Journal of Racial and Ethnic Health Disparities最新文献

Black Americans residing in rural communities are often excluded from clinical trials for hypertension, despite having a high prevalence of the disease and frequent complications. This report describes our research team's experience to support recruitment and retention of rural Black patients with uncontrolled hypertension in the southeastern United States in a cluster-randomized clinical trial. While the focus of this report is on enrollment and engagement, the strategies employed were grounded in long-standing community-engaged research efforts and guided by principles of trust-building, transparency, and shared leadership. We share the challenges encountered and reflect on lessons learned to inform future approaches that authentically engage historically excluded and under-represented communities as active partners in research.

The scientific literature continues to recognize the changing health status of migrants residing in geographic destinations outside their homeland. However, very little research has compared the health of Caribbean residents within their homeland with those across various diasporic destinations. This five-country study examined the physical and mental health of Caribbeans within the region and those in host countries, and whether the length of time in host countries is associated with declining health. We analyzed population-based data collected in Jamaica (2005), Guyana (2005), Canada (2000/2001, 2003, and 2005), the United States (2001-2003), and England (1998-2000). Parallel descriptive statistics and multivariate logistic regression were used to assess the health status of first-generation Caribbeans. The study revealed that Caribbean people within the region generally maintained a higher degree of health advantage compared to Caribbean migrants in North America and England. Length of time was associated with physical and mental health problems within certain host countries. Sociodemographic factors contribute to health. The findings suggest that first-generation Caribbeans might initially lose certain health benefits in host countries, although we find trends for improved cardiovascular health over time in Canada. Further exploration of other influences on health among Caribbeans across the diaspora is needed.

Background: Suicide is an increasing public health crisis, especially impacting older adults and racial/ethnic minority groups. The aim of this study was to investigate risk and protective factors for suicidal ideation among Asian American adults by age, as well as differences in suicidal ideation and health care needs across age and subethnic groups.

Design: This cross-sectional study used data from the 2021-2022 California Health Interview Survey and included adults aged 18 and older who self-identified as Asian. Measured variables included age, sex, subethnicity (Chinese, Korean, Japanese, Vietnamese, Filipino, South Asian, Southeast Asian, Other Asian), suicide risk factors, mental health care barriers, and protective social environment indicators. Suicidal ideation and behavioral healthcare needs (i.e., for mental illness or substance use) were the outcomes of interest.

Results: Of 7240 participants, the largest subgroups were Chinese and Filipino respondents. Older adults reported lower levels of suicide ideation and behavioral healthcare needs compared to the younger age group. Among Asian subethnic groups, Other Asian and Korean Americans reported the highest levels of suicidal ideation (23.1% and 20.7%) and behavioral healthcare needs (20.5% and 18.4%). Healthcare discrimination was uniquely associated with suicidal ideation among older Asian adults (PR 4.19, p < .001). Other risk factors included a history of intimate partner violence, household mental health history, psychological distress, chronic pain, and healthcare costs.

Conclusions and relevance: Findings identified significant age and subethnic differences in suicidal ideation. Despite having a lower overall risk, older Asian adults remain susceptible to healthcare discrimination and ongoing mental distress that elevates their risk for suicidality.

Introduction: Social determinants of health are gaining prominence in pain research. This study measured the association between residing in disadvantaged neighborhoods in the United States and using opioids for chronic low back pain.

Methods: This retrospective cohort study included patients from a national pain research registry from April 2016 through August 2024. Patients were classified using quintile rankings for disadvantaged neighborhoods based on the Area Deprivation Index (ADI). Frequency of opioid use was measured at quarterly intervals for 12 months. Multivariable analysis adjusted for patient-level demographic, behavioral, psychological, and clinical characteristics.

Results: The mean (SD) age of 1757 patients was 53.1 (13.1) years, and 1298 (73.9%) were female. The 7738 patient encounters initially demonstrated a dose-response with higher ADI quintiles associated with more frequent opioid use. In multivariable analysis, ADI quintiles were no longer associated with frequency of opioid use. Non-White patients used opioids more often than White patients (OR, 1.38; 95% CI, 1.09-1.75), whereas Hispanic patients used opioids less often than non-Hispanic patients (OR, 0.66; 95% CI, 0.47-0.93). Similarly, when compared with non-Hispanic White referents, Black patients used opioids more often (OR, 1.53; 95% CI, 1.18-1.97) and Hispanic patients used opioids less often (OR, 0.68; 95% CI, 0.47-0.97).

Conclusions: The association of ADI quintile with frequency of opioid use was obviated after controlling for patient-level characteristics. Black and Hispanic patients reported divergent frequencies of opioid use. Policymakers, administrators, researchers, and clinicians should exercise caution when extrapolating results based on aggregate measures of social determinants of health to individual patients.

Background: Multiracial adults represent a growing U.S. population but are often grouped together or reassigned to single-race categories in public health research, when they are included in analysis at all. Aggregation obscures subgroup variation and limits opportunities for targeted prevention.

Methods: We analyzed 2014-2023 California Behavioral Risk Factor Surveillance System data (n = 100,177) to estimate prevalence of 28 chronic disease and aging-related risk factors across racial and ethnic groups, including disaggregated Multiracial subgroups. We classified participants based on all self-identified races, limited aggregatation to subgroups with N < 50, and standardized prevalence by age and sex using 2020 California population distributions. Survey-weighted methods produced prevalence estimates, relative standard errors, and subgroup comparisons.

