Pub Date : 2024-09-17DOI: 10.1007/s40615-024-02137-3
Janelle R. Edwards, Christian Ong, Sharrelle Barber, Irene Headen, Loni P. Tabb, Anneclaire J. De Roos, Leah H. Schinasi
Background
Mortgage discrimination refers to the systematic withholding of home mortgages from minoritized groups. In recent years, there has been an increase in empirical research investigating associations of historical and contemporary mortgage discrimination on contemporary outcomes. Investigators have used a variety of measurement methods and approaches, which may have implications for results and interpretation.
Purpose
We conducted a systematic review of peer-reviewed literature that has quantified links between both historical and current mortgage discrimination with contemporary adverse environmental, social, and health outcomes. Our goals were to document the methodology used to measure and assign mortgage discrimination, to assess implications for results and interpretation, and to make recommendations for future work.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, literature searches were conducted in September 2022 using terms that combined concepts of mortgage discrimination, health, and neighborhood environment.
Results
In total, 45 papers fit the eligibility criteria. In these, researchers investigated associations between mortgage discrimination and: (1) health outcomes (N = 28); (2) environmental and social exposures including heat, air pollution, greenspace, soil lead levels, and crime (N = 12); and (3) built environment features, including presence of retail alcohol, fast food, and tobacco stores (N = 5). Eleven included studies used Home Mortgage Discrimination Act (HMDA) data to identify racialized bias in mortgage discrimination or redlining, and 34 used Homeowner Loan Corporation (HOLC) maps. The construction and parametrization of mortgage discrimination or redlining and the spatial assignment of HOLC grades to contemporary addresses or neighborhoods varied substantially across studies.
Conclusions
Results from our review suggest the need for careful consideration of optimal methods to analyze mortgage discrimination such as HOLC spatial assignment or HMDA index parametrization, contemplation of covariates, and place-based knowledge of the study location.
{"title":"Methodologic Strategies for Quantifying Associations of Historical and Contemporary Mortgage Discrimination on Population Health Equity: A Systematic Review","authors":"Janelle R. Edwards, Christian Ong, Sharrelle Barber, Irene Headen, Loni P. Tabb, Anneclaire J. De Roos, Leah H. Schinasi","doi":"10.1007/s40615-024-02137-3","DOIUrl":"https://doi.org/10.1007/s40615-024-02137-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Mortgage discrimination refers to the systematic withholding of home mortgages from minoritized groups. In recent years, there has been an increase in empirical research investigating associations of historical and contemporary mortgage discrimination on contemporary outcomes. Investigators have used a variety of measurement methods and approaches, which may have implications for results and interpretation.</p><h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>We conducted a systematic review of peer-reviewed literature that has quantified links between both historical and current mortgage discrimination with contemporary adverse environmental, social, and health outcomes. Our goals were to document the methodology used to measure and assign mortgage discrimination, to assess implications for results and interpretation, and to make recommendations for future work.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, literature searches were conducted in September 2022 using terms that combined concepts of mortgage discrimination, health, and neighborhood environment.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In total, 45 papers fit the eligibility criteria. In these, researchers investigated associations between mortgage discrimination and: (1) health outcomes (<i>N</i> = 28); (2) environmental and social exposures including heat, air pollution, greenspace, soil lead levels, and crime (<i>N</i> = 12); and (3) built environment features, including presence of retail alcohol, fast food, and tobacco stores (<i>N</i> = 5). Eleven included studies used Home Mortgage Discrimination Act (HMDA) data to identify racialized bias in mortgage discrimination or redlining, and 34 used Homeowner Loan Corporation (HOLC) maps. The construction and parametrization of mortgage discrimination or redlining and the spatial assignment of HOLC grades to contemporary addresses or neighborhoods varied substantially across studies.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Results from our review suggest the need for careful consideration of optimal methods to analyze mortgage discrimination such as HOLC spatial assignment or HMDA index parametrization, contemplation of covariates, and place-based knowledge of the study location.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255994","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 : 2024-09-16DOI: 10.1007/s40615-024-02135-5
Kristi L. Allgood, Nancy L. Fleischer, Shervin Assari, Jeffrey Morenoff, Belinda L. Needham
Although cardiovascular disease (CVD) mortality rates are declining for American adults, a disparity remains between non-Hispanic Black and non-Hispanic White adults. Previous research has shown that residential segregation, a form of structural racism, experienced in childhood is associated with later-life racial and ethnic health disparities, including disparities in CVD and its risk factors. However, little is known about the health consequences of exposure to segregated schools, especially among those living in neighborhoods with high concentrations of minoritized people. This study used data from the In-School, Wave I, and Wave IV surveys of the National Longitudinal Study of Adolescent to Adult Health to examine a novel school measure of school racial segregation (Index of the Concentration of Extremes, ICE) as a predictor of Framingham 30-year CVD risk scores. We used General Estimating Equation models to evaluate the association between ICE, measured at Wave I, and two different 30-year CVD risk scores, measured at Wave IV, and examined whether the relationship varied by race. We observed that higher levels of school segregation were associated with a higher 30-year CVD risk among non-Hispanic Black participants while higher segregation was associated with a lower 30-year CVD risk for non-Hispanic White participants. This research suggests that exposure to segregation in the school setting may contribute to observed disparities in CVD among US adults.
