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Is It Safe for Me to Get It? Factors Influencing COVID-19 Vaccination Decision-Making among Postpartum Women Who Are Black and Hispanic in Deep South. 我接种安全吗?影响南部黑人和西班牙裔产后妇女 COVID-19 疫苗接种决策的因素。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-14 DOI: 10.1007/s40615-024-01931-3
Ran Zhang, Tiffany Byrd, Shan Qiao, Myriam E Torres, Xiaoming Li, Jihong Liu

Background: COVID-19 vaccination is vital for ending the pandemic, yet safety concerns persist among pregnant and postpartum women, especially those who are Black and Hispanic. This study aims to explore factors that influence postpartum women's vaccination decision-making during pregnancy and postpartum through women's lived experiences and maternal care providers' (MCPs) observations.

Methods: From January to August 2022, we conducted semi-structured interviews with postpartum women who are Black and Hispanic and with MCPs. Participants were recruited from obstetric and pediatric clinics in South Carolina and had given birth in 2021. Thematic analysis was employed for data analysis.

Results: The study involved 19 Black and 20 Hispanic women, along with 9 MCPs, and revealed both barriers and facilitators to COVID-19 vaccination. The factors that influence pregnant and postpartum women's decision about COVID-19 vaccine uptake included: 1) awareness of health threats associated with COVID-19 vaccines, 2) vaccine availability and accessibility, 3) vaccine-related knowledge and exposure to misinformation, 4) concerns regarding pre-existing health conditions and potential side effects of COVID-19 vaccines, 5) emotional factors associated with vaccination decision-making processes, 6) concerns about the well-being of infants, 7) cultural perspectives, and 8) encouragement by trusted supporters.

Conclusion: The findings suggest that reliable information, social support, and trusted MCPs' advice can motivate COVID-19 vaccination among pregnant and postpartum women who are Black and Hispanic. However, barriers such as misinformation, mistrust in the health care system, and fears of potential side effects impede vaccination uptake. Future interventions should address these barriers, consider health disparities, involve trusted MCPs, and initiate conversations about vaccines to promote vaccination among these populations.

背景:接种 COVID-19 疫苗对终止大流行至关重要,但孕妇和产后妇女,尤其是黑人和西班牙裔妇女对疫苗接种的安全性仍然存在担忧。本研究旨在通过妇女的亲身经历和孕产妇保健提供者(MCPs)的观察,探讨影响产后妇女在孕期和产后做出疫苗接种决策的因素:2022 年 1 月至 8 月,我们对黑人和西班牙裔产后妇女以及产妇护理人员进行了半结构化访谈。访谈对象来自南卡罗来纳州的产科和儿科诊所,于 2021 年分娩。数据分析采用了主题分析法:该研究涉及 19 名黑人妇女和 20 名西班牙裔妇女,以及 9 名产妇和新生儿护理人员,揭示了接种 COVID-19 疫苗的障碍和促进因素。影响孕妇和产后妇女决定接种 COVID-19 疫苗的因素包括1) 对 COVID-19 疫苗相关健康威胁的认识;2) 疫苗的可用性和可及性;3) 疫苗相关知识和错误信息的接触;4) 对已有健康状况和 COVID-19 疫苗潜在副作用的担忧;5) 与疫苗接种决策过程相关的情感因素;6) 对婴儿健康的担忧;7) 文化视角;8) 可信赖的支持者的鼓励:研究结果表明,可靠的信息、社会支持和可信赖的医学保健人员的建议可促使黑人和西班牙裔孕妇及产后妇女接种 COVID-19 疫苗。然而,错误信息、对医疗保健系统的不信任以及对潜在副作用的恐惧等障碍阻碍了疫苗的接种。未来的干预措施应解决这些障碍,考虑健康差异,让可信赖的 MCP 参与进来,并发起有关疫苗的对话,以促进这些人群的疫苗接种。
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引用次数: 0
Emotional and Financial Stressors in New York City During the COVID-19 Pandemic: A Consecutive Cross-Sectional Analysis. COVID-19 大流行期间纽约市的情感和经济压力:连续横断面分析。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-21 DOI: 10.1007/s40615-024-01921-5
David J Heller, Devin Madden, Timnit Berhane, Nina A Bickell, Grace Van Hyfte, Sarah Miller, Umut Ozbek, Jung-Yi Lin, Rebecca M Schwartz, Robert A Lopez, Guedy Arniella, Victoria Mayer, Carol R Horowitz, Emma K Benn, Nita Vangeepuram

Mental and financial hardship during the COVID-19 pandemic in New York City was severe, but how vulnerable groups have been disproportionately impacted is incompletely understood. In partnership with community stakeholders, we administered a web-based survey to a convenience sample of New York City residents (18 + years) from May 2020 to April 2021 to evaluate their financial and emotional stressors. We analyzed outcomes by race, ethnicity, and education level. A total of 1854 adults completed the survey across three consecutive non-overlapping samples. Fifty-five percent identified other than non-Latinx White. Sixty-four percent reported emotional stress; 38%, 32%, and 32% reported symptoms of anxiety, depression, and post-traumatic stress disorder respectively; and 21% reported a large adverse financial impact. The leading unmet needs were mental health and food services (both 19%), and health services (18%). Need for both resources grew over time. Adverse financial impact directly correlated with presence of all four adverse mental health outcomes above. In multivariate analysis, non-White race and lack of college degree were associated with adverse financial impact, whereas LGBT identity and lack of college degree were associated with mental health impact. Throughout the COVID-19 pandemic, participants in this research demonstrated a large and growing mental and financial strain, disproportionately associated with lower education level, non-White race, and LGBT status. Our findings suggest an urgent need to differentially target COVID-19 mental health and resource support in New York City to persons in these vulnerable communities.

