Pub Date : 2024-08-01Epub Date: 2023-07-11DOI: 10.1007/s40615-023-01704-4
Anu G Gaba, Li Cao, Rebecca J Renfrew, DeAnn Witte, Janet M Wernisch, Abe E Sahmoun, Sanjay Goel, Kristi A Egland, Ross D Crosby
Importance: Breast cancer (BC) death rates have not improved for American Indian/Alaska Native (AI/AN) women, whereas, it has significantly decreased for non-Hispanic White (White) women.
Objective: Delineate the differences in patient and tumor characteristics among AI/AN and Whites with BC, and its impact on age and stage at diagnosis as well as overall survival (OS).
Methods: Hospital-based, cohort study using the National Cancer Database to identify female AI/AN and Whites diagnosed with BC between the years 2004 and 2016.
Results: BC in 6866 AI/AN (0.3%) and 1,987,324 Whites (99.7%) were studied. The median age at diagnosis was 58 for AI/AN and 62 for Whites. AI BC patients traveled double the distance for treatment, lived in lower median income zip codes, had a higher percentage of uninsured, higher comorbidities, lower percentage of Stage 0/I, larger tumor size, greater number of positive lymph nodes, higher proportion of triple negative and HER2-positive BC than Whites. All the above comparisons were significant, p<0.001. Association between patient/tumor characteristics with age and stage at diagnosis was not significantly different between AI/AN and Whites. Unadjusted OS was worse for AI/AN as compared to Whites (HR=1.07, 95% CI=1.01-1.14, p=0.023). After adjustment of all covariates, OS was not different (HR=1.038, 95%CI=0.902-1.195, p=0.601).
Conclusion: There were significant differences in patient/tumor characteristics among AI/AN and White BC which adversely impacted OS in AI/AN. However, when adjusted for various covariates, the survival was similar, suggesting that the worse survival in AI/AN is mostly the impact of known biological, socio-economic, and environmental determinants of health.
重要性:美国印第安人/阿拉斯加原住民(AI/AN)妇女的乳腺癌(BC)死亡率没有改善,而非西班牙裔白人(White)妇女的乳腺癌死亡率却显著下降:方法:基于医院的队列研究,利用国家癌症数据库识别2004年至2016年期间确诊为BC的美国印第安/阿拉斯加原住民和白人女性患者和肿瘤特征的差异,及其对确诊时的年龄和分期以及总生存率(OS)的影响:研究对象包括6866名美国原住民/印第安人(0.3%)和1987324名白人(99.7%)。美国原住民/印第安人确诊时的中位年龄为 58 岁,白人为 62 岁。与白人相比,亚裔 BC 患者接受治疗的路程长一倍,居住在收入中位数较低的邮政编码中,无保险的比例较高,合并症较多,0/I 期的比例较低,肿瘤体积较大,阳性淋巴结数量较多,三阴性和 HER2 阳性 BC 的比例较高。上述所有比较结果均具有显著性,p结论:亚裔美国人和白人 BC 患者/肿瘤特征存在明显差异,这对亚裔美国人的 OS 有不利影响。然而,在对各种协变量进行调整后,存活率相似,这表明亚裔美国人/印第安人的存活率较低主要是受已知的生物、社会经济和环境健康决定因素的影响。
{"title":"Differences in Breast Cancers Among American Indian/Alaska Native and non-Hispanic Whites in the USA.","authors":"Anu G Gaba, Li Cao, Rebecca J Renfrew, DeAnn Witte, Janet M Wernisch, Abe E Sahmoun, Sanjay Goel, Kristi A Egland, Ross D Crosby","doi":"10.1007/s40615-023-01704-4","DOIUrl":"10.1007/s40615-023-01704-4","url":null,"abstract":"<p><strong>Importance: </strong>Breast cancer (BC) death rates have not improved for American Indian/Alaska Native (AI/AN) women, whereas, it has significantly decreased for non-Hispanic White (White) women.</p><p><strong>Objective: </strong>Delineate the differences in patient and tumor characteristics among AI/AN and Whites with BC, and its impact on age and stage at diagnosis as well as overall survival (OS).</p><p><strong>Methods: </strong>Hospital-based, cohort study using the National Cancer Database to identify female AI/AN and Whites diagnosed with BC between the years 2004 and 2016.</p><p><strong>Results: </strong>BC in 6866 AI/AN (0.3%) and 1,987,324 Whites (99.7%) were studied. The median age at diagnosis was 58 for AI/AN and 62 for Whites. AI BC patients traveled double the distance for treatment, lived in lower median income zip codes, had a higher percentage of uninsured, higher comorbidities, lower percentage of Stage 0/I, larger tumor size, greater number of positive lymph nodes, higher proportion of triple negative and HER2-positive BC than Whites. All the above comparisons were significant, p<0.001. Association between patient/tumor characteristics with age and stage at diagnosis was not significantly different between AI/AN and Whites. Unadjusted OS was worse for AI/AN as compared to Whites (HR=1.07, 95% CI=1.01-1.14, p=0.023). After adjustment of all covariates, OS was not different (HR=1.038, 95%CI=0.902-1.195, p=0.601).</p><p><strong>Conclusion: </strong>There were significant differences in patient/tumor characteristics among AI/AN and White BC which adversely impacted OS in AI/AN. However, when adjusted for various covariates, the survival was similar, suggesting that the worse survival in AI/AN is mostly the impact of known biological, socio-economic, and environmental determinants of health.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-25DOI: 10.1007/s40615-023-01697-0
Fernanda Lima Cross, Cristina B Bares, Joel Lucio, Karen G Chartier