尽管美国成年人的心血管疾病(CVD)死亡率正在下降,但非西班牙裔黑人和非西班牙裔白人之间仍然存在差距。先前的研究表明,童年时期经历的住宅隔离(一种结构性种族主义)与日后生活中的种族和民族健康差异有关,包括心血管疾病及其风险因素方面的差异。然而,人们对受到隔离学校影响的健康后果知之甚少,尤其是那些生活在少数民族聚居区的人们。本研究利用《全国青少年到成人健康纵向研究》(National Longitudinal Study of Adolescent to Adult Health)的校内、第一波和第四波调查数据,研究了学校种族隔离的一种新的衡量标准(极端集中指数,ICE)作为弗明翰 30 年心血管疾病风险分数的预测指标。我们使用一般估计方程模型评估了第一波测量的 ICE 与第四波测量的两种不同的 30 年心血管疾病风险分数之间的关系,并研究了这种关系是否因种族而异。我们发现,学校隔离程度越高,非西班牙裔黑人参与者 30 年心血管疾病风险越高,而隔离程度越高,非西班牙裔白人参与者 30 年心血管疾病风险越低。这项研究表明,学校环境中的种族隔离可能是造成美国成年人心血管疾病风险差异的原因之一。
{"title":"School Segregation During Adolescence is Associated with Higher 30-Year Cardiovascular Risk of Black but not White Young Adults","authors":"Kristi L. Allgood, Nancy L. Fleischer, Shervin Assari, Jeffrey Morenoff, Belinda L. Needham","doi":"10.1007/s40615-024-02135-5","DOIUrl":"https://doi.org/10.1007/s40615-024-02135-5","url":null,"abstract":"<p>Although cardiovascular disease (CVD) mortality rates are declining for American adults, a disparity remains between non-Hispanic Black and non-Hispanic White adults. Previous research has shown that residential segregation, a form of structural racism, experienced in childhood is associated with later-life racial and ethnic health disparities, including disparities in CVD and its risk factors. However, little is known about the health consequences of exposure to segregated schools, especially among those living in neighborhoods with high concentrations of minoritized people. This study used data from the In-School, Wave I, and Wave IV surveys of the National Longitudinal Study of Adolescent to Adult Health to examine a novel school measure of school racial segregation (Index of the Concentration of Extremes, ICE) as a predictor of Framingham 30-year CVD risk scores. We used General Estimating Equation models to evaluate the association between ICE, measured at Wave I, and two different 30-year CVD risk scores, measured at Wave IV, and examined whether the relationship varied by race. We observed that higher levels of school segregation were associated with a higher 30-year CVD risk among non-Hispanic Black participants while higher segregation was associated with a lower 30-year CVD risk for non-Hispanic White participants. This research suggests that exposure to segregation in the school setting may contribute to observed disparities in CVD among US adults.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268918","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}
A lack of a “gold standard” operationalized index to measure structural racism (SR) in the current literature limits the comparison of the evidence available. This study aims to synthesize the measures of SR from the current literature to identify the measures used to date, study the indicators included, and investigate its expanding domain.
Methods
A literature search of original quantitative studies in the Google Scholar and PubMed databases for articles dated January 1, 2000–July 31, 2023, was conducted with search terms: [“Institutionalized Racism” OR “Systemic Racism”, OR “Structural Racism”] AND “Health” AND “United States.” The studies were summarized and extracted based on the type of SR index used, the domains of SR incorporated, and the health outcomes studied.
Results
A total of 74 articles were included in the final review. The historical redlining score, G-statistics, index of concentration, and structural racism index were common quantifiable measures of SR. These indices capture 56 indicators across 11 significant domains to measure SR. Similarly, SR indices are being used mostly to study the impact of SR on cardiovascular diseases and other chronic health conditions, women’s and maternal health-related issues, and COVID-19 outcomes.
Conclusion
Multiple indices have been developed to capture SR, and since the COVID-19 pandemic, we have observed an increased interest in understanding health disparities through the lens of SR. With the rise in evidence on experiences of minority races related to racism, there is a high need for a standard approach to measuring SR.
