Journal of Racial and Ethnic Health Disparities最新文献

Objective: To compare the variability of metabolic parameters in the development of obesity, as determined by BMI, in adult indigenous and Caucasian residents living in the territories of the Russian Arctic and having a sedentary lifestyle.

Methods: BMI was used to identify respondents with normal weight, overweight, and obesity. The insulin content and metabolic parameters, including fatty acids (FA), were determined, and HOMA-IR was calculated.

Results: The progression of obesity was accompanied by an augmentation in triglyceride (TG) concentrations, an increase in FA levels. In women, the level of high-density lipoprotein cholesterol (HDL-C) decreased. Concurrently, an escalation in glucose levels was observed among Caucasian women, while Caucasian men exhibited an increase in low-density lipoprotein cholesterol. A rise in insulin levels and HOMA-IR was also observed, with this rise being more pronounced among Caucasian subjects. Conversely, indigenous women exhibited lower levels of FAs, TG, and glucose compared to their Caucasian counterparts. Among the male population, Caucasian men have higher levels of HDL-C.

Conclusions: Overweight and obesity are prevalent among the population of the Russian Arctic, irrespective of ethnicity. However, a notable exception is observed among indigenous men, who exhibit a lower prevalence of obesity (13.6%). In both ethnic groups, obesity was associated with cardiometabolic risk factors, particularly among female subjects. However, the metabolic consequences of obesity in the indigenous population were comparatively less pronounced than in the Caucasian population. Furthermore, selective insulin resistance may be present in indigenous populations, particularly in the context of lower glucose and FAs levels.

Background: Exhaustive evidence about the impact of racial disparities in oncological outcomes after a negative prostate biopsy is still lacking. We explored the relationship between race and long-term oncological risk among men with an initial negative prostate biopsy using a contemporary U.S.

Cohort:

Methods: Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) men who had a negative prostate biopsy at Henry Ford Health between 1995-2023 were included. An Area Deprivation Index (ADI)-score was assigned to each patient based on their residential census-block group. The higher the ADI, the more the area has a socio-economic disadvantage. Competing-risk methods were used to estimate the cumulative incidence of any PCa diagnosis, clinically significant PCa diagnosis, receipt of active treatment, Prostate Cancer Specific Mortality (PCSM) and Other Cause Mortality (OCM) for the entire cohort of patients, after stratification according to race. Fine-Gray regression models tested the impact of race on the aforementioned outcomes.

Results: We included 17,446 men, 5,729 (30.3%) of whom were NHB. Within a median follow-up time of 7.8 years, the 15-years estimated rates of any PCa diagnosis, clinically significant PCa, active treatment and PCSM were 15.9% vs. 9.5%, 10.7% vs. 6.4%, 10.4% vs. 6.4% and 2.4% vs. 1.3%, for NHB versus NHW patients, respectively (all p-value < 0.0001). At multivariable analysis, NHB men had significantly higher hazard of any PCa (HR:1.90), clinically significant PCa (HR:1.91), active treatment for PCa (HR:1.84) and PCSM (HR:1.89) (all p < 0.001).

Conclusions: NHB men, even after an initial negative prostate biopsy, face a higher risk of subsequent any PCa, clinically significant disease, active treatment and PCSM. Overall, these findings underscore the multifaceted impact of racial disparities on PCa prognosis.

Objectives: Limited evidence suggests possible disparities in COVID-19 across race/ethnicity, metropolitan status, and healthcare access. This study investigated racial/ethnic, metropolitan, and healthcare access disparities in Long COVID among U.S. adults.

Methods: 2022-2023 cross-sectional Behavioral Risk Factor Surveillance System data were analyzed. U.S. adults who had COVID-19 were included, resulting in a final weighted sample size of n = 80,093,998. Logistic regressions examined associations between race/ethnicity, metropolitan status, health insurance and ever or currently experiencing Long COVID and reductions in daily function. Interactions were examined for metropolitan status and health insurance.

Results: Versus non-Hispanic White (NHW) respondents, a higher odds of Long COVID were observed for Non-Hispanic American Indian/Alaskan Native (ever adj. OR = 1.24, 95% CI: 1.01, 1.53; currently adj. OR = 1.72, 95% CI: 1.39, 2.12) and Other Race/Multiracial (ever adj. OR = 1.41, 95% CI: 1.18, 1.62; currently adj. OR = 1.35, 95% CI: 1.16, 1.58) respondents. Black (ever adj. OR = 0.84, 95% CI: 0.76, 0.93), Asian (ever adj. OR = 0.54, 95% CI: 0.42, 0.70), and Native Hawaiian/Pacific Islander (currently adj. OR = 0.61, 95% CI: 0.39, 0.95) respondents had a lower odds. Non-metropolitan residents had a higher odds (ever adj. OR = 1.16, 95% CI: 1.08, 1.25; currently adj. OR = 1.16, 95% CI: 1.08, 1.24) versus metropolitan residents. Uninsured respondents had a higher odds versus insured respondents (currently adj. OR = 1.24, 95%: 1.08, 1.44). Interactions were statistically significant for metropolitan status (ever p-value = 0.026) and health insurance (ever p-value = 0.006; currently p-value = 0.008).

