Journal of Racial and Ethnic Health Disparities最新文献

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.

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.

Background: Non‑Hispanic Black patients have higher non‑elective cesarean rates than Whites, but it is unclear how much of this gap is due to observable patient and hospital factors versus unmeasured structural influences.

Methods: We analyzed 160,122 patients who were either Non-Hispanic Black or White using New York State Statewide Planning and Research Cooperative System (SPARCS) files for New York City and Long Island for the years 2018-2022. Racial group characteristics were compared using chi-square tests and the Oaxaca Blinder decomposition method was employed to decompose the racial disparity in cesarean surgery into explained and unexplained components.

Results: Cesarean rates were 37.8 % for Non-Hispanic Black patients and 27.8 % for White patients (difference = -10.0 percentage points, p = 0.001). A small percentage of hospitals accounted for the majority of Black deliveries: 10 of the 51 hospitals accounted for 51.3 % of all Black births. Furthermore, 29.3 % of all Black deliveries occurred in facilities where White deliveries comprised <1 %. Observable factors explained only 7% (+ 0.77 percentage points; p = 0.71) of the overall gap, whereas unexplained effects accounted for 107% (-10.73; p < 0.001). Hospitals alone accounted for 40 % of the unexplained component, suggesting differential treatment within hospital driving a large share of the observed disparity in cesarian rates.

Conclusions: Differential treatment by hospitals contributed almost half of the total Black/White disparity in non-elective cesarean deliveries. Interventions that standardize practice and distribute resources equitably across hospitals are essential to help close this gap.

This study analyzed the temporal trends in nutritional status markers (2008 to 2023) and food consumption markers (2015 to 2023) in riverside communities in Brazil using data from the Food and Nutrition Surveillance System (SISVAN). This is a time series study, based on secondary data available on the SISVAN online platform, concerning the period from 2008 to 2023 for anthropometry and from 2015 to 2023 for food consumption, using the Brazilian riverside population as the analysed community. The Prais-Winsten regression model was used for the analysis, with p-value < 0.05 considered significant. An increase in anthropometry records was registered, as well as reductions in low height for age in children and adolescents, thinness in children aged 5 to 9 years, and being underweight in adults and the elderly. There was an increase in being overweight among adolescents and the elderly, and obesity among adults and the elderly. The consumption of beans, greens and vegetables increased among adults, and with greens and vegetables among the elderly. There was an increase in the consumption of hamburgers and sausages among children aged 5 to 9 years. The evidence from this study demonstrated that SISVAN is an important tool for monitoring the health of the population. Despite the decrease in malnutrition indicators, there was an increase in obesity in some age groups. Factors such as climate change, deforestation, and weak public policies have impacted the traditional dietary practices of riverside dwellers.

Background: Black women in the United States face maternal mortality rates three to four times higher than their White counterparts despite advancements in obstetric care. Structural racism, gendered stereotypes, psychosocial stressors, and intersecting oppressions amplify the risk of adverse maternal health outcomes. This is part of a broader " dual burden" or stigma of being both Black and a woman. To further explain this dual burden, this study introduces the concept of "Black Tears" as an analytical framework that synthesizes the intersecting crises shaping Black maternal health.

Objectives: This qualitative study examines how psychosocial stressors, and institutional inequities intersect to shape Black maternal experiences.

Design: This study employed an interpretive (hermeneutic) phenomenological approach to explore the lived experiences of Black mothers.

Methods: Five Black and one Black Hispanic woman (aged 18-32) who had given birth in Kansas or Missouri participated in in-depth semi-structured interviews. Guided by an integrated framework of Critical Race Theory (CRT), the SBW schema, and interpretive phenomenology, transcripts were analyzed to uncover the essential themes of their maternal healthcare encounters.

Results: Three interrelated themes emerged: [1] the invalidation of embodied knowledge: dismissal of pain and concerns [2], the performance of strength: suppressing vulnerability to be heard, and [3] the weight of systemic bias: navigating a hostile environment. These findings reveal the persistent "tears" of Black women's maternal health concerns and the normalization of their suffering within medical contexts.

Conclusion: Black women's maternal experiences are shaped by historical inequities, racialized stereotypes, and institutional neglect. The endorsement of the SBW stereotype has been shown to lead to coping strategies like "identity shifting," where Black women alter their behaviors to mitigate discrimination. Culturally responsive care models, provider training, and policy reforms centered on Black maternal voices are urgently needed to disrupt systemic harms.