The current study aimed to understand the effects of adverse childhood experiences (ACEs) and cultural factors on Latinx parents' tobacco use. Tobacco use is the leading cause of death among Latinx individuals in the USA, and parental use has long-term secondary harm for children. Thus, it is important to examine cultural protective factors that could prevent Latinx parents and children from the negative health effects of tobacco use. Data came from 2813 18- to 50-year-old Latinx respondents who participated in the Wave 3 of the National Epidemiological Survey on Alcohol and Related Conditions. They reported having children living in their household and had complete data for the variables of interest. In this sample (mean age = 33.5 years, 53.7% female), 16.4% (95%CI = 14.7%, 18.4%) and 7.4% (95%CI = 6.4%, 8.6%) were current and former smokers, respectively. The multivariate multinomial logistic regression analysis showed that experiencing more ACEs categories was associated with increased likelihood of current and former tobacco use compared to never use. Past year discrimination experiences and being US born (2nd and 3rd-generation parents) also increased the likelihood of current use. Differences in risk of current and former tobacco use were found based on respondents' country of origin, with protection against tobacco use found for most countries compared to being from Puerto Rico. Stronger ethnic-racial identity was not protective against tobacco use. Findings show the importance of considering ACEs and cultural factors when designing and implementing tobacco cessation programs for Latinx parents and increasing awareness of the impact of parents' tobacco use on their children.
{"title":"Adverse Childhood Experiences and Tobacco Use among Latinx Parents in the USA.","authors":"Fernanda Lima Cross, Cristina B Bares, Joel Lucio, Karen G Chartier","doi":"10.1007/s40615-023-01697-0","DOIUrl":"10.1007/s40615-023-01697-0","url":null,"abstract":"<p><p>The current study aimed to understand the effects of adverse childhood experiences (ACEs) and cultural factors on Latinx parents' tobacco use. Tobacco use is the leading cause of death among Latinx individuals in the USA, and parental use has long-term secondary harm for children. Thus, it is important to examine cultural protective factors that could prevent Latinx parents and children from the negative health effects of tobacco use. Data came from 2813 18- to 50-year-old Latinx respondents who participated in the Wave 3 of the National Epidemiological Survey on Alcohol and Related Conditions. They reported having children living in their household and had complete data for the variables of interest. In this sample (mean age = 33.5 years, 53.7% female), 16.4% (95%CI = 14.7%, 18.4%) and 7.4% (95%CI = 6.4%, 8.6%) were current and former smokers, respectively. The multivariate multinomial logistic regression analysis showed that experiencing more ACEs categories was associated with increased likelihood of current and former tobacco use compared to never use. Past year discrimination experiences and being US born (2nd and 3rd-generation parents) also increased the likelihood of current use. Differences in risk of current and former tobacco use were found based on respondents' country of origin, with protection against tobacco use found for most countries compared to being from Puerto Rico. Stronger ethnic-racial identity was not protective against tobacco use. Findings show the importance of considering ACEs and cultural factors when designing and implementing tobacco cessation programs for Latinx parents and increasing awareness of the impact of parents' tobacco use on their children.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9868718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-21DOI: 10.1007/s40615-023-01700-8
Alyson Ma, Jason Campbell, Alison Sanchez, Steven Sumner, Mindy Ma
Objective: To examine the association of patient-provider racial and ethnic concordance on healthcare use within Hispanic ethnic subgroups.
Methods: We estimate multivariate probit models using data from the Medical Expenditure Panel Survey, the only national data source measuring how patients use and pay for medical care, health insurance, and out-of-pocket spending. We collect and utilize data on preventive care visits, visits for new health problems, and visits for ongoing health problems from survey years 2007-2017 to measure health outcomes. Additionally, we include data on race and ethnicity concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis. The sample includes 59,158 observations: 74.3% identified as Mexican, 10.6% identified as Puerto Rican, 5.1% identified as Cuban, 4.8% identified as Dominican, and 5.2% classified in the survey as Other Hispanics. Foreign-born respondents comprised 56% of the sample. A total of 8% (4678) of cases in the sample involved Hispanic provider-patient concordance.
Results: Hispanic patient-provider concordance is statistically significant and positively associated with higher probabilities of seeking preventive care (coef=.211, P<.001), seeking care for a new problem (coef=.208, P<.001), and seeking care for an ongoing problem (coef=.208, P<.001). We also find that the association is not equal across the Hispanic subgroups. The association is lowest for Mexicans in preventive care (coef=.165, P<.001) and new problems (coef=.165, P<.001) and highest for Cubans in preventive care (coef=.256, P<.001) and ongoing problems (coef=.284, P<.001). Results are robust to the interaction of the Hispanic patient-provider concordance for the Hispanic patient categories and being foreign-born.