Results: Multiracial subgroups had the highest prevalence for 24 of 28 outcomes. Prevalence differences across Multiracial subgroups also exceeded 20 percentage points for nearly half of all outcomes. American Indian or Alaska Native-Black and Hispanic-Black-White adults showed the greatest burden of chronic disease, poor general health, and disability in the sample. In contrast, while several Asian Multiracial subgroups (e.g., Asian-Black, Asian-Native Hawaiian or Pacific Islander) had the lowest prevalence across multiple domains, Asian-White adults were not consistently the healthiest Multiracial subgroup.

Discussion: Health outcomes for Multiracial adults do not follow a fixed hierarchy; subgroup position varies across domains. Wide variation is masked by common aggregation practices, leading to missed opportunities to identify and support high-burden subgroups. Surveillance systems should expand capacity to collect and report disaggregated race and ethnicity data to strengthen prevention efforts.

Introduction: Racial segregation is a recognized cause of racial health disparities. One factor that has contributed to racial segregation is municipal zoning policies that exclude people of color and those of low income from advantaged residential neighborhoods. Few studies have explicitly explored the relationship between zoning policies and health. Using data on zoning policies in Chicago in 1923 and 2012, we examined inequities in life expectancy across census tracts in relation to the proportion of land in each tract zoned for specific purposes.

Methods: For each Chicago census tract, we obtained data on historical and current zoning policies and current health outcomes and life expectancy. Using regression analysis and structural equation modeling, we examined the relationship between zoning policies and life expectancy and possible mediators of this relationship.

Results: Life expectancy across 694 census tracts in Chicago varied from a low of 59.9 years to a high of 90.0 years. The greatest predictor of differences in life expectancy across census tracts was the degree of racialized economic advantage. Zoning policies in both 1923 and 2012 were significantly related to life expectancy, and this relationship was mediated by differences in racialized economic advantage. The structural equation model had a root mean square error of approximation of 0.064, a Tucker-Lewis index of 0.960, a confirmatory fit index of 0.973, and a standardized root mean square residual of 0.048.

Conclusion: Zoning policy is significantly related to life expectancy, a relationship mediated by racialized economic advantage. Both past and modern-day exclusionary zoning policies appear to be associated with current health outcomes. These findings suggest that zoning reform could be one possible mechanism for redress if it gives specific attention to decreasing concentrated advantage and creating opportunities for Black households to build wealth.

Background: Black cisgender women are disproportionately affected by HIV, yet have a low uptake of pre-exposure prophylaxis (PrEP). Barriers to HIV prevention exist on the individual, provider, and system level. This qualitative study aimed to explore factors associated with accessing culturally-appropriate PrEP educational materials and advertisements and receiving PrEP information from providers for Black women.

Methods: Focus groups were conducted at three federally qualified health centers in Illinois, Florida, and North Carolina with Black female patients from August 2022 to February 2023. Women were asked about their awareness and knowledge of PrEP, thoughts on patient-facing PrEP materials, and ideas for improving PrEP uptake among Black women. Transcripts were analyzed thematically using the Stanford Lightning Report Method.

Results: Twenty-five women participated across nine focus groups. Barriers and facilitators to patient education to increase PrEP uptake among Black women were identified across the individual, provider, and system level. Barriers included low awareness and knowledge of PrEP, inaccurate self-perceived risk of HIV, and stigma and medical mistrust. Facilitators included positive attitudes toward PrEP, better representation in educational materials and advertisements, improved provider-patient relationship, and additional support via mental wellness resources and community (social networks).

Conclusions: Women reported minimal representation and knowledge regarding PrEP, yet demonstrated high interest in learning more about PrEP and sharing that information with others. Black women must be featured prominently in mainstream PrEP advertisements and PrEP educational materials and included by providers in discussions about PrEP. Increasing funding and support for these efforts will be instrumental to promote PrEP uptake among Black women and to reduce HIV transmission within this population.

Introduction: In this article, we aim to study the effects of racial disparities on inpatient cardiac arrest (IPCA) outcomes in the USA.

Methods: We have utilized the 2021 National Inpatient Sample, an all-payer inpatient database based in the USA, to identify IPCA nationwide. Multivariate linear and logistic regressions were performed to study the effects of racial and socioeconomic disparities on IPCA. The primary outcome was inpatient mortality, and secondary outcomes were length of stay (LOS), total hospital charges (THC), discharge to subacute rehab, and rates of advanced cardiac interventions. We have additionally performed subgroup analysis looking into healthcare utilization based on mortality in the predefined races.

Results: We identified 177,645 IPCAs, with 133,995 (75.4%) resulting in inpatient mortality. Using the White population as a reference, the Hispanic population had the highest rates of inpatient mortality, with an adjusted odds ratio (aOR) of 1.57 (CI 1.43-1.72), followed by the unassigned races, aOR of 1.31 (CI 1.17-1.47), the Black population with an aOR of 1.24 (CI 1.16-1.33), and the Asian population with an aOR of 1.16 (CI 1.01-1.33). Among the secondary outcomes tested, the Black population had the highest LOS, and the Hispanic patients had the highest THC.

Conclusions: We underscore the potential effects of racial disparities on IPCA outcomes. Further studies should be directed towards narrowing the disparity gaps and providing equal care in IPCA among different races and social classes.