Journal of Racial and Ethnic Health Disparities最新文献

Objective: This study aimed to apply Andersen's behavioral model of health services to examine the association of patient-provider racial and ethnic concordance on health care use within Asian American subgroups with a focus on nativity.

Methods: We estimate multivariate probit models using data from the Medical Expenditure Panel Survey. We collect and utilize data on preventive care visits, visits for new health problems, visits for ongoing health problems, and number of doctor's visits from survey years 2013-2017 to measure health utilization. Additionally, we include data on racial and ethnic concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis to capture predisposing, enabling, and need factors. Our sample includes 61,667 observations, mainly White respondents (86.2%) with 3.0% Indian American respondents, 3.1% Chinese American respondents, 2.3% Filipino American respondents, and 5.4% respondents classified in the survey as Other Asians. A total of 3% (1847) of the cases in the sample involved Asian provider-patient concordance.

Results: Our study provides evidence of differences in health utilization within Asian subgroups even after controlling for enabling, need, and other predisposing factors. Namely, Asian American patient-provider concordance is associated with statistically significant increases in the probabilities of seeking preventive care, seeking care for a new problem, and seeking care for an ongoing problem, relative to Asian American patients with non-Asian American providers. We also find that the association is not equal across the Asian American subgroups. The Asian American patient-provider concordance is consistently positive and significant for Chinese Americans. For the number of provider visits, the association is only positive and significant for foreign-born Chinese American patients.

Conclusions: The overall results support the positive association between the predisposing factor of Asian patient-provider race concordance and health care utilization. Moreover, patient-provider concordance is particularly important for the Chinese subgroup, which is less likely to seek medical care relative to White patients. The findings suggest that the diversity in the Asian population should be taken into account when designing outreach programs, particularly for non-US-born patients.

Introduction: To assess the utilization and prostate cancer (PCa)-specific mortality (PCSM) between non-Hispanic Black (NHB) and non-Hispanic White (NHW) on active surveillance (AS) with intermediate risk PCa (iPCa).

Methods: The Surveillance, Epidemiology, and End Results database was queried between 2010-2016. The rate of AS was calculated per year between NHB and NHW using univariable logistic analysis (UVA) and multivariable logistic analysis (MVA). Next, inverse probability of treatment weighting was performed on those that underwent watchful waiting (WW) and competing-risks cumulative incidence function (CIF) and MVA were used to assess the impact of race on other-cause mortality (OCM) and PCSM. Statistical significance defined as p < 0.05, but some observations were deemed non-statistically significant per our Benjamini-Hochberg procedures, RESULTS: 50,315 patients had iPCa, and 3,310 underwent AS/WW. The rate of AS increased amongst NHB (+ 3.1%) and NHW (+ 5.7%) from 2010 - 2016. UVA did not show an association with race, but MVA showed a negative association, based on our Benjamini-Hochberg correction, between NHB and AS [OR 0.68 (95% CI: 5.4-0.87; p = 0.002)]. On CIF, NHB and NHW had non-significant differences in OCM in the weighted cohort (p = 0.03), due to the Benjamini-Hochberg correction, and that was confirmed with MVA with a HR of 1.23 (95% CI: 1.02-1.49; p = 0.03). However, the CIF on PCSM showed NHB had a higher risk of PCSM (p < 0.0001), and that was confirmed with MVA with a HR of 3.01 (95% CI: 2.00-4.53; p < 0.001).

Conclusion: The utilization of AS for iPCa increased amongst NHB and NHW patients. Unfortunately, NHB race was associated with increased risk of PCSM from one year to the next compared to NHW patients.

Little data demonstrates the feasibility of place-based, neighborhood-level care delivered by health coaches in medically underserved neighborhoods to expand access to essential primary care and address health disparities. This concurrent mixed-methods pilot study describes experience with the innovative Neighborhood Health Hub Program in Memphis, TN. Patient characteristics, including body mass index (BMI), blood glucose, blood pressure, and service utilization, were assessed. Key informant interviews and community meetings were conducted in an initial community listening period to guide program development. Patient experience with program services was assessed using semi-structured client interviews. In year 1, 355 year-one clients were outreached, 146 (41.1%) through community events, 149 (42%) walk-ins, 38 (10.7%) door-to-door communication, 34 (9.6%) telephone, and 9 (2.5%) referral. Of the 198 (56.1%) fully screened, mean age was 52.0 (± 15.9) years, 94.5% were African American, 55.8% female, and 32.7% without a primary care provider. Baseline blood pressure was uncontrolled (≥ 140/90) in 52.3%, BMI was ≥ 30 in 50%, and random plasma glucose was high (≥ 130 mg/dl) in 23.4%. The majority (68.3%) participated in individual health coaching. Sixty-eight group sessions had an average of 4 participants (range 1-13) and were focused on chronic illness management (39.7%), exercise (26.5%), or nutrition (25.0%). Major qualitative themes highlighted the importance of social barriers and social support for chronic condition management. Place-based, neighborhood-level care delivered by health coaches in medically underserved neighborhoods is a promising approach for extending primary care, expanding access to essential preventive and primary care, reducing health disparities, and improving patient outcomes.

