discrimination and medical mistrust in this population. This exploratory mixed-methods study aimed to: (1) examine the relationship between intersectional factors and medical mistrust, (2) identify between-group differences, and (3) qualitatively explore how perceived discrimination influences mistrust.

Methods: Black/African-American participants (n = 21; mean age = 51.9, SD = 6.96), predominantly female (85.7%), completed the Group-Based Medical Mistrust Survey (GBMMS). Semi-structured interviews were conducted to explore perceived discrimination. Quantitative analyses included descriptive statistics, correlations, and one-way ANOVA using SPSS V.29. Qualitative data were analyzed inductively to identify common themes.

Results: The mean GBMMS score was 3.41 (SD = 0.74). No significant correlations were found between intersectional factors and overall mistrust. However, income indicated significant between-group differences among two GBMMS subscales: Suspicion and Lack of Support from Providers. Five themes emerged from interviews, highlighting the nuanced role of discrimination in shaping mistrust. Although due to the small sample size, the findings are preliminary.

Conclusion: These results suggest income may influence specific dimensions of medical mistrust among middle-aged Black adults. Qualitative insights emphasize the complex relationship between discrimination and mistrust, underscoring the need for community-engaged research. Future studies should expand sample sizes and prioritize culturally responsive approaches to address mistrust and improve healthcare experiences.

Objective: To compare the variability of metabolic parameters in the development of obesity, as determined by BMI, in adult indigenous and Caucasian residents living in the territories of the Russian Arctic and having a sedentary lifestyle.

Methods: BMI was used to identify respondents with normal weight, overweight, and obesity. The insulin content and metabolic parameters, including fatty acids (FA), were determined, and HOMA-IR was calculated.

Results: The progression of obesity was accompanied by an augmentation in triglyceride (TG) concentrations, an increase in FA levels. In women, the level of high-density lipoprotein cholesterol (HDL-C) decreased. Concurrently, an escalation in glucose levels was observed among Caucasian women, while Caucasian men exhibited an increase in low-density lipoprotein cholesterol. A rise in insulin levels and HOMA-IR was also observed, with this rise being more pronounced among Caucasian subjects. Conversely, indigenous women exhibited lower levels of FAs, TG, and glucose compared to their Caucasian counterparts. Among the male population, Caucasian men have higher levels of HDL-C.

Conclusions: Overweight and obesity are prevalent among the population of the Russian Arctic, irrespective of ethnicity. However, a notable exception is observed among indigenous men, who exhibit a lower prevalence of obesity (13.6%). In both ethnic groups, obesity was associated with cardiometabolic risk factors, particularly among female subjects. However, the metabolic consequences of obesity in the indigenous population were comparatively less pronounced than in the Caucasian population. Furthermore, selective insulin resistance may be present in indigenous populations, particularly in the context of lower glucose and FAs levels.

Background: Exhaustive evidence about the impact of racial disparities in oncological outcomes after a negative prostate biopsy is still lacking. We explored the relationship between race and long-term oncological risk among men with an initial negative prostate biopsy using a contemporary U.S.

Cohort:

Methods: Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) men who had a negative prostate biopsy at Henry Ford Health between 1995-2023 were included. An Area Deprivation Index (ADI)-score was assigned to each patient based on their residential census-block group. The higher the ADI, the more the area has a socio-economic disadvantage. Competing-risk methods were used to estimate the cumulative incidence of any PCa diagnosis, clinically significant PCa diagnosis, receipt of active treatment, Prostate Cancer Specific Mortality (PCSM) and Other Cause Mortality (OCM) for the entire cohort of patients, after stratification according to race. Fine-Gray regression models tested the impact of race on the aforementioned outcomes.

Results: We included 17,446 men, 5,729 (30.3%) of whom were NHB. Within a median follow-up time of 7.8 years, the 15-years estimated rates of any PCa diagnosis, clinically significant PCa, active treatment and PCSM were 15.9% vs. 9.5%, 10.7% vs. 6.4%, 10.4% vs. 6.4% and 2.4% vs. 1.3%, for NHB versus NHW patients, respectively (all p-value < 0.0001). At multivariable analysis, NHB men had significantly higher hazard of any PCa (HR:1.90), clinically significant PCa (HR:1.91), active treatment for PCa (HR:1.84) and PCSM (HR:1.89) (all p < 0.001).

Conclusions: NHB men, even after an initial negative prostate biopsy, face a higher risk of subsequent any PCa, clinically significant disease, active treatment and PCSM. Overall, these findings underscore the multifaceted impact of racial disparities on PCa prognosis.