Journal of Racial and Ethnic Health Disparities最新文献

Background: Since January 2020, COVID-19 has affected more than 100 million people in the U.S. Previous studies on racial and ethnic disparities related to characteristics and outcomes of COVID-19 patients have been insightful. However, appropriate epidemiologic age-standardization of the disease burden and disparities for hospitalization data are lacking.

Objective: To identify and describe racial and ethnic disparities for primary COVID-19 hospitalizations in the U.S. in 2020.

Methods: In this nationally representative observational study, we use the National Inpatient Sample to quantify racial and ethnic disparities in COVID-19 hospitalizations. Descriptive statistics for patient characteristics, common comorbidities, age-standardized hospitalization rates, inpatient complications, and mortality among COVID-19 hospitalizations were contrasted by race and ethnicity.

Results: There were 1,058,815 primary COVID-19 hospitalizations in 2020. Of those, 47.2% were female, with median age of 66 (IQR, 54, 77). Overall inpatient mortality rate was 11.1%. When compared to White patients, Black, Hispanic, and Native American patients had higher age-standardized hospitalization rate ratios of 2.42 (95% CI 2.40-2.43), 2.26 (2.25-2.28), and 2.51 (2.46-2.56), respectively. Non-White patients had increased age-adjusted rates for procedures and complications. Factors associated with inpatient mortality include age, male sex, Hispanic or Native American race or ethnicity, lower income, Medicaid, heart failure, arrhythmias, coagulopathy, and chronic liver disease.

Conclusions: Marginalized populations in the U.S. had over twice the COVID-19 hospitalization rate relative to White patients. Age-adjusted mortality rates were highest for Black, Hispanic, and Native American patients. Careful consideration for vulnerable populations is encouraged during highly communicable respiratory pandemics.

Background: While several reports confirm that long COVID is associated with poorer health, few studies explore how long COVID directly impacts the lives of Black Americans who experienced higher mortality rates early in the pandemic. Even fewer studies utilize both quantitative and qualitative methods to identify pertinent long COVID symptoms. The current study, therefore, sought to identify points of overlap and divergence when comparing qualitative vs. quantitative descriptions of long COVID experiences among Black adults in the United States.

Methods: We analyzed cross-sectional surveys collected from the AmeriSpeak panel through the National Opinion Research Center (NORC) at the University of Chicago. This panel includes a probability-based sample of adults across the United States. Respondents completed online surveys between April and June 2022. We compared outcomes among participants who reported experiencing post-acute sequelae of COVID-19 (i.e., long COVID) to those who reported experiencing SARS-CoV-2 without long COVID.

Results: Nearly all qualitative responses focused on matters of physical health like prolonged coughing, cardiovascular concerns, troubled breathing, fatigue, headaches, memory loss, and bodily pains. Quantitative results, however, showed that Black adults living with long COVID reported significantly more anxiety, depressive symptoms, and hopelessness. Persons with long COVID were also significantly more likely to report experiencing psychosis, suicidal ideation, suicide plans, and suicide attempts within the last year.

Conclusions: Black adults with long COVID experienced worse outcomes across all mental health measures. Despite the COVID-19 Public Health Emergency expiration in May 2023, urgent efforts are still required to not only treat both the physical and mental health needs of persons living with long COVID, but to effectively prevent the spread and transmission of COVID-19.

Primary liver cancer, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma was the sixth leading cause of cancer death in the United States in 2023. Hispanic people constitute approximately 19% of the nation's total population according to the US Census. Hispanic patients have the highest relative incidence rates of liver cancer compared to non-Hispanic Whites and non-Hispanic Blacks, a disparity frequently overlooked in cancer research. In this study, our primary objective was to analyze the potential underrepresentation of Hispanic individuals in liver cancer research databases. We identified databases that had liver cancer-specific studies and be population-based in the United States. Our search yielded 7 cancer genomic databases, which were analyzed according to incidence percentages across ethnicity and race categories. Our study included 3104 patients; ethnic data was not reported for 13.1% (n = 406) of the patients. Samples were predominantly from individuals who identified as Not Hispanic (81.0%), Hispanic individuals represented 5.9%. Race was reported as follows: non-Hispanic Whites (61.0%), Asians (22.0%), non-Hispanic Blacks (5.4%), Other (3.1%), Native American/American Indian/Alaska Native (0.4%), Pacific Islander/Native Hawaiian (0.2%) and not reported (7.9%). These findings collectively underscore significant disparities in the representation of ethnic and racial groups, particularly Hispanics. Given the present racial and ethnic demographics of the US population and the projected surge in the Hispanic population in forthcoming years, it becomes imperative to address health disparities that may worsen without efforts to enhance proper inclusion in cancer research.