Conclusions: In summary, racial disparities were observed in health utilization within Hispanic subgroups. While Hispanic patient-provider concordance is statistically significant in associating with healthcare utilization, the findings indicate that this association varies across Hispanic subpopulations. The observations suggest the importance of disaggregating Hispanic racial and ethnic categories into more similar cultural or origin groups. Linked with the existence of significant differences in mortality and other health outcomes across Hispanic subgroups, our results have implications for the design of community health promotion activities which should take these differences into account. Studies or community health programs which utilize generalized findings about Hispanic populations overlook differences across subgroups which may be crucial in promoting healthcare utilization.
{"title":"Racial Concordance on Healthcare Use within Hispanic Population Subgroups.","authors":"Alyson Ma, Jason Campbell, Alison Sanchez, Steven Sumner, Mindy Ma","doi":"10.1007/s40615-023-01700-8","DOIUrl":"10.1007/s40615-023-01700-8","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association of patient-provider racial and ethnic concordance on healthcare use within Hispanic ethnic subgroups.</p><p><strong>Methods: </strong>We estimate multivariate probit models using data from the Medical Expenditure Panel Survey, the only national data source measuring how patients use and pay for medical care, health insurance, and out-of-pocket spending. We collect and utilize data on preventive care visits, visits for new health problems, and visits for ongoing health problems from survey years 2007-2017 to measure health outcomes. Additionally, we include data on race and ethnicity concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis. The sample includes 59,158 observations: 74.3% identified as Mexican, 10.6% identified as Puerto Rican, 5.1% identified as Cuban, 4.8% identified as Dominican, and 5.2% classified in the survey as Other Hispanics. Foreign-born respondents comprised 56% of the sample. A total of 8% (4678) of cases in the sample involved Hispanic provider-patient concordance.</p><p><strong>Results: </strong>Hispanic patient-provider concordance is statistically significant and positively associated with higher probabilities of seeking preventive care (coef=.211, P<.001), seeking care for a new problem (coef=.208, P<.001), and seeking care for an ongoing problem (coef=.208, P<.001). We also find that the association is not equal across the Hispanic subgroups. The association is lowest for Mexicans in preventive care (coef=.165, P<.001) and new problems (coef=.165, P<.001) and highest for Cubans in preventive care (coef=.256, P<.001) and ongoing problems (coef=.284, P<.001). Results are robust to the interaction of the Hispanic patient-provider concordance for the Hispanic patient categories and being foreign-born.</p><p><strong>Conclusions: </strong>In summary, racial disparities were observed in health utilization within Hispanic subgroups. While Hispanic patient-provider concordance is statistically significant in associating with healthcare utilization, the findings indicate that this association varies across Hispanic subpopulations. The observations suggest the importance of disaggregating Hispanic racial and ethnic categories into more similar cultural or origin groups. Linked with the existence of significant differences in mortality and other health outcomes across Hispanic subgroups, our results have implications for the design of community health promotion activities which should take these differences into account. Studies or community health programs which utilize generalized findings about Hispanic populations overlook differences across subgroups which may be crucial in promoting healthcare utilization.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1007/s40615-024-02109-7
Matt Ignacio, Sabrina Oesterle, Natalia Rodriguez-González, Gilberto Lopez, Stephanie Ayers, Ann Carver, Wendy Wolfersteig, James Herbert Williams, Samantha Sabo, Sairam Parthasarathy
Objectives: Communities of color might disproportionately experience long-term consequences of COVID-19, known as Long COVID. We sought to understand the awareness of and experiences with Long COVID among African American/Black (AA/B), Hispanic/Latino (H/L), and Indigenous (Native) adults (18 + years of age) in Arizona who previously tested positive for COVID-19.
Methods: Between December 2022 and April 2023, the Arizona Community Engagement Alliance (AZCEAL) conducted 12 focus groups and surveys with 65 AA/B, H/L and Native community members. Data from focus groups were analyzed using thematic analysis to identify emerging issues. Survey data provided demographic information about participants and quantitative assessments of Long COVID experiences were used to augment focus group data.
Results: Study participants across all three racial/ethnic groups had limited to no awareness of the term Long COVID, yet many described experiencing or witnessing friends and family endure physical symptoms consistent with Long COVID (e.g., brain fog, loss of memory, fatigue) as well as associated mental health issues (e.g., anxiety, worry, post-traumatic stress disorder). Participants identified a need for Long COVID mental health and other health resources, as well as increased access to Long COVID information.
Conclusion: To prevent Long COVID health inequities among AA/B, H/L, and Native adults living in AZ, health-related organizations and providers should increase access to culturally relevant, community-based Long COVID-specific information, mental health services, and other health resources aimed at serving these populations.
