Journal of Racial and Ethnic Health Disparities最新文献

Background: American Indians have the highest mortality and hospitalizations from head injury of all US groups; however, little is known about prevalence, risk, or outcomes in this population.

Methods: The Strong Heart Study recruited American Indians representing 11 tribes and communities across three regions for two sequential examinations in 2010-2019. Participants were asked to self-report prior head injury, loss of consciousness (LOC), cause, sociodemographics, and behaviors (age, sex, education, bilingual, smoking, alcohol use, stroke). Cognitive testing covered executive function, phonemic fluency, processing speed, and memory. Analyses tabulated summaries and multivariate logistic regressions estimated risk associations.

Results: This older cohort of American Indians (visit 1 N = 818, follow-up visit 2 N = 403) was mean age 73 at intake, with mean 6.7 years between exams. At visit 1, 40% reported prior head injury, majority with LOC; 4-6% reported injury with LOC > 20 min. Incidence analysis estimated 3.5 cases per 100 person-years. Primary causes were falls, motor vehicles, sports, fight or assault, military (bullet, blast, fragment), and horse-riding incidents. Male sex and prior stroke were independently associated with higher risk, but age, education, bilingual, smoking, and alcohol use were not associated with risk. Those with previous head injury had significantly worse depressive symptoms, quality of life, fatigue, social functioning, pain, general health, and processing speed.

Conclusion: These findings suggest very high prevalence, incidence, and risk of head injury in older American Indians, with substantial impacts on quality of life and well-being. Future research should prospectively evaluate risk and prevention opportunities in this population.

Depression tends to be experienced across generations and among racial/ethnic groups through various pathways. However, little is known about racial/ethnic variations in the transmission of adolescent depression among different racial/ethnic groups. This study aims to investigate the intergenerational transmission of adolescent depression across three generations among White, Black, and Hispanic groups. Data were drawn from the Future of Families and Child Wellbeing Study. This study used a nationally representative sample of 2,604 individuals. A multi-group serial mediation analysis was conducted using structural equation modeling. As hypothesized, adolescent depression was transmitted across three generations, from the maternal side. Furthermore, the intergenerational transmission of depression was identified as a sequential transfer from one generation to the next, as opposed to exhibiting a generation-skipping effect. However, no statistically significant racial/ethnic variation was found in the pathways of intergenerational transmission of adolescent depression. In conclusion, depression is a mental disorder that can be transmitted from one generation to the next, and its transmission pathway is shared and similar across White, Black, and Hispanic groups. Regardless of racial/ethnic group, the intergenerational transmission process of depression can be halted with the implementation of appropriate interventions and treatment.

Background: Acknowledging patients' spiritual concerns can enhance well-being and is essential to patient-centered chronic illness care. However, unmet spiritual care needs remain a major area of suffering, particularly among under-resourced populations. Limited research exists on how spiritual concerns are acknowledged and integrated into the care of chronically ill older Black patients in these settings.

Purpose: This study aimed to explore the spiritual concerns and needs of chronically ill older Black patients from under-resourced areas and to identify available spiritual support resources for patients seeking healthcare through a community safety net health service.

Methods: Using a qualitative descriptive design, we interviewed 13 chronically ill, older Black patients and key clinicians (physicians, nurse practitioners, allied health, and clergy). The interview focused on patients' illness-related spiritual concerns, sources of distress, and desired spiritual support resources. Participants also reviewed the Spiritual Care and Assessment Intervention (SCAI), a spiritual care intervention, and provided feedback on its content, format, and delivery.

Results: Five themes emerged from qualitative interviews: (1) spirituality is integral to seriously ill Southern patients; (2) clinicians should strive to address spiritual health in encounters; (3) socioeconomic barriers and competing demands impact priority of accessing spiritual care services; (4) spiritual care interventions should be patient-driven, compassionate, and fully integrated into medical care as a comprehensive service; and (5) participants thought SCAI was appropriate for use but should be shortened and provided in-person to increase accessibility.

Discussion: Findings will inform the development and piloting of small-scale culturally responsive spiritual care intervention tailored for seriously ill older Black adults in an ambulatory care setting.

Purpose: Native Americans (NAs) have the highest prevalence of diabetes mellitus (DM) of any racial group in the USA and are therefore at higher risk for diabetic retinopathy (DR) and diabetic macular edema (DME). This study estimated the prevalence of DR and DME among NAs receiving eye exams at the Citizen Potawatomi Nation (CPN) clinic, a tribal clinic in Oklahoma serving members of multiple tribes, and characterized risk markers associated with the presence and severity of DR.