Conclusions: Long COVID is experienced unequally across race/ethnicity and metropolitan/non-metropolitan residence. Further research is needed to understand this heterogeneity and the effects of Long COVID.

Very few studies have examined perceptions of children's use of COVID-19 prevention behaviors during the pandemic and whether such perceptions varied by race-ethnicity. Using data from the COVID-19 in American Communities - 2 Survey collected between March and April 2022, this study examines race-ethnic disparities in perceptions of children's use of the various preventive behaviors recommended by the CDC during the pandemic. First, it used logistic regression models to examine disparities in perceptions of children's effective use of masking, social distancing, hand washing, and avoiding crowded places. Second, it used GLM models to examine disparities in perceptions of children's frequent use of multiple of these behaviors. Compared to Whites, Blacks had the highest odds of perceiving that children should maximize their use of masking, social distancing, and avoiding large groups. Asians also had higher odds of perceiving that children should avoid large crowds compared to Whites. Additionally, Blacks were the most likely to have positive perceptions of children's intense use of more than one of these behaviors. Perceptions of children's use of social distancing and avoiding large crowds were positively associated with having friends and families who died from COVID-19. Respondents in households with COVID-19 orphans were less likely to believe that children should maximize their use of hand washing avoiding large crowds, or using more than one preventive behavior compared to other respondents. The implications of these findings for policy and practice are discussed.

African American women are at higher risk of adverse pregnancy outcomes (APOs) than women in other racial and ethnic groups in the United States, which can lead to an increased risk of maternal mortality and morbidity. These disparities have been attributed to inequities in social determinants of health. This study explores the experiences of healthcare discrimination and resilience among African American women. From December 2023 to August 2024, we conducted 30 semi-structured interviews with African American/Black (AA/BL) postpartum women in Milwaukee, Wisconsin, USA. The interviews included the following content domains: life experiences of pregnancy, adverse pregnancy outcomes, healthcare racism or discrimination during pregnancy, stress, and resilience. Interviews were transcribed verbatim and coded using MAXQDA 2024 qualitative software. Themes were generated using thematic analysis to understand how AA/BL women experience discrimination during pregnancy and childbirth and how resilience manifests in their lives. Two themes were identified: 1. Perceived healthcare discrimination during pregnancy and childbirth, and 2. Leveraging resilience to mitigate experiences of healthcare discrimination and life stressors. The results highlight that AA/BL women experience healthcare discrimination during pregnancy and childbirth, including poor quality care, and mitigate these experiences by seeking Black OBGYN providers. It is evident from the stories in our study that AA/BL women are highly resilient and display positive coping mechanisms to overcome challenges in their lives. While resilience can help to buffer against adversity, systems and policies should be in place to protect against stressors.

Background: Immigrants' employment is linked with health care access in the US, but we lack a thorough understanding of how immigrants' experiences of employment exclusions influence their health care access in the context of immigrant racialization. We aimed to assess employment exclusions (i.e., exclusions from jobs and violations at work) across Asian and Latine foreign-born adults, the two largest immigrant racial groups, and their associations with health care access. We also sought to understand variations by race, and current or past legal status.

Methods: We used 2018-2020 Research on Immigrant Health and State Policy survey data from 2,010 Latine and Asian foreign-born adults in California. We measured seven indicators of employment exclusions and used weighted logistic regression to estimate associations between employment exclusions and health care access: usual source of care and delaying care in the past 12 months. We tested race, current legal status and past legal status as moderators.

Results: Nearly one-quarter (23.8%) of respondents reported ≥1 employment exclusion. Latine racial identity, current status as a non-citizen without permanent residency, and being previously undocumented was associated with greater employment exclusions. Employment exclusions were associated with 1.47 times (95% CI: 1.27, 1.69) greater odds of delaying care. Previous undocumented status, but not race or current legal status, moderated associations between violations at work and delay in care.

Conclusions: Latine immigrants face a greater number of barriers to employment opportunities and protections of worker rights compared to Asians, while employment exclusions and past legal status drives poorer health care utilization.

Medical gaslighting, defined as the minimization or dismissal of a patient's symptoms by healthcare providers, has gained increasing visibility, particularly among marginalized populations. This phenomenon disproportionately impacts individuals facing systemic inequities related to race, gender and class, effects that are compounded at the intersection of these identities. Medical gaslighting contributes to misdiagnosis, delayed care, emotional distress, and long-term mistrust in healthcare systems. Through an intersectional framework and illustrative case studies, this paper examines how implicit bias, structural racism, and the historical mistreatment of marginalized groups contribute to the erasure of patient experiences. The emotional and psychological toll of medical gaslighting further exacerbates existing health disparities. To address this issue, we explore strategies including provider education on implicit bias, expanded patient advocacy, and policy reforms aimed at promoting health equity. These interventions are critical for restoring trust and improving health outcomes, particularly for those most vulnerable to systemic healthcare neglect.