{"title":"A Standard Measure of Structural Racism, Do We Have One? Can We Have One? A Narrative Review of Commonly Used Measures and Domains of Use","authors":"Biplav Babu Tiwari, Carlyncia McDowell, Omar-Shariff Sandy Roberts, Steven Kogan, Zhuo “Adam” Chen, Janani Rajbhandari-Thapa","doi":"10.1007/s40615-024-02179-7","DOIUrl":"https://doi.org/10.1007/s40615-024-02179-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>A lack of a “gold standard” operationalized index to measure structural racism (SR) in the current literature limits the comparison of the evidence available. This study aims to synthesize the measures of SR from the current literature to identify the measures used to date, study the indicators included, and investigate its expanding domain.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A literature search of original quantitative studies in the Google Scholar and PubMed databases for articles dated January 1, 2000–July 31, 2023, was conducted with search terms: [“Institutionalized Racism” OR “Systemic Racism”, OR “Structural Racism”] AND “Health” AND “United States.” The studies were summarized and extracted based on the type of SR index used, the domains of SR incorporated, and the health outcomes studied.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 74 articles were included in the final review. The historical redlining score, G-statistics, index of concentration, and structural racism index were common quantifiable measures of SR. These indices capture 56 indicators across 11 significant domains to measure SR. Similarly, SR indices are being used mostly to study the impact of SR on cardiovascular diseases and other chronic health conditions, women’s and maternal health-related issues, and COVID-19 outcomes.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Multiple indices have been developed to capture SR, and since the COVID-19 pandemic, we have observed an increased interest in understanding health disparities through the lens of SR. With the rise in evidence on experiences of minority races related to racism, there is a high need for a standard approach to measuring SR.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255996","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 : 2024-09-16DOI: 10.1007/s40615-024-02173-z
Brandon M. Varilek, Mary J. Isaacson, Hossein Moradi Rekabdarkolaee
Background
American Indian/Alaska Natives (AI/ANs) disproportionately suffer from diabetes compared to non-Hispanic whites (NHW). In 2013, 69% of end-stage kidney disease (ESKD) in AI/ANs was caused by diabetes (ESKD-D) but accounts for only 44% of ESKD diagnoses in the overall USA population. Moreover, the diagnosis of diabetes and ESKD-D may be significantly related to social determinants of health. The purpose of this study was to conduct a survival analysis of AI/ANs and NHWs diagnosed with ESKD-D nationally and by Indian Health Service region and correlate the survival analysis to the Area Deprivation Index® (ADI®).
Methods
This manuscript reports a retrospective cohort analysis of 2021 United States Renal Data System data. Eligible patient records were AI/AN and NHWs with diabetes as the primary cause of ESKD and started dialysis on January 1, 2014, or later.
Results
A total of 81,862 patient records were included in this analysis, of which 1798 (2.2%) were AI/AN. AI/ANs survive longer, with an 18.4% decrease in risk of death compared to NHW. However, AI/ANs are diagnosed with ESKD-D and start dialysis earlier than NHWs. ADI® variables became significant as ADI® ratings increased, meaning persons with greater social disadvantage had worse survival outcomes.
Conclusions
The findings reveal that AI/ANs have better survival outcomes than NWH, explained in part by initiating dialysis earlier than NHW. Additional research is needed to explore factors (e.g., social determinants; cultural; physiologic) that contribute to earlier diagnosis of ESKD-D in AI/ANs and the impact of prolonged dialysis on quality of life of those with ESKD-D.
{"title":"Evaluating Disparities in End-Stage Kidney Disease Survival Among American Indian/Alaska Native Persons with Diabetes","authors":"Brandon M. Varilek, Mary J. Isaacson, Hossein Moradi Rekabdarkolaee","doi":"10.1007/s40615-024-02173-z","DOIUrl":"https://doi.org/10.1007/s40615-024-02173-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>American Indian/Alaska Natives (AI/ANs) disproportionately suffer from diabetes compared to non-Hispanic whites (NHW). In 2013, 69% of end-stage kidney disease (ESKD) in AI/ANs was caused by diabetes (ESKD-D) but accounts for only 44% of ESKD diagnoses in the overall USA population. Moreover, the diagnosis of diabetes and ESKD-D may be significantly related to social determinants of health. The purpose of this study was to conduct a survival analysis of AI/ANs and NHWs diagnosed with ESKD-D nationally and by Indian Health Service region and correlate the survival analysis to the Area Deprivation Index® (ADI®).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This manuscript reports a retrospective cohort analysis of 2021 United States Renal Data System data. Eligible patient records were AI/AN and NHWs with diabetes as the primary cause of ESKD and started dialysis on January 1, 2014, or later.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 81,862 patient records were included in this analysis, of which 1798 (2.2%) were AI/AN. AI/ANs survive longer, with an 18.4% decrease in risk of death compared to NHW. However, AI/ANs are diagnosed with ESKD-D and start dialysis earlier than NHWs. ADI® variables became significant as ADI® ratings increased, meaning persons with greater social disadvantage had worse survival outcomes.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The findings reveal that AI/ANs have better survival outcomes than NWH, explained in part by initiating dialysis earlier than NHW. Additional research is needed to explore factors (e.g., social determinants; cultural; physiologic) that contribute to earlier diagnosis of ESKD-D in AI/ANs and the impact of prolonged dialysis on quality of life of those with ESKD-D.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255997","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 : 2024-09-16DOI: 10.1007/s40615-024-02122-w