Objective: The primary objective of this cross-sectional study is to investigate the association between vitamin D deficiency (VDD) and diabetes and see if this association is the same for adult (age ≥ 20) African Americans (AAs) and Whites. The secondary objective is to examine the distribution of the 25-hydroxyvitamin D test among AAs and Whites and to evaluate the appropriateness of using the same cut-off point for both groups to diagnose VDD.

Methods: Our analysis is based on the 2011-2014 National Health and Nutrition Examination Surveys (NHANES). We used two common propensity score adjustment methods to analyze the data-propensity score matching (PSM) and the inverse probability of treatment weighting (IPTW).

Results: The prevalence of diabetes for AAs and Whites was 12.27% (95% CI, 10.47-14.07%) and 7.24% (95% CI, 6.35-8.13%), respectively. The prevalence of VDD for AAs and Whites was 65.29% (95% CI, 62.01-68.58%) and 19.49% (95% CI, 16.53-22.45%), respectively. Under PSM, the odds ratios for the diabetes-VDD association for AAs and Whites were 0.94 (95% CI, 0.70-1.27) and 2.16 (95% CI, 1.49-3.13), respectively. Under IPTW, the VDD-diabetes odds ratios for AAs and Whites were 0.83 (95% CI, 0.64-1.10) and 2.35 (95% CI, 1.67-3.30), respectively. Our results further demonstrate that the 25-hydroxyvitamin D measurements are significantly different for AAs and Whites across the general population, as well as the vitamin D-sufficient and vitamin D-deficient populations.

Conclusion: The prevalence of VDD and diabetes was higher for AAs compared to Whites. However, VDD was associated with increased diabetes risk for Whites but not for AAs. Though more research is needed to explain why this is the case, a reason for this may be that the 25-hydroxyvitamin D test or its associated cut-off point for defining VDD may not accurately reflect the vitamin D status among AAs.

Background: Structural racism is associated with alcohol and tobacco use among Black Americans. There is a need to understand how this relationship differs within varying groups of Black Americans. This study assessed the moderating roles of age, gender, and income in the association between structural racism and binge alcohol consumption and tobacco smoking status among Black Americans.

Methods: A state-level index of structural racism was merged with data from a national probability sample of 1946 Black Americans. Hierarchical linear and logistic regression models tested associations between structural racism (measured by residential segregation, and economic, incarceration, and educational inequities) and binge alcohol use and smoking status among Black Americans by stratified by age, gender, and income. Moderating effects of age, gender, and income were tested using slope estimate comparisons.

Results: Results indicated statistically significant positive associations between incarceration disparities and binge drinking and smoking status among Black Americans below age 65. An inverse association was detected between education disparities and smoking status among Black Americans below age 65 and among higher-income Black Americans. Age, gender, and income were not significant moderators of these associations.

Conclusions: Age, gender, and income do not moderate the association between state-level structural racism and binge alcohol or tobacco use behaviors among the current sample of Black Americans.

Impact: Addressing structural racism may have implications for reducing participation in binge drinking and tobacco use behaviors among Black Americans, regardless of their age, gender, or income. This has implications for healthy equity and cancer prevention and control.

Objective: The objective of this study was to characterize and compare national estimates of mental healthcare use among White and Asian American groups to provide an update using post Affordable Care Act data.

Methods: We analyzed yearly cross-sectional data from the 2013-2019 Medical Expenditure Panel Survey, including White (n = 112,590) and Asian American (n = 10,210) individuals, and examined rates of mental healthcare use for Asian (overall), Asian Indian, Chinese, Filipino, and Other Asian individuals relative to White individuals. Using multivariable logistic regression models and predictive margin methods, we estimated overall Asian disparities and Asian subgroup disparities compared to White group rates in mental health care (outpatient, specialty, psychotropic medication) among adults with and without elevated risk for mental illness. Regression models were adjusted for variables related to need for treatment, demographic, and socioeconomic status variables.

Results: Asian individuals had lower rates of mental healthcare use than White individuals. Unadjusted results and adjusted regression model predictions are consistent in identifying wide disparities in mental health care treatment across risk for mental illness, Asian subgroups, and types of treatment.

Conclusions: Asian Americans have significantly lower rates of mental healthcare use than White Americans, even among those with elevated risk for mental illness. There is small variation by Asian subgroups but disparities persist across subgroups and types of treatment. Our results imply interventions are needed to improve linguistically, culturally, and ethnically tailored outreach and engagement in treatment services, as well as examining treatment and its effectiveness for Asian American individuals living with psychological distress.