目标:有色人种可能过多地经历 COVID-19 的长期后果,即所谓的 Long COVID。我们试图了解亚利桑那州曾对 COVID-19 检测呈阳性的非洲裔美国人/黑人(AA/B)、西班牙裔/拉丁美洲人(H/L)和土著(Native)成年人(18 岁以上)对 Long COVID 的认识和经历:2022 年 12 月至 2023 年 4 月期间,亚利桑那州社区参与联盟 (AZCEAL) 对 65 名 AA/B、H/L 和土著社区成员进行了 12 次焦点小组讨论和调查。我们采用主题分析法对焦点小组的数据进行了分析,以确定新出现的问题。调查结果:结果:所有三个种族/民族群体的研究参与者对 "长期慢性阻塞性肺病"(Long COVID)一词的认识有限或一无所知,但许多人描述了他们经历或目睹朋友和家人忍受与 "长期慢性阻塞性肺病"(Long COVID)一致的身体症状(如脑雾、失忆、疲劳)以及相关的心理健康问题(如焦虑、担忧、创伤后应激障碍)。参与者认为有必要提供长期慢性阻塞性肺病心理健康和其他健康资源,并增加获取长期慢性阻塞性肺病信息的渠道:为了防止居住在亚利桑那州的成年黑人、亚裔美国人和黑人以及土著人中出现 Long COVID 健康不平等现象,与健康相关的组织和服务提供者应增加这些人群获取与文化相关的、基于社区的 Long COVID 特定信息、心理健康服务和其他健康资源的机会。
{"title":"Limited Awareness of Long COVID Despite Common Experience of Symptoms Among African American/Black, Hispanic/Latino, and Indigenous Adults in Arizona.","authors":"Matt Ignacio, Sabrina Oesterle, Natalia Rodriguez-González, Gilberto Lopez, Stephanie Ayers, Ann Carver, Wendy Wolfersteig, James Herbert Williams, Samantha Sabo, Sairam Parthasarathy","doi":"10.1007/s40615-024-02109-7","DOIUrl":"https://doi.org/10.1007/s40615-024-02109-7","url":null,"abstract":"<p><strong>Objectives: </strong>Communities of color might disproportionately experience long-term consequences of COVID-19, known as Long COVID. We sought to understand the awareness of and experiences with Long COVID among African American/Black (AA/B), Hispanic/Latino (H/L), and Indigenous (Native) adults (18 + years of age) in Arizona who previously tested positive for COVID-19.</p><p><strong>Methods: </strong>Between December 2022 and April 2023, the Arizona Community Engagement Alliance (AZCEAL) conducted 12 focus groups and surveys with 65 AA/B, H/L and Native community members. Data from focus groups were analyzed using thematic analysis to identify emerging issues. Survey data provided demographic information about participants and quantitative assessments of Long COVID experiences were used to augment focus group data.</p><p><strong>Results: </strong>Study participants across all three racial/ethnic groups had limited to no awareness of the term Long COVID, yet many described experiencing or witnessing friends and family endure physical symptoms consistent with Long COVID (e.g., brain fog, loss of memory, fatigue) as well as associated mental health issues (e.g., anxiety, worry, post-traumatic stress disorder). Participants identified a need for Long COVID mental health and other health resources, as well as increased access to Long COVID information.</p><p><strong>Conclusion: </strong>To prevent Long COVID health inequities among AA/B, H/L, and Native adults living in AZ, health-related organizations and providers should increase access to culturally relevant, community-based Long COVID-specific information, mental health services, and other health resources aimed at serving these populations.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-06-20DOI: 10.1007/s40615-023-01679-2
Ayobami Adebayo, Daniel Laroche
Glaucoma is an ophthalmic disorder that affects a significant number of Blacks globally. A leading cause of this condition is an age-related enlargement of the lens and increased intraocular pressure. Although Blacks are affected by glaucoma at a higher rate than their Caucasian counterparts, there remains a lack of emphasis placed on the detection, diagnosis, monitoring, and treatment of glaucoma in this population. Education regarding glaucoma in the African and African American populations is essential to reducing rates of glaucoma-related visual impairment and improving treatment success. In this article, we highlight specific issues and limitations to the management of glaucoma, which affects Blacks at a higher rate. In addition, we also review the backgrounds of Blacks globally and examine historical events that have contributed to financial inequality and wealth/health disparities affecting glaucoma management. Lastly, we suggest reparations and solutions that health care professionals can use to improve glaucoma screening and management.
{"title":"Unfulfilled Needs in the Detection, Diagnosis, Monitoring, Treatment, and Understanding of Glaucoma in Blacks Globally.","authors":"Ayobami Adebayo, Daniel Laroche","doi":"10.1007/s40615-023-01679-2","DOIUrl":"10.1007/s40615-023-01679-2","url":null,"abstract":"<p><p>Glaucoma is an ophthalmic disorder that affects a significant number of Blacks globally. A leading cause of this condition is an age-related enlargement of the lens and increased intraocular pressure. Although Blacks are affected by glaucoma at a higher rate than their Caucasian counterparts, there remains a lack of emphasis placed on the detection, diagnosis, monitoring, and treatment of glaucoma in this population. Education regarding glaucoma in the African and African American populations is essential to reducing rates of glaucoma-related visual impairment and improving treatment success. In this article, we highlight specific issues and limitations to the management of glaucoma, which affects Blacks at a higher rate. In addition, we also review the backgrounds of Blacks globally and examine historical events that have contributed to financial inequality and wealth/health disparities affecting glaucoma management. Lastly, we suggest reparations and solutions that health care professionals can use to improve glaucoma screening and management.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9667256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-05DOI: 10.1007/s40615-023-01692-5
Ariel R Belasen, Alan T Belasen, Mickenzie Bass
The socioeconomic shocks of the first COVID-19 pandemic wave disproportionately affected vulnerable groups. But did that trend continue to hold during the Delta and Omicron waves? Leveraging data from the Johns Hopkins Coronavirus Resource Center, this paper examines whether demographic inequalities persisted across the waves of COVID-19 infections. The current study utilizes fixed effects regressions to isolate the marginal relationships between socioeconomic factors with case counts and death counts. Factors include levels of urbanization, age, gender, racial distribution, educational attainment, and household income, along with time- and state-specific COVID-19 restrictions and other time invariant controls captured via fixed effects controls. County-level health outcomes in large metropolitan areas show that despite higher incidence rates in suburban and exurban counties, urban counties still had disproportionately poor outcomes in the latter COVID-19 waves. Policy makers should consider health disparities when developing long-term public health regulatory policies to help shield low-income households from the adverse effects of COVID-19 and future pandemics.