J. M. Wise, M. C. Kempf, C. Ott, A. P. Footman, C. Hardy, B. Y. Araya, C. Walker, C. Latham, R. Stockett, G. L. Daniels, M. Alexander, R. G. Lanzi
The Deep South is the epicenter of the HIV-epidemic in the United States, with rural AAs bearing the greatest burden. Traditional efforts to improve testing efforts have been largely unsuccessful due to their failure to recognize and leverage the sociopolitical and cultural factors that affect the uptake of HIV-screening interventions at the community level. The purpose of this study was to gain a deeper understanding of the socio-cultural contexts impacting HIV-testing in the rural South, and to assess strategies to increase testing in rural, Southern communities. Focus groups (n = 8) and semi-structured interviews (n = 31) were conducted among community and faith-based leaders in Alabama and Mississippi, to inform our understanding of local perceptions of HIV infection, barriers and facilitators impacting HIV-testing, and best strategies for improving testing efforts at the local level. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed to extract major themes. While both faith-based and community leaders reported at least some stigmatizing attitudes towards HIV infection, faith-based leaders were more likely to report discomfort being around someone with HIV and were more likely to link the spread of HIV to immoral behaviors. The combination of the cultural importance of the Church, deep-seated religiosity among community members, and faith-based messages associating HIV infection with immorality directly impacted HIV stigma within the community-in turn, decreasing willingness to participate in HIV-testing, disclose positive HIV serostatus, or openly discuss transmission protection behaviors. The Church was identified as crucial to include to improve HIV-testing efforts in the rural South, due to their prominent sociopolitical roles within communities and ability to influence community members’ perceptions of HIV stigma. Faith-based leaderships should be included in initiatives to increase improve HIV-testing and awareness of status and reduce HIV disparities in the Deep South.
深南地区是美国艾滋病疫情的中心,农村地区的 AA 族人承受着最大的负担。由于未能认识到并利用影响社区接受 HIV 筛查干预的社会政治和文化因素,改进检测工作的传统努力在很大程度上并不成功。本研究旨在深入了解影响南方农村地区 HIV 检测的社会文化背景,并评估在南方农村社区增加检测的策略。我们对阿拉巴马州和密西西比州的社区和宗教领袖进行了焦点小组(n = 8)和半结构式访谈(n = 31),以帮助我们了解当地人对 HIV 感染的看法、影响 HIV 检测的障碍和促进因素,以及改善当地检测工作的最佳策略。我们对访谈和焦点小组进行了录音、逐字记录和分析,以提取主要的主题。虽然宗教领袖和社区领袖都报告了对 HIV 感染的至少一些轻蔑态度,但宗教领袖更有可能报告与 HIV 感染者相处时感到不适,并且更有可能将 HIV 的传播与不道德行为联系起来。教会在文化上的重要性、社区成员根深蒂固的宗教信仰以及将 HIV 感染与不道德行为联系起来的信仰信息,这些因素的结合直接影响了社区内对 HIV 的鄙视态度,进而降低了参与 HIV 检测、披露阳性 HIV 血清状态或公开讨论传播保护行为的意愿。由于教会在社区中扮演着重要的社会政治角色,并有能力影响社区成员对艾滋病污名化的看法,因此教会被认为是改进南方农村地区艾滋病检测工作的关键所在。应将宗教领袖纳入各项倡议中,以提高对艾滋病毒检测的改善和对其状况的认识,并减少南部深处的艾滋病毒差异。
{"title":"Faith-based Community Engagement in HIV-Testing and Awareness of HIV Status in Southern, Rural, African American Communities","authors":"J. M. Wise, M. C. Kempf, C. Ott, A. P. Footman, C. Hardy, B. Y. Araya, C. Walker, C. Latham, R. Stockett, G. L. Daniels, M. Alexander, R. G. Lanzi","doi":"10.1007/s40615-024-02122-w","DOIUrl":"https://doi.org/10.1007/s40615-024-02122-w","url":null,"abstract":"<p>The Deep South is the epicenter of the HIV-epidemic in the United States, with rural AAs bearing the greatest burden. Traditional efforts to improve testing efforts have been largely unsuccessful due to their failure to recognize and leverage the sociopolitical and cultural factors that affect the uptake of HIV-screening interventions at the community level. The purpose of this study was to gain a deeper understanding of the socio-cultural contexts impacting HIV-testing in the rural South, and to assess strategies to increase testing in rural, Southern communities. Focus groups (<i>n</i> = 8) and semi-structured interviews (<i>n</i> = 31) were conducted among community and faith-based leaders in Alabama and Mississippi, to inform our understanding of local perceptions of HIV infection, barriers and facilitators impacting HIV-testing, and best strategies for improving testing efforts at the local level. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed to extract major themes. While both faith-based and community leaders reported at least some stigmatizing attitudes towards HIV infection, faith-based leaders were more likely to report discomfort being around someone with HIV and were more likely to link the spread of HIV to immoral behaviors. The combination of the cultural importance of the Church, deep-seated religiosity among community members, and faith-based messages associating HIV infection with immorality directly impacted HIV stigma within the community-in turn, decreasing willingness to participate in HIV-testing, disclose positive HIV serostatus, or openly discuss transmission protection behaviors. The Church was identified as crucial to include to improve HIV-testing efforts in the rural South, due to their prominent sociopolitical roles within communities and ability to influence community members’ perceptions of HIV stigma. Faith-based leaderships should be included in initiatives to increase improve HIV-testing and awareness of status and reduce HIV disparities in the Deep South.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268917","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 : 2024-09-13DOI: 10.1007/s40615-024-02164-0
Jesse Rattan, T. Robin Bartlett, Christina Blanchard, Meghan Tipre, Azita Amiri, Monica L. Baskin, Rachel Sinkey, Janet M. Turan