Methods: A retrospective chart review identified tribal members with DM who received dilated retinal fundus exams at the CPN clinic between 2021 and 2023. The presence and stage of DR and DME among participants were recorded. Hypotheses of association between the presence or severity of DR and medical and socioeconomic factors were tested.

Results: Among the 504 participants, the prevalence of DR was 19.4% (95% CI 16.1-23.2%), including 16.3% (95% CI 13.2-19.8%) with non-proliferative DR and 3.2% (95% CI 1.8-5.1%) with proliferative DR, and 3.4% (95% CI 2.0-5.4%) with DME. Nephropathy, longer duration of DM, higher HbA1c, insulin use, and Medicaid insurance were associated with the presence of DR (p < 0.05).

Conclusions: This study found a lower prevalence of DR than did earlier studies of NAs with DM. The mean HbA1c in this cohort was lower than in earlier studies, suggesting that diabetes management has improved. Several medical or socioeconomic factors were associated with the presence and severity of DR.

Patient-provider trust is associated with optimal HIV care engagement and ART adherence. However, cross-cultural examination of trust in providers in this diverse population is limited. The current study examines data from 1272 Miami-Dade County Ryan White Program clients. Study objectives were to explore the psychometric properties of the HCR Trust Scale-Revised translated in Haitian Creole and Spanish and to evaluate similarities and differences in responses to the HCR Trust Scale-Revised across Non-Hispanic Black, Haitian, and Hispanic participants and the English, Haitian Creole, and Spanish translations of the scale. Results indicated that the HCR Trust Scale-Revised has a single structure with good reliability for all groups except Haitian participants, for which response patterns were characterized by low variance and high endorsement of alternative response options. We draw on previous literature examining patient-provider experiences to discuss the importance of considering culture in the measurement of patient-provider trust.

Hidradenitis suppurativa (HS) is a debilitating and understudied inflammatory skin disease that disproportionately impacts Black Americans. The objective of this study was to explore the role that race and ethnicity may play in HS patients' perceptions of physician bias and their care quality. We administered a cross-sectional anonymous online survey to individuals with HS from June 13 to 30, 2021. Items from the Commonwealth Fund 2001 Health Care Quality Survey were employed to evaluate whether participants felt they were judged based on their race or ethnicity. Data was analyzed utilizing the test of equal or given proportions for assessing statistical significance with a threshold p-value < 0.05. The survey received a total of 1040 responses. The cohort was majority female and racially and ethnically diverse, with participants from six continents. Overall, 15.2% (136/894) of respondents reported feeling that they would receive better care if they were of a different race/ethnicity, and 13.6% (122/894) felt their primary HS provider treated them unfairly based on their race. Participants who belonged to minority groups more often reported feeling that they would receive better medical care if they were of a different race/ethnicity and felt that they were treated unfairly due to their race/ethnicity compared to White participants. These findings highlight the need to better understand the complex systemic and interpersonal factors at play in interactions between HS patients and healthcare providers to ensure that patients can receive much-needed care.

Background: Heightened anti-Arab/Middle Eastern and North African (MENA) xenophobia in the United States (US) coupled with the addition of a MENA category on the next US Census call into attention the health needs of this minoritized population. Targeted research is needed to better understand the factors that influence Arab/MENA American participation in US-based health research and health care.

Methods: A novel qualitative interview guide was constructed to better understand the health research experiences, health care experiences and needs of Arab/MENA patients nationally. Patients were recruited through the Arab American Health Network Alliance (AAHNA) community connections. Semi-structured interviews were conducted virtually in English and Arabic, and qualitative data was interpreted through iterative thematic analysis using inductive reasoning.

Results: A total of seventeen interviews (n = 17) were completed (14 in English, 3 in Arabic). Notably, the majority identified as female (82%) and have resided in the US for 18 years or longer (53%). Three main themes were identified (1) Individual-level Comfortability and Access to Research Participation, (2) Advancing Community Health Outcomes and Participation, and (3) Structural Barriers as Drivers of Health Disparities.

Conclusion: The health research and health care experiences explored in this project have the potential of informing future inquiries on Arab/MENA American health. For instance, we suggest building community trust, providing equitable compensation and support, increasing health workforce diversity, and advocating for affordable health care, all to improve Arab/MENA patient participation in health research.