Introduction: Canada's Black population has more than doubled over the last two decades, with the fastest growth occurring in the Prairie provinces of Manitoba, Saskatchewan, and Alberta. Despite a growing interest in Black health research in Canada, there is still limited knowledge on culturally responsive approaches to collecting, analyzing, and reporting health data on Black Canadians. This review presents a synthesis of challenges and strategies for conducting culturally responsive health research in Black communities.

Methods: Guided by Arksey and O'Malley's framework [1], this scoping review addresses the questions: What cultural considerations inform health data collection methods with Black Canadians on the Prairies? What gaps exist in current use of culturally appropriate approaches to health research with this population? We systematically searched selected electronic databases-Sociological Abstracts, PsychINFO, Embase, Social Science Citation Index, Social Services Abstract, Social Work Abstracts, CINAHL, Scopus, Medline, Cochrane Library, Proquest, and Web of Science-for studies on Black health in Manitoba, Saskatchewan, and Alberta. We completed a citation chaining of selected studies, searched thesis repositories, and consulted Black health researchers on the Prairies. Using our inclusion criteria, we screened 453 records and selected 27 articles for the review.

Results: Most of the included articles described research conducted in Alberta (77.7%) and between 2015 and 2022 (74.1%). We identified four themes relevant to culturally responsive approaches to Black health research: use of theory in research design; research leadership; research participation, uptake, and community engagement; and data collection procedures.

Conclusions: Black leadership, critical representation on project teams, and partnerships with community gatekeepers can improve trust, acceptability, and research uptake. Cultural considerations in Black health research include attending to gender, age, and religion in data collection. There is also a need to reform research practices and guidelines to attend to the social, cultural, and religious needs of Black Canadians.

Introduction

Pregnancy-related health in the USA fares worse than similarly resourced countries and the gap continues to widen. This trend however is disproportionately experienced by women of color. We have come to understand that this is due to the systems and structures that perpetuate racism. Despite our awareness of this, the voices of the community impacted by these systems have been largely left out of research. The authors aimed to utilize participatory research methods within a qualitative design to ask Black pregnant and parenting women about their lived experiences of pregnancy and perinatal health services.

Methods

Over three focus groups, the authors gathered information from 12 participants. Participants were Black women currently pregnant or pregnant in the last year, ages 22–37 years old. Participants shared their experiences and views on racial disparities within perinatal health care. Our analytic goal was to explore the questions: “What are Black women talking about in relation to perinatal health”; “Where do Black women get information about perinatal health disparities?”; and “How do Black women feel when they hear or talk about perinatal health risks?”.

Results

In general, participants felt that the burden to understand their pregnancy risks and options was theirs alone to carry. This resulted in their utilization of and reliance on the internet, social supports, and holistic providers such as doulas for information about how to reduce their risk for maternal morbidity and mortality.

Discussion

Results demonstrate patients’ receptivity to frank conversation about perinatal health disparities, and their willingness to partner with their providers to reduce risks in pregnancy. While interventions to reduce perinatal health risks must be systemic, they cannot move forward without including the voices of and partnering with the community they hope to positively impact.

There is a growing recognition that Social Determinants of Health (SDoH) can inform some sources of physical and mental health disparities among the Latinx population. The current study sought to expand previous research by exploring the singular and interactive influence of financial strain and subjective social status—two common and clinically important SDoH factors—on pain intensity, pain disability, general depression, social anxiety, and anxious arousal. The current sample consisted of 155 Latinx adults (81.3% female; M_age = 40.02 years, SD = 10.61) presenting for care at a Federally Qualified Health Center (FQHC). Multivariate results demonstrated that financial strain was statistically significantly associated with greater pain intensity, pain disability, general depression, and anxious arousal, but not social anxiety. Further, lower subjective social status was related to greater general depression, social anxiety, and anxious arousal but not with higher levels of pain indices. An interactive effect was found wherein the combination of higher levels of financial strain and low levels of subjective social status was related to general depression and anxious arousal. This is the first study to empirically evaluate the main and interactive effects of financial strain and subjective social status regarding numerous physical and mental health symptoms. These findings clarify how two prevalent SDoH factors influence health outcomes. Specifically, the results suggest that a multi-risk conceptualization can advance a fine-grained understanding of Latinx health disparities by showing differential associations between SDoH factors and clinical outcomes that are frequently the source of health inequities in the Latinx population.