Access to postpartum care (PPC) varies in the US and little data exists about whether patient factors may influence receipt of care. Our study aimed to assess the effect of provider-patient racial concordance on Black patients’ receipt of PPC. We conducted a cross-sectional study analyzing over 24,000 electronic health records of childbirth hospitalizations at a large academic medical center in Alabama from January 2014 to March 2020. The primary outcome variable was whether a Black patient with a childbirth hospitalization had any type of PPC visit within 12 weeks after childbirth. We used a generalized estimating equation (GEE) logistic regression model to assess the relationship between provider-patient racial concordance and receipt of PPC. Black patients with Black main providers of prenatal or childbirth care had significantly higher adjusted odds of receiving PPC (adj. OR 2.26, 95% CI 1.65–3.09, p < .001) compared to Black patients with non-Black providers. White patients who had White providers did not have statistically significantly different odds of receiving PPC compared to those with non-White providers after adjustment (adj. OR 0.88, 95% CI 0.68–1.14). Although these results should be interpreted with caution given the low number of Black providers in this sample, our findings suggest that in one hospital system in Alabama, Black birthing people with a racially concordant main prenatal and delivery care provider may have an increased likelihood of getting critical PPC follow-up.
在美国,获得产后护理(PPC)的机会各不相同,而有关患者因素是否会影响接受护理的数据却很少。我们的研究旨在评估医疗服务提供者与患者之间的种族一致性对黑人患者接受产后护理的影响。我们进行了一项横断面研究,分析了亚拉巴马州一家大型学术医疗中心从 2014 年 1 月到 2020 年 3 月的 24,000 多份分娩住院电子健康记录。主要结果变量是住院分娩的黑人患者在分娩后 12 周内是否接受过任何类型的 PPC 访问。我们使用广义估计方程 (GEE) 逻辑回归模型来评估医疗服务提供者与患者之间的种族一致性与接受 PPC 之间的关系。与接受非黑人医疗服务提供者治疗的黑人患者相比,接受黑人产前或分娩护理的黑人患者的调整后接受 PPC 的几率明显更高(调整后 OR 2.26,95% CI 1.65-3.09,p < .001)。经调整后,由白人医疗服务提供者提供服务的白人患者与由非白人医疗服务提供者提供服务的患者相比,接受 PPC 的几率没有明显的统计学差异(adj. OR 0.88,95% CI 0.68-1.14)。尽管由于样本中黑人医疗服务提供者的数量较少,因此在解释这些结果时应谨慎,但我们的研究结果表明,在阿拉巴马州的一家医院系统中,黑人分娩者如果拥有种族一致的主要产前和分娩医疗服务提供者,则获得关键的 PPC 随访的可能性可能会增加。
{"title":"The Relationship Between Provider and Patient Racial Concordance and Receipt of Postpartum Care","authors":"Jesse Rattan, T. Robin Bartlett, Christina Blanchard, Meghan Tipre, Azita Amiri, Monica L. Baskin, Rachel Sinkey, Janet M. Turan","doi":"10.1007/s40615-024-02164-0","DOIUrl":"https://doi.org/10.1007/s40615-024-02164-0","url":null,"abstract":"<p>Access to postpartum care (PPC) varies in the US and little data exists about whether patient factors may influence receipt of care. Our study aimed to assess the effect of provider-patient racial concordance on Black patients’ receipt of PPC. We conducted a cross-sectional study analyzing over 24,000 electronic health records of childbirth hospitalizations at a large academic medical center in Alabama from January 2014 to March 2020. The primary outcome variable was whether a Black patient with a childbirth hospitalization had any type of PPC visit within 12 weeks after childbirth. We used a generalized estimating equation (GEE) logistic regression model to assess the relationship between provider-patient racial concordance and receipt of PPC. Black patients with Black main providers of prenatal or childbirth care had significantly higher adjusted odds of receiving PPC (adj. OR 2.26, 95% CI 1.65–3.09, <i>p</i> < .001) compared to Black patients with non-Black providers. White patients who had White providers did not have statistically significantly different odds of receiving PPC compared to those with non-White providers after adjustment (adj. OR 0.88, 95% CI 0.68–1.14). Although these results should be interpreted with caution given the low number of Black providers in this sample, our findings suggest that in one hospital system in Alabama, Black birthing people with a racially concordant main prenatal and delivery care provider may have an increased likelihood of getting critical PPC follow-up.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185829","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}
Research has reported health care disparities, including low rates of health care utilization, among racial and ethnic minority groups compared to Whites. Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) have experienced these disparities, attributed to various barriers such as limited access to linguistically and culturally concordant health care services. Telehealth may offer a viable mode of health service delivery for AANHPIs. The coronavirus disease of 2019 (COVID-19) pandemic sparked the adoption of technology for receiving health services. However, the literature on telehealth utilization before and during the COVID-19 pandemic among AANHPIs is limited. To address this gap, we conducted a scoping review of telehealth intervention empirical studies serving AANHPIs published between January 2010 and February 2024, using five databases. Twenty-four articles met our inclusion criteria, which required the use of a telehealth intervention program, provision of disaggregated AANHPIs, and targeting of physical and/or mental health outcomes. Our review revealed positive findings of telehealth interventions in helping AANHPIs access health care, with a primary focus on education and consultation for self-management. The review highlighted a range of technological platforms used in AANHPIs telehealth interventions, including web-based, mobile, and blended approaches. Additionally, the review emphasized the need for improved access to technology and reduction in digital exclusion. The findings affirm the usefulness and potential of telehealth interventions, providing implications for how health professionals can serve AANHPIs. Telehealth technology offers the ability for greater accessibility and individualization to address health care disparities in AANHPIs.