Background: Food insecurity disproportionately affects Black households in the United States (US) and is linked to adverse perinatal health outcomes. Addressing food insecurity is crucial for improving maternal and infant health outcomes, especially among Black mothers. This scoping review explores the impact of food insecurity and low food access (i.e., food deserts) on various maternal health outcomes during the perinatal period among Black women.

Methods: Using the Joanna Briggs Institute guidelines for scoping reviews, literature searches were conducted in PubMed, CINAHL, and Web of Science databases from January 2013 to January 2023. Eligible studies focused on Black women in the US experiencing food insecurity and reporting maternal health outcomes.

Results: Of 154 initially identified studies, nine met the inclusion criteria. Findings reveal diverse associations between food insecurity and perinatal outcomes among Black women, including gestational diabetes, breastfeeding practices, and maternal anemia. While some studies demonstrated direct links, others explored stressors associated with food insecurity during pregnancy.

Conclusion: The current literature suggests that food insecurity exacerbates health disparities among Black birthing individuals, contributing to adverse perinatal health outcomes. Addressing food insecurity is crucial for improving maternal health equity. It is recommended that food insecurity screening and tailored support services be integrated into prenatal care services. To promote health equity, public health policies should prioritize interventions targeting food insecurity among Black birthing individuals and communities. Collaborative efforts between legislators, providers, educators, researchers, and communities are needed to implement comprehensive interventions addressing the systemic inequities from which food insecurity stems, to achieve health and nutritional equity for all birthing individuals.

Asian Americans (AA) have an increased risk of developing type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) compared to non-Hispanic White Americans, yet over half of AA patients with T2DM are underdiagnosed or untreated. Surgical stress, known to exacerbate hyperglycemia in T2DM, is also associated with increased morbidity and mortality. Thus, AA patients may be at elevated risk of experiencing poor outcomes following surgery. This review aims to summarize the available literature on the perioperative (defined as before, during, and after surgery) risk and outcomes of T2DM in AA surgical patients and identify specific knowledge gaps. A scoping review protocol was developed in accordance with PRISMA guidelines. Medline, Embase, Web of Science, Scopus, and Cochrane CENTRAL were comprehensively searched for publications without language or date limits on perioperative management of undiagnosed and diagnosed T2DM and/or MetS in AA. Inclusion criteria included full-text studies conducted in the United States (U.S.), specified AA with T2DM and/or MetS as a study population, and focused on perioperative considerations or clinical outcomes. Search results yielded 862 articles imported into Covidence for title, abstracts, full-text screening, and data extraction. Fifteen publications were identified for full review: 13 (86.6%) retrospective cohort study articles, 1 (6.6%) review article, and 1 (6.6%) randomized controlled trial. These articles represented 2,494,987 total patients and 38,440 aggregate Asian American patients (1.5%). Notable findings amongst studies included (1) higher T2DM rates among AA compared to other racial/ethnic groups, (2) diagnosis variations among AA ethnic subgroups, (3) and conflicting findings on postoperative complications in AA. This review highlights knowledge gaps in our current understanding of disparities regarding perioperative risks and outcomes of AA surgical patients with T2DM and/or MetS. There is a need for stronger research methodologies to guide evidence-based recommendations regarding the perioperative risks and optimal management of this patient population.

During the COVID-19 quarantine, the insufficient prioritization of sexual and reproductive health (SRH) resources exacerbated health disparities experienced by young Black women in the post-pandemic period. The historical legacy of medical treatment of Black women persists within current systems of care. In this study, we use the biopsychosocial framework to investigate perceived healthcare treatment and barriers to accessing SRH resources for Black women. We aim to understand how perceived provider treatment impacts SRH experiences and which experiences were perceived as a barrier to accessing SRH resources. Using a cross-sectional design, Qualtrics Panel participants, between ages 18 and 29 years, who identify as Black/African American and female, and living in the USA responded to a sexual health questionnaire. Results from T-test, chi-squared test, and logistic regression models indicate that perceptions of poor provider treatment are associated with poorer SRH experiences, with decreased odds of receiving a prescription for a birth control method (CI 0.913-0.978); receiving a check-up or medical test related to using birth control (CI 0.93-0.997); receiving counseling or information about birth control (CI 0.917-0.983); and asking a question about whether the participant wants to become pregnant in the next year (CI 0.900-0.97). Sexual health advocates should focus on marginalized groups accessing SRH resources. These groups experienced exacerbated sexual health disparities due to treatment delays during COVID-related quarantine orders. Social work and public health researchers should investigate how state and federal policies can prioritize equitable treatment for those most affected by the COVID-19 pandemic in a post-pandemic era.

Purpose: To examine the relationship between residential racial and economic segregation and main causes of death at the county level in the USA.