{"title":"Tracking the Uneven Outcomes of COVID-19 on Racial and Ethnic Groups: Implications for Health Policy.","authors":"Ariel R Belasen, Alan T Belasen, Mickenzie Bass","doi":"10.1007/s40615-023-01692-5","DOIUrl":"10.1007/s40615-023-01692-5","url":null,"abstract":"<p><p>The socioeconomic shocks of the first COVID-19 pandemic wave disproportionately affected vulnerable groups. But did that trend continue to hold during the Delta and Omicron waves? Leveraging data from the Johns Hopkins Coronavirus Resource Center, this paper examines whether demographic inequalities persisted across the waves of COVID-19 infections. The current study utilizes fixed effects regressions to isolate the marginal relationships between socioeconomic factors with case counts and death counts. Factors include levels of urbanization, age, gender, racial distribution, educational attainment, and household income, along with time- and state-specific COVID-19 restrictions and other time invariant controls captured via fixed effects controls. County-level health outcomes in large metropolitan areas show that despite higher incidence rates in suburban and exurban counties, urban counties still had disproportionately poor outcomes in the latter COVID-19 waves. Policy makers should consider health disparities when developing long-term public health regulatory policies to help shield low-income households from the adverse effects of COVID-19 and future pandemics.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9758388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-27DOI: 10.1007/s40615-023-01714-2
Hassan Ashktorab, Gholamreza Oskrochi, Suryanarayana Reddy Challa, Lakshmi G Chirumamilla, Faezeh Ahangarzadeh, Boubini Jones-Wonni, Nader Shayegh, Mudasir Rashid, Zainab Naqvi, Elizabeth Ekpe, Sen Sabyasachi, Anteneh Zenebe, Hassan Brim
Background and aim: Type 2 diabetes mellitus (DM) is a common comorbidity in the minority population and is associated with poor outcomes in COVID-19 patients. We hypothesized that COVID-19 patients with pre-existing diabetes mellitus are prone to fatal outcomes compared to non-diabetic patients. We aimed to illustrate the characteristics and outcomes and identify the risk factors for in-hospital mortality of COVID-19 patients with DM.
Methods: In this single-center retrospective study, electronic medical records of hospitalized patients with confirmed COVID-19 diagnosis at Howard University Hospital (HUH) from March 2020 to Dec 2021 were analyzed. Clinical, demographic, and serological information, as well as outcomes, were recorded and analyzed.
Results: Among 463 COVID-19 patients, 66.3% (n = 307) were African Americans (AA) and 35.9% (n = 166) had diabetes, with a mean age of 64 years. The majority of the diabetic patients were AA (n = 123, 74.1%) and had a higher mortality rate (n = 26, 74.3%) compared to others. Length of stay in the hospital is significantly more for the diabetic than for the non-diabetic patients (11.3 vs. 8.3 days, p = 0.03). A higher proportion of ICU admission (32.3% vs. 17.9%, p = < 0.001), intubation (17% vs. 11.7%, p = 0.04), and increased mortality (21.1% vs. 12.2%, p = 0.01) were identified in COVID-19 patients with DM than in those with no DM. Among DM patients, non-survivors were older (69.9 vs. 62.9 years). DM patients were more likely to have underlying hypertension (72.3% vs. 43.3%, p = < 0.001), obesity (44.8% vs. 32.1%, p = 0.007), chronic kidney disease (23.6 vs. 11.8%, p = 0.001), and cardiovascular disease (29.5% vs. 14.3%, p = 0.001) than the non-DM patients. HbA1C above 9%, indicating poorly controlled hyperglycemia, was associated with poor outcome among the DM subjects. AST (23.5% vs. 31.3%) and creatinine (61.4% vs. 37.9%) were significantly more elevated in DM COVID-19 patients (all p-values < 0.05). The levels of serum troponin (42.5% vs. 30.9%, p = 0.03), interleukin-6 (67.2 vs. 50%, p = 0.04), ferritin (65.6% vs. 44.6%, p = 0.03), procalcitonin (58.1% vs. 46.1, p = 0.03), and D-dimers (92.8% vs. 86.5%, p = 0.04) were significantly higher in DM patients as compared to those in non-DM COVID-19 patients, indicating more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm.