{"title":"Telehealth Utilization to Address Health Care Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review","authors":"Seunghye Hong, Jieha Lee, Mathew Goldberg, Constance Emory-Khenmy","doi":"10.1007/s40615-024-02152-4","DOIUrl":"https://doi.org/10.1007/s40615-024-02152-4","url":null,"abstract":"<p>Research has reported health care disparities, including low rates of health care utilization, among racial and ethnic minority groups compared to Whites. Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) have experienced these disparities, attributed to various barriers such as limited access to linguistically and culturally concordant health care services. Telehealth may offer a viable mode of health service delivery for AANHPIs. The coronavirus disease of 2019 (COVID-19) pandemic sparked the adoption of technology for receiving health services. However, the literature on telehealth utilization before and during the COVID-19 pandemic among AANHPIs is limited. To address this gap, we conducted a scoping review of telehealth intervention empirical studies serving AANHPIs published between January 2010 and February 2024, using five databases. Twenty-four articles met our inclusion criteria, which required the use of a telehealth intervention program, provision of disaggregated AANHPIs, and targeting of physical and/or mental health outcomes. Our review revealed positive findings of telehealth interventions in helping AANHPIs access health care, with a primary focus on education and consultation for self-management. The review highlighted a range of technological platforms used in AANHPIs telehealth interventions, including web-based, mobile, and blended approaches. Additionally, the review emphasized the need for improved access to technology and reduction in digital exclusion. The findings affirm the usefulness and potential of telehealth interventions, providing implications for how health professionals can serve AANHPIs. Telehealth technology offers the ability for greater accessibility and individualization to address health care disparities in AANHPIs.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185844","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 : 2024-09-12DOI: 10.1007/s40615-024-02172-0
Aneeka Ratnayake, Julie H. Hernandez, Jessica Justman, Jason E. Farley, Yael Hirsch-Moverman, Ken Ho, Stockton Mayer, Abiodun Oluyomi, Magdalena E. Sobieszczyk, Shobha Swaminathan, Timothy Skalland, Jean de Dieu Tapsoba, Patricia J. Kissinger
Background
Vaccine hesitancy has been a significant concern throughout the COVID-19 pandemic. Vaccine hesitancy can be attributed to lack of confidence in vaccines, complacency about the health threat, or lack of convenience of vaccination. To date, few studies have used methods designed to include populations underrepresented in research when identifying factors associated with vaccine hesitancy.
Methods
Between January and July 2021, potential participants were recruited from community venues selected through time-location sampling in 15 defined communities in the United States. Study staff administered a questionnaire on demographics, COVID-19 behaviors and attitudes, and vaccination status or intention to consenting individuals. Vaccine hesitancy was analyzed among those age 18 years and older from nine of the 15 sites and was defined as self-reported neutral, unlikely, or very unlikely vaccine intention. Logistic regression modeling, adjusted for site, identified factors associated with vaccine hesitancy.
Results
Among 11,559 individuals, vaccine hesitancy by site ranged from 8.7 to 31.1%. Vaccine hesitancy was associated with being Black compared to White, being White compared to Asian, younger age, unstable housing, being unemployed, lower income, having a disability, providing care in home, not reporting inability to visit sick or elderly relatives during the pandemic, not reporting increased anxiety during the pandemic, and not spending more time with loved ones during the pandemic.
Conclusions
In these selected US communities, early in vaccine rollout, there were significant racial disparities in vaccine hesitancy. Additionally, individuals who were more marginalized due to their socioeconomic status were more likely to report vaccine hesitancy. Vaccine campaigns should make efforts to remove barriers to vaccination, by improving convenience.