Methods: Residential racial and economic segregation quintiles were determined using the Index of Concentration at the Extremes (ICE). Linear mixed-effects model was applied to calculate adjusted mortality rate ratios (aRR).

Results: The ICE for race + income outperformed the ICE for race and the ICE for income. Among 3142 counties, the average age-adjusted all-cause mortality rates were 980.25, 919.82, 844.37, 781.82, and 703.01 per 100,000 across ICE for race + income quintiles, from the most deprived to the most privileged, respectively (p for trend: < 0.001). The corresponding aRRs for all-cause mortality were 1.32, 1.23, 1.17, 1.10, and 1 (p for trend: < 0.001). Furthermore, both mortality rates and aRRs for all 11 main causes of death showed a significant decrease from the most deprived to the most privileged counties (p for trend: < 0.001).

Conclusions: There is a strong association between residential racial and economic segregation and age-adjusted all-cause mortality as well as the 11 main causes of death in US counties, with a clear decreasing trend observed across ICE for race + income quintiles. These findings underscore the urgent need for policy interventions to reduce residential segregation, including equitable urban planning, investment in underserved communities, and improved access to healthcare and education in disadvantaged areas. Addressing these structural inequities could be an effective strategy for reducing mortality disparities and advancing health equity.

Employing a US national sample (N = 1041), this project investigates the relationship between media usage and vaccine hesitancy, as well as the potential variations in this relationship based on vaccine types and individuals' racial backgrounds. Findings revealed that participants held different levels of acceptance of different vaccines. Compared to other racial groups, African Americans held a lower level of positive attitudes toward different types of vaccines; however, racial groups did not differ significantly in terms of intention to receive vaccines. Individuals' exposure to information emphasizing various aspects of vaccination either mitigate or enhance their vaccine hesitancy. In addition, the number of social media platforms individuals regularly use is negatively associated with their vaccine hesitancy. The study offers valuable insights for addressing vaccine hesitancy in diverse populations. Theoretical and practical implications were discussed.

The life expectancy gap between Black and White Americans has narrowed, but progress remains slow due to the persistent consequences of lifetime exposure to structural and interpersonal experiences of racism and discrimination in various settings, for example, disadvantaged housing, neighborhood, and economic conditions. It is important to understand challenges and facilitators to healthy aging among Black Americans, i.e., maintaining functional ability and well-being in older age. We explore the intersection of housing, neighborhoods, and healthy aging among Black adults who live in two predominantly Black, low-income neighborhoods in Pittsburgh, Pennsylvania. This complementary multi-method study combined survey data (n = 642) and qualitative interviews (n = 60) to delve into the perspectives of individuals aged 35 to 89. Survey and interview respondents were mostly renters (76% and 77% respectively), and about a fifth of those surveyed and interviewed reported any major home environment problems. Half of interviewees described poor quality housing as a source of stress, such as mold, building design, accessibility, and relational difficulties with their landlords and building managers. Buildings' social environment was an important dimension of housing quality among renters-behavioral and value differences between older and younger tenants caused frustration. Survey respondents were mostly (73%) satisfied with their neighborhoods' livability. Good access to transportation and community spaces were seen as positive factors to be sustained and encouraged in future. Policy implications include tracking health outcomes in housing programs for aging Black adults to inform improvements and enhanced oversight and coordination to ensure high-quality housing that meets the needs of older adults.

Background: Insufficient research has been done on NASH-related cirrhosis mortality and potential racial disparities in mortality rates.

Objective: This study aims to analyze racial differences in mortality rates among patients with non-alcoholic fatty liver disease (NAFLD), non-alcoholic fatty liver (NAFL), and non-alcoholic steatohepatitis (NASH), hypothesizing that hazard ratios for mortality among patients with NAFLD, NAFL, and NASH would be significantly different for Mexican American patients compared to other racial groups.

Methods: Data from NHANES III (1988-1994) representing the U.S. population were analyzed. Bivariate analysis and Cox proportional hazards models were employed to determine mortality rates and predictors across different racial/ethnic groups, adjusting for variables age, gender, smoking status (current, former, non-smoker), BMI (normal, overweight, obese), and a series of biomarkers.

Results: The prevalence of liver diseases in the sample was: NAFLD (12.1%), NAFL (20.0%), and NASH (3.1%). Deceased patients with NASH had the highest weighted mortality rate (50.6%), followed by NAFLD (39.1%) and NAFL (35.5%). Compared to White patients, Black and Mexican American patients exhibited lower mortality rates for NAFLD. Mexican American patients also had lower mortality rates for NFAL and NASH. White patients showed higher hazard ratios (HR) for NAFLD and NAFL compared to Black and Mexican-American patients. However, for NASH, there were no significant differences in HR between racial/ethnic groups.

Conclusions: Despite higher prevalence rates among Mexican American and Black patients, their mortality rates for NAFLD, NAFL, and NASH were comparable or lower than those for Whites. This highlights the need for further research to inform better management and treatment strategies.