Conclusion: The prevalence of DM is high among hospitalized COVID-19 patients in our cohort. While DM patients have a higher mortality rate and ICU admission than non-DM patients, other factors such as underlying comorbidities, old age, elevated creatinine, AST, serum inflammatory markers, and D-dimer are more significant predictors of fatal outcomes. DM patients had higher metabolic derangements, hypercoagulability, and severe inflammatory response. No significant difference of outcome was noted be
{"title":"High Prevalence of Diabetes Among Hospitalized COVID-19 Minority Patients: Data from a Single Tertiary Hospital.","authors":"Hassan Ashktorab, Gholamreza Oskrochi, Suryanarayana Reddy Challa, Lakshmi G Chirumamilla, Faezeh Ahangarzadeh, Boubini Jones-Wonni, Nader Shayegh, Mudasir Rashid, Zainab Naqvi, Elizabeth Ekpe, Sen Sabyasachi, Anteneh Zenebe, Hassan Brim","doi":"10.1007/s40615-023-01714-2","DOIUrl":"10.1007/s40615-023-01714-2","url":null,"abstract":"<p><strong>Background and aim: </strong>Type 2 diabetes mellitus (DM) is a common comorbidity in the minority population and is associated with poor outcomes in COVID-19 patients. We hypothesized that COVID-19 patients with pre-existing diabetes mellitus are prone to fatal outcomes compared to non-diabetic patients. We aimed to illustrate the characteristics and outcomes and identify the risk factors for in-hospital mortality of COVID-19 patients with DM.</p><p><strong>Methods: </strong>In this single-center retrospective study, electronic medical records of hospitalized patients with confirmed COVID-19 diagnosis at Howard University Hospital (HUH) from March 2020 to Dec 2021 were analyzed. Clinical, demographic, and serological information, as well as outcomes, were recorded and analyzed.</p><p><strong>Results: </strong>Among 463 COVID-19 patients, 66.3% (n = 307) were African Americans (AA) and 35.9% (n = 166) had diabetes, with a mean age of 64 years. The majority of the diabetic patients were AA (n = 123, 74.1%) and had a higher mortality rate (n = 26, 74.3%) compared to others. Length of stay in the hospital is significantly more for the diabetic than for the non-diabetic patients (11.3 vs. 8.3 days, p = 0.03). A higher proportion of ICU admission (32.3% vs. 17.9%, p = < 0.001), intubation (17% vs. 11.7%, p = 0.04), and increased mortality (21.1% vs. 12.2%, p = 0.01) were identified in COVID-19 patients with DM than in those with no DM. Among DM patients, non-survivors were older (69.9 vs. 62.9 years). DM patients were more likely to have underlying hypertension (72.3% vs. 43.3%, p = < 0.001), obesity (44.8% vs. 32.1%, p = 0.007), chronic kidney disease (23.6 vs. 11.8%, p = 0.001), and cardiovascular disease (29.5% vs. 14.3%, p = 0.001) than the non-DM patients. HbA1C above 9%, indicating poorly controlled hyperglycemia, was associated with poor outcome among the DM subjects. AST (23.5% vs. 31.3%) and creatinine (61.4% vs. 37.9%) were significantly more elevated in DM COVID-19 patients (all p-values < 0.05). The levels of serum troponin (42.5% vs. 30.9%, p = 0.03), interleukin-6 (67.2 vs. 50%, p = 0.04), ferritin (65.6% vs. 44.6%, p = 0.03), procalcitonin (58.1% vs. 46.1, p = 0.03), and D-dimers (92.8% vs. 86.5%, p = 0.04) were significantly higher in DM patients as compared to those in non-DM COVID-19 patients, indicating more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm.</p><p><strong>Conclusion: </strong>The prevalence of DM is high among hospitalized COVID-19 patients in our cohort. While DM patients have a higher mortality rate and ICU admission than non-DM patients, other factors such as underlying comorbidities, old age, elevated creatinine, AST, serum inflammatory markers, and D-dimer are more significant predictors of fatal outcomes. DM patients had higher metabolic derangements, hypercoagulability, and severe inflammatory response. No significant difference of outcome was noted be","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9942310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-17DOI: 10.1007/s40615-023-01691-6
Sebastian Acevedo, Sarah Malarkey, Humberto Baquerizo, Asia Lefebre, Joachim Sackey, Pamela Valera
Objectives: Evaluated how COVID-19 impacted Latino health across social, economic, and emotional dimensions and differentiated whether adverse COVID-19-related effects persisted across respondents.
Methods: In both English and Spanish, a cross-sectional survey was conducted in the USA from June 2021 to April 2022. Chi-square tests, Z-tests, and T-tests were used to test for significant differences between Spanish- and English-speaking respondents. Multiple linear regressions were carried out to understand whether previously established determinants of health for Latinos accounted for greater COVID-19-related adversity across social, economic, and mental health dimensions. English as a primary language was significantly related to greater adverse emotional/mental health COVID-19 experiences after controlling for other social determinants of health factors (β = - 0.355, p < 0.001). Individuals who reported worrying about housing loss were significantly more likely to experience more adverse economic adversity due to COVID-19 (β = - 0.234, p < 0.001). Household income < $35,000 (β = 0.083, p < 0.05), having more than 5 people living in the same home (β = -0.102, p < 0.05), and work-related transportation barriers (β = - 0.114, p < 0.05) all increased the likelihood of household-related stressors occurring because of the pandemic.
Conclusions: The study highlights the heterogeneity in the Latino community and the key social, economic, and community-level factors most strongly correlated with adverse COVID-19-related outcomes.