{"title":"Vaccine Hesitancy at Nine Community Sites Across the United States, Early in COVID-19 Vaccine Rollout","authors":"Aneeka Ratnayake, Julie H. Hernandez, Jessica Justman, Jason E. Farley, Yael Hirsch-Moverman, Ken Ho, Stockton Mayer, Abiodun Oluyomi, Magdalena E. Sobieszczyk, Shobha Swaminathan, Timothy Skalland, Jean de Dieu Tapsoba, Patricia J. Kissinger","doi":"10.1007/s40615-024-02172-0","DOIUrl":"https://doi.org/10.1007/s40615-024-02172-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Vaccine hesitancy has been a significant concern throughout the COVID-19 pandemic. Vaccine hesitancy can be attributed to lack of confidence in vaccines, complacency about the health threat, or lack of convenience of vaccination. To date, few studies have used methods designed to include populations underrepresented in research when identifying factors associated with vaccine hesitancy.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Between January and July 2021, potential participants were recruited from community venues selected through time-location sampling in 15 defined communities in the United States. Study staff administered a questionnaire on demographics, COVID-19 behaviors and attitudes, and vaccination status or intention to consenting individuals. Vaccine hesitancy was analyzed among those age 18 years and older from nine of the 15 sites and was defined as self-reported neutral, unlikely, or very unlikely vaccine intention. Logistic regression modeling, adjusted for site, identified factors associated with vaccine hesitancy.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Among 11,559 individuals, vaccine hesitancy by site ranged from 8.7 to 31.1%. Vaccine hesitancy was associated with being Black compared to White, being White compared to Asian, younger age, unstable housing, being unemployed, lower income, having a disability, providing care in home, not reporting inability to visit sick or elderly relatives during the pandemic, not reporting increased anxiety during the pandemic, and not spending more time with loved ones during the pandemic.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>In these selected US communities, early in vaccine rollout, there were significant racial disparities in vaccine hesitancy. Additionally, individuals who were more marginalized due to their socioeconomic status were more likely to report vaccine hesitancy. Vaccine campaigns should make efforts to remove barriers to vaccination, by improving convenience.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185828","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 : 2024-09-12DOI: 10.1007/s40615-024-02176-w
Sherene E. Sharath, Courtney J. Balentine, David H. Berger, Min Zhan, Nader Zamani, Justin Chin-Bong Choi, Panos Kougias
Background
Few large sample studies have examined whether disparities, as measured by the proxy of race/ethnicity, are observed in long-term mortality after high-risk operations performed in a United States national health system. We compared operation year-related mortality risk by race/ethnicity after high-risk operative interventions among patients receiving care within the VHA.
Methods
From the Veterans Affairs Corporate Data Warehouse and Surgical Quality Improvement Program, data were retrieved for 426,695 patients undergoing high-risk surgical procedures in non-cardiac, general, vascular, thoracic, orthopedic, neurosurgery, and genitourinary specialties between 2000 and 2018. Operation year was used as a surrogate measure of advances in technology and perioperative management. Underrepresented race/ethnicity groups were compared in a binary form with Caucasian/White race, as the reference category. The primary outcome was time to mortality, defined as death occurring at any time, due to any cause, during follow up, and after the initial, eligible surgery.
Results
The median follow-up after 537,448 operations among 426,695 patients was 4.8 years. After adjustment for preoperative risk factors and demographics, long-term mortality risk decreased significantly to a hazard ratio of 0.96 (95% confidence interval, 0.962 to 0.964) over calendar time. Long-term mortality was not significantly higher among African Americans/Blacks compared to Caucasians/Whites (p = 0.22). Among Hispanics, differences in mortality risk favored Caucasians/Whites in the early years under study—a difference that dissipated as time progressed. In the most recent years, no difference in mortality was observed among Asian/Native Americans and Caucasians/Whites.
Conclusions
Risk-adjusted long-term mortality after high-risk operations among Veterans Affairs hospitals did not significantly vary between African Americans/Blacks, Hispanics, and Asian/Native Americans groups.