Despite the fact that perceptions of racialized discrimination, health-related stigma, and pain-related injustice have been associated with worse patient functioning, little is known about their unique relationships in Black youth living with sickle cell disease (SCD). In this study, we (1) examined the prevalence of perceptions of racialized discrimination, perceptions of health-related stigma, and pain-related injustice appraisals and (2) investigated how the aforementioned variables were uniquely related to functioning (i.e., functional disability, depressive, and anxiety symptoms) in Black youth living with SCD. The study sample included 30 non-Hispanic Black or African American youth living with SCD (17 male, 13 female youths). The average age of the sample was approximately 11.3 years (SD = 2.73). Zero-order correlations and hierarchical regressions were used to examine and compare the multivariate relationships between perceived racialized discrimination, perceived health-related stigma, and perceived pain-related injustice and outcome variables (functional disability, anxiety symptoms, and depressive symptoms). For functional disability, perceived racialized discrimination and perceived pain-related injustice were significant predictors in the final model (F(3,26) = 11.00, p < .01). For depressive symptoms, health-related stigma trended toward significance (p = .09) as a predictor in the final model (F(2,26) = 6.69, p < .01). For anxiety symptoms, perceived pain-related injustice was the only significant predictor in the final model (F(3,26) = 10.25, p < .001). Results suggest that the youth living with SCD experience and perceive racialized discrimination, health-related stigma, and injustice surrounding their pain experience and these factors are associated with worse outcomes.

Aims: To investigate the impact of low socioeconomic status (SES) and/or membership in ethnic minority has on HbA1c before and during the COVID-19 lockdown.

Methods: A retrospective cohort study was conducted between March 2019 and March 2021, based on data from electronic medical records of 17,072 patients with type-2 diabetes, collected by Clalit (Israel's largest health maintenance organization). Low SES was compared to high and ethnic minorities (Arabs and ultra-Orthodox Jews) were compared to the general Israeli population of mostly Jewish, but not ultra-Orthodox, Israeli citizens. Quantile regressions were used to examine the impact of SES and ethnic minority membership on HbA1c levels in the 0.10, 0.25, 0.50, 0.75, 0.90 quantiles before and during the lockdown.

Results: In the pre-lockdown period, patients with type-2 diabetes of low versus high SES, and Arabs versus the general population, had higher HbA1c. During the lockdown HbA1c levels of low versus high SES rose significantly in the 0.10 and 0.90 quantiles, and among Arabs HbA1c levels rose significantly across all quantiles, with a remarkable increment in the 0.90 quantile (from 0.316% in the pre-lockdown period to 0.730% in the lockdown period). Ultra-Orthodox Jewish diabetic patients had a marginally higher mean HbA1C level regardless of the period. Quantile regressions did not reveal a significant difference between the ultra-Orthodox Jewish and the general population.

Conclusion: The lockdown exacerbated disparities in glycemic control between low and high SES individuals and between Arab minority and the general population.

Background: Disparities persist in adverse birth outcomes - preterm birth and small-for-gestational age (SGA) among racialized populations. Previous studies have indicated that voting restrictions are associated with health outcomes, such as access to health insurance and teenage birth rates. This paper examines whether the association between voting restrictions and adverse birth outcomes varies according to birthing individuals' race/ethnicity.

Methods: These analyses merged individual-level 2019-2020 Pregnancy Risk Assessment Monitoring System (PRAMS, 8th edition) data with state-level exposure information. The exposure, the Cost of Voting Index (COVI), is a 2020 state-level measure of voting restrictions, and the outcomes were preterm birth and SGA. Multilevel logistic regression, survey-weighted models adjusted for sociodemographic and geographically-based characteristics. Subanalyses examined if the association differed by race (non-Hispanic White, non-Hispanic Black, Hispanic, API, Other).

Results: In the unadjusted model, a standard deviation increase in COVI was associated with increased odds of preterm birth (OR = 1.11, 95% CI = 0.98, 1.25) and SGA (OR = 1.12, 95% CI = 1.02, 1.22). The association for SGA was still significant in the fully adjusted models. Results differed by race/ethnicity with the largest effects among API (OR = 1.20, 95% CI = 0.95, 1.52) for preterm birth and OR = 1.27, 95% CI = 1.01, 1.59) for SGA respectively).

Conclusion: Our results suggest structural voting barriers disproportionately increase the odds of adverse birth outcomes, especially for API-birthing individuals. Increasing voting restrictions may amplify existing birth inequities.