{"title":"Social Determinant of Health Framework to Examine the Impact of COVID-19 on Latino Health.","authors":"Sebastian Acevedo, Sarah Malarkey, Humberto Baquerizo, Asia Lefebre, Joachim Sackey, Pamela Valera","doi":"10.1007/s40615-023-01691-6","DOIUrl":"10.1007/s40615-023-01691-6","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluated how COVID-19 impacted Latino health across social, economic, and emotional dimensions and differentiated whether adverse COVID-19-related effects persisted across respondents.</p><p><strong>Methods: </strong>In both English and Spanish, a cross-sectional survey was conducted in the USA from June 2021 to April 2022. Chi-square tests, Z-tests, and T-tests were used to test for significant differences between Spanish- and English-speaking respondents. Multiple linear regressions were carried out to understand whether previously established determinants of health for Latinos accounted for greater COVID-19-related adversity across social, economic, and mental health dimensions. English as a primary language was significantly related to greater adverse emotional/mental health COVID-19 experiences after controlling for other social determinants of health factors (β = - 0.355, p < 0.001). Individuals who reported worrying about housing loss were significantly more likely to experience more adverse economic adversity due to COVID-19 (β = - 0.234, p < 0.001). Household income < $35,000 (β = 0.083, p < 0.05), having more than 5 people living in the same home (β = -0.102, p < 0.05), and work-related transportation barriers (β = - 0.114, p < 0.05) all increased the likelihood of household-related stressors occurring because of the pandemic.</p><p><strong>Conclusions: </strong>The study highlights the heterogeneity in the Latino community and the key social, economic, and community-level factors most strongly correlated with adverse COVID-19-related outcomes.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10185819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Severe Acute Respiratory Syndrome (SARS) represents a serious public health problem for the indigenous peoples of Brazil, since acute respiratory infections are the main causes of morbidity and mortality in this population.
Objective: To assess cases of SARS in Brazilian indigenous peoples in the context of the COVID-19 pandemic, as well as sociodemographic and health factors associated with deaths from SARS in this population.
Methods: Ecological study carried out based on secondary data from the Brazilian Database for Epidemiological Surveillance of Influenza referring to the Brazilian indigenous population with SARS in 2020. The variables included sociodemographic factors and health conditions. Statistical analyses were carried out considering absolute (n) and relative (%) frequencies and logistic regression with odds ratios (OR), with death as the outcome of interest.
Results: A total of 3062 cases were reported in the analyzed period. Of these, there was a predominance of men (54.6%), adults (41.4%), with comorbidities (52.3%), with low levels of schooling (67.4%) and residents of rural areas (55.8%). Cases and deaths were concentrated in the states of Amazonas and Mato Grosso do Sul, states in the North and Midwest of Brazil. A greater chance of death was observed in elderly indigenous people (OR = 6.29; 95%CI 4.71-8.39), with low levels of schooling (OR = 1.72; 95%CI 1.22-2.28), residents of rural areas (OR = 1.35; 95%CI 1.12-1.62), and with comorbidities (OR = 1.87; 95%CI 1.42-2.46), especially obesity (OR = 2.56; 95%CI 1.07-6.11).
Conclusion: The study was able to trace the clinical-epidemiological profile, as well as identify the groups of indigenous people most vulnerable to SARS as a result of COVID-19 and evolution to death in Brazil. The findings show the high impact on the morbidity and mortality of the Brazilian indigenous population exposed to SARS and are relevant for epidemiological health surveillance, since they can guide preventive public policy actions and quality of life measures for this ethnic group in Brazil.
{"title":"Severe Acute Respiratory Syndrome (SARS) in the Context of the COVID-19 Pandemic Among Indigenous Peoples of Brazil: Epidemiology and Risk Factors Associated with Death.","authors":"Thiago Emanuel Rodrigues Novaes, Darlan Martins Lara, Shana Ginar da Silva","doi":"10.1007/s40615-023-01660-z","DOIUrl":"10.1007/s40615-023-01660-z","url":null,"abstract":"<p><strong>Introduction: </strong>Severe Acute Respiratory Syndrome (SARS) represents a serious public health problem for the indigenous peoples of Brazil, since acute respiratory infections are the main causes of morbidity and mortality in this population.</p><p><strong>Objective: </strong>To assess cases of SARS in Brazilian indigenous peoples in the context of the COVID-19 pandemic, as well as sociodemographic and health factors associated with deaths from SARS in this population.</p><p><strong>Methods: </strong>Ecological study carried out based on secondary data from the Brazilian Database for Epidemiological Surveillance of Influenza referring to the Brazilian indigenous population with SARS in 2020. The variables included sociodemographic factors and health conditions. Statistical analyses were carried out considering absolute (n) and relative (%) frequencies and logistic regression with odds ratios (OR), with death as the outcome of interest.</p><p><strong>Results: </strong>A total of 3062 cases were reported in the analyzed period. Of these, there was a predominance of men (54.6%), adults (41.4%), with comorbidities (52.3%), with low levels of schooling (67.4%) and residents of rural areas (55.8%). Cases and deaths were concentrated in the states of Amazonas and Mato Grosso do Sul, states in the North and Midwest of Brazil. A greater chance of death was observed in elderly indigenous people (OR = 6.29; 95%CI 4.71-8.39), with low levels of schooling (OR = 1.72; 95%CI 1.22-2.28), residents of rural areas (OR = 1.35; 95%CI 1.12-1.62), and with comorbidities (OR = 1.87; 95%CI 1.42-2.46), especially obesity (OR = 2.56; 95%CI 1.07-6.11).</p><p><strong>Conclusion: </strong>The study was able to trace the clinical-epidemiological profile, as well as identify the groups of indigenous people most vulnerable to SARS as a result of COVID-19 and evolution to death in Brazil. The findings show the high impact on the morbidity and mortality of the Brazilian indigenous population exposed to SARS and are relevant for epidemiological health surveillance, since they can guide preventive public policy actions and quality of life measures for this ethnic group in Brazil.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9627877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-19DOI: 10.1007/s40615-023-01705-3
Giselle K Perez, Julia T Rabin, Megha Tandon, Nicole M Strauss, Kelly Irwin, Lisa Philpotts, Jamie Ostroff, Elyse R Park
Objective: To characterize the representation of Black and Hispanic cancer patients in tobacco treatment trials, and to offer recommendations for future research.