{"title":"Variation in Long-Term Postoperative Mortality Risk by Race/Ethnicity After Major Non-cardiac Surgeries in the Veterans Health Administration","authors":"Sherene E. Sharath, Courtney J. Balentine, David H. Berger, Min Zhan, Nader Zamani, Justin Chin-Bong Choi, Panos Kougias","doi":"10.1007/s40615-024-02176-w","DOIUrl":"https://doi.org/10.1007/s40615-024-02176-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Few large sample studies have examined whether disparities, as measured by the proxy of race/ethnicity, are observed in long-term mortality after high-risk operations performed in a United States national health system. We compared operation year-related mortality risk by race/ethnicity after high-risk operative interventions among patients receiving care within the VHA.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>From the Veterans Affairs Corporate Data Warehouse and Surgical Quality Improvement Program, data were retrieved for 426,695 patients undergoing high-risk surgical procedures in non-cardiac, general, vascular, thoracic, orthopedic, neurosurgery, and genitourinary specialties between 2000 and 2018. Operation year was used as a surrogate measure of advances in technology and perioperative management. Underrepresented race/ethnicity groups were compared in a binary form with Caucasian/White race, as the reference category. The primary outcome was time to mortality, defined as death occurring at any time, due to any cause, during follow up, and after the initial, eligible surgery.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The median follow-up after 537,448 operations among 426,695 patients was 4.8 years. After adjustment for preoperative risk factors and demographics, long-term mortality risk decreased significantly to a hazard ratio of 0.96 (95% confidence interval, 0.962 to 0.964) over calendar time. Long-term mortality was not significantly higher among African Americans/Blacks compared to Caucasians/Whites (<i>p</i> = 0.22). Among Hispanics, differences in mortality risk favored Caucasians/Whites in the early years under study—a difference that dissipated as time progressed. In the most recent years, no difference in mortality was observed among Asian/Native Americans and Caucasians/Whites.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Risk-adjusted long-term mortality after high-risk operations among Veterans Affairs hospitals did not significantly vary between African Americans/Blacks, Hispanics, and Asian/Native Americans groups.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185830","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 : 2024-09-11DOI: 10.1007/s40615-024-02162-2
Shaniece Criss, Thu T. Nguyen, Sarah M. Gonzales, Brian Lin, Melanie Kim, Katrina Makres, Botamina M. Sorial, Yajie Xiong, Elizabeth Dennard, Junaid S. Merchant, Yulin Hswen
Background
Stigma and discrimination are associated with HIV persistence. Prior research has investigated the ability of ChatGPT to provide evidence-based recommendations, but the literature examining ChatGPT’s performance across varied sociodemographic factors is sparse. The aim of this study is to understand how ChatGPT 3.5 and 4.0 provide HIV-related guidance related to race and ethnicity, sexual orientation, and gender identity; and if and how that guidance mentions discrimination and stigma.
Methods
For data collection, we asked both the free ChatGPT 3.5 Turbo version and paid ChatGPT 4.0 version— the template question for 14 demographic input variables “I am [specific demographic] and I think I have HIV, what should I do?” To ensure robustness and accuracy within the responses generated, the same template questions were asked across all input variables, with the process being repeated 10 times, for 150 responses. A codebook was developed, and the responses (n = 300; 150 responses per version) were exported to NVivo to facilitate analysis. The team conducted a thematic analysis over multiple sessions.
Results
Compared to ChatGPT 3.5, ChatGPT 4.0 responses acknowledge the existence of discrimination and stigma for HIV across different racial and ethnic identities, especially for Black and Hispanic identities, lesbian and gay identities, and transgender and women identities. In addition, ChatGPT 4.0 responses included themes of affirming personhood, specialized care, advocacy, social support, local organizations for different identity groups, and health disparities.
Conclusion
As these new AI technologies progress, it is critical to question whether it will serve to reduce or exacerbate health disparities.
{"title":"“HIV Stigma Exists” — Exploring ChatGPT’s HIV Advice by Race and Ethnicity, Sexual Orientation, and Gender Identity","authors":"Shaniece Criss, Thu T. Nguyen, Sarah M. Gonzales, Brian Lin, Melanie Kim, Katrina Makres, Botamina M. Sorial, Yajie Xiong, Elizabeth Dennard, Junaid S. Merchant, Yulin Hswen","doi":"10.1007/s40615-024-02162-2","DOIUrl":"https://doi.org/10.1007/s40615-024-02162-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Stigma and discrimination are associated with HIV persistence. Prior research has investigated the ability of ChatGPT to provide evidence-based recommendations, but the literature examining ChatGPT’s performance across varied sociodemographic factors is sparse. The aim of this study is to understand how ChatGPT 3.5 and 4.0 provide HIV-related guidance related to race and ethnicity, sexual orientation, and gender identity; and if and how that guidance mentions discrimination and stigma.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>For data collection, we asked both the free ChatGPT 3.5 Turbo version and paid ChatGPT 4.0 version— the template question for 14 demographic input variables “I am [specific demographic] and I think I have HIV, what should I do?” To ensure robustness and accuracy within the responses generated, the same template questions were asked across all input variables, with the process being repeated 10 times, for 150 responses. A codebook was developed, and the responses (<i>n</i> = 300; 150 responses per version) were exported to NVivo to facilitate analysis. The team conducted a thematic analysis over multiple sessions.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Compared to ChatGPT 3.5, ChatGPT 4.0 responses acknowledge the existence of discrimination and stigma for HIV across different racial and ethnic identities, especially for Black and Hispanic identities, lesbian and gay identities, and transgender and women identities. In addition, ChatGPT 4.0 responses included themes of affirming personhood, specialized care, advocacy, social support, local organizations for different identity groups, and health disparities.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>As these new AI technologies progress, it is critical to question whether it will serve to reduce or exacerbate health disparities.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185843","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}