Methods: We conducted two systematic searches of the literature (2018, 2021) using 5 databases (MEDLINE via EBSCO, Pubmed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE)) to examine the prevalence of tobacco trials that included Black or Hispanic cancer patients. Two coders independently screened all articles at title, abstract, and full-text to identify eligible trials. Information about the proportion of Black and Hispanic patients included, trial design features, and whether the authors analyzed outcomes for Black and Hispanic patients were documented.
Results: Of 4682 identified studies, only 10 published trials included and reported on the rates of Black or Hispanic cancer patients enrolled in their tobacco trial. The proportion of enrolled Black cancer patients ranged from 2 to 55.6%. Only our studies documented enrollment rates for Hispanics, and rates were less than 6%. None of the studies offered strategies to promote or the accrual of Black or Hispanic patients.
Discussion: There remains a large gap in the literature regarding the reach and efficacy of tobacco treatment for Black and Hispanic cancer patients. Black and Hispanic cancer patients remain largely under-represented in tobacco cessation trials, limiting the applicability of existing, evidence-based treatments. To optimize intervention generalizability, future studies should emphasize the targeted recruitment and engagement of these patients in tobacco trials.
目的:描述黑人和西班牙裔癌症患者在烟草治疗试验中的代表性,并为未来的研究提供建议。方法:我们使用5个数据库(MEDLINE via EBSCO,Pubmed,PsycInfo,Cucumulative Index to Nursing and Allied Health literature(CINAHL),Exceptta Medica Database(EMBASE))对文献进行了两次系统检索(20182021),以检查包括黑人或西班牙裔癌症患者的烟草试验的流行率。两名编码人员分别对所有文章的标题、摘要和全文进行了独立筛选,以确定符合条件的试验。记录了黑人和西班牙裔患者的比例、试验设计特征以及作者是否分析了黑人和拉美裔患者的结果等信息。结果:在4682项已确定的研究中,只有10项已发表的试验包括并报告了黑人或西班牙裔癌症患者参与烟草试验的比率。注册的癌症黑人患者比例在2%到55.6%之间。只有我们的研究记录了西班牙裔患者的注册率,且注册率低于6%。没有一项研究提供促进或增加黑人或西班牙裔患者的策略。讨论:关于黑人和西班牙裔癌症患者烟草治疗的范围和疗效,文献中仍有很大差距。黑人和西班牙裔癌症患者在戒烟试验中的表现仍然严重不足,限制了现有循证治疗的适用性。为了优化干预的可推广性,未来的研究应该强调这些患者在烟草试验中的定向招募和参与。
{"title":"Do Tobacco Treatment Trials Address Disparities in Smoking Outcomes Among Black and Hispanic Cancer Patients? A Systematic Review of Smoking Cessation Interventions for Black and Hispanic Patients Diagnosed with Cancer.","authors":"Giselle K Perez, Julia T Rabin, Megha Tandon, Nicole M Strauss, Kelly Irwin, Lisa Philpotts, Jamie Ostroff, Elyse R Park","doi":"10.1007/s40615-023-01705-3","DOIUrl":"10.1007/s40615-023-01705-3","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the representation of Black and Hispanic cancer patients in tobacco treatment trials, and to offer recommendations for future research.</p><p><strong>Methods: </strong>We conducted two systematic searches of the literature (2018, 2021) using 5 databases (MEDLINE via EBSCO, Pubmed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE)) to examine the prevalence of tobacco trials that included Black or Hispanic cancer patients. Two coders independently screened all articles at title, abstract, and full-text to identify eligible trials. Information about the proportion of Black and Hispanic patients included, trial design features, and whether the authors analyzed outcomes for Black and Hispanic patients were documented.</p><p><strong>Results: </strong>Of 4682 identified studies, only 10 published trials included and reported on the rates of Black or Hispanic cancer patients enrolled in their tobacco trial. The proportion of enrolled Black cancer patients ranged from 2 to 55.6%. Only our studies documented enrollment rates for Hispanics, and rates were less than 6%. None of the studies offered strategies to promote or the accrual of Black or Hispanic patients.</p><p><strong>Discussion: </strong>There remains a large gap in the literature regarding the reach and efficacy of tobacco treatment for Black and Hispanic cancer patients. Black and Hispanic cancer patients remain largely under-represented in tobacco cessation trials, limiting the applicability of existing, evidence-based treatments. To optimize intervention generalizability, future studies should emphasize the targeted recruitment and engagement of these patients in tobacco trials.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10214116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}