纽约市在 COVID-19 大流行期间遭受了严重的精神和经济困难,但对弱势群体如何受到不成比例的影响却不甚了解。我们与社区利益相关者合作,在 2020 年 5 月至 2021 年 4 月期间对纽约市居民(18 岁以上)进行了网络调查,以评估他们的经济和精神压力。我们按种族、民族和教育水平对结果进行了分析。在连续三个不重叠的样本中,共有 1854 名成年人完成了调查。55%的人被认定为非拉丁裔白人。64%的人报告了情绪压力;分别有 38%、32% 和 32% 的人报告了焦虑、抑郁和创伤后应激障碍的症状;21% 的人报告了巨大的负面经济影响。最主要的未满足需求是心理健康和食品服务(均为 19%)以及医疗服务(18%)。随着时间的推移,对这两种资源的需求都在增加。不利的财务影响与上述所有四种不利的心理健康结果直接相关。在多变量分析中,非白人种族和缺乏大学学位与不良经济影响相关,而女同性恋、男同性恋、双性恋和变性者身份和缺乏大学学位与心理健康影响相关。在 COVID-19 大流行的整个过程中,本研究的参与者表现出了巨大且不断增长的精神和经济压力,这与较低的教育水平、非白人种族和 LGBT 身份有着不成比例的关系。我们的研究结果表明,纽约市迫切需要针对这些弱势群体提供不同的 COVID-19 心理健康和资源支持。
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引用次数: 0
Intersecting Inequities in COVID-19 Vaccination: A Discourse Analysis of Information Use and Decision-Making Among Ethnically Diverse Parents in Canada. COVID-19 疫苗接种中的交叉不公平现象:对加拿大不同种族家长的信息使用和决策的话语分析》(A Discourse Analysis of Information Use and Decision-Making Among Ethnic Diverse Parents in Canada)。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-26 DOI: 10.1007/s40615-024-01940-2
Emmanuel A Marfo, Terra Manca, Eunah Cha, Laura Aylsworth, S Michelle Driedger, Samantha B Meyer, Catherine Pelletier, Ève Dubé, Shannon E MacDonald

Background: Little is known about how intersecting social privilege and disadvantage contribute to inequities in COVID-19 information use and vaccine access. This study explored how social inequities intersect to shape access to and use of COVID-19 information and vaccines among parents in Canada.

Methods: We conducted semi-structured interviews on COVID-19 vaccination information use with ethnically diverse parents of children ages 11 to 18 years from April to August 2022. We purposefully invited parents from respondents to a national online survey to ensure representation across diverse intersecting social identities. Five researchers coded transcripts in NVivo using a discourse analysis approach informed by intersectionality. Our analysis focused on use of vaccine information and intersecting privileges and oppressions, including identifying with equity-denied group(s).

Results: Interview participants (N = 48) identified as ethnically diverse non-Indigenous (n = 40) and Indigenous (n = 8) Peoples from seven Canadian provinces. Racialized minority or Indigenous participants reflected on historical and contemporary events of racism from government and medical institutions as barriers to trust and access to COVID-19 information, vaccines, and the Canadian healthcare system. Participants with privileged social locations showed greater comfort in resisting public health measures. Despite the urgency to receive COVID-19 vaccines, information gaps and transportation barriers delayed vaccination among some participants living with chronic medical conditions.

Conclusion: Historicization of colonialism and ongoing events of racism are a major barrier to trusting public health information. Fostering partnerships with trusted leaders and/or healthcare workers from racialized communities may help rebuild trust. Healthcare systems need to continuously implement strategies to restore trust with Indigenous and racialized populations.

背景:人们对社会特权和劣势的交织如何导致 COVID-19 信息使用和疫苗接种方面的不平等知之甚少。本研究探讨了社会不平等如何交织在一起,影响加拿大家长对 COVID-19 信息和疫苗的获取和使用:2022 年 4 月至 8 月,我们就 COVID-19 疫苗接种信息的使用情况对不同种族的 11 至 18 岁儿童家长进行了半结构化访谈。我们特意从全国在线调查的受访者中邀请家长,以确保不同交叉社会身份的代表性。五位研究人员在 NVivo 中使用以交叉性为基础的话语分析方法对记录誊本进行了编码。我们的分析侧重于疫苗信息的使用以及交叉特权和压迫,包括认同被剥夺公平的群体:访谈参与者(48 人)被认定为来自加拿大七个省份的不同种族的非土著(40 人)和土著(8 人)。少数种族或原住民参与者认为,政府和医疗机构在历史和当代的种族主义事件阻碍了他们对 COVID-19 信息、疫苗和加拿大医疗系统的信任和使用。社会地位优越的参与者在抵制公共卫生措施方面表现得更为从容。尽管接种 COVID-19 疫苗迫在眉睫,但信息差距和交通障碍延误了一些患有慢性疾病的参与者接种疫苗:结论:殖民主义的历史化和正在发生的种族主义事件是人们信任公共卫生信息的主要障碍。与可信赖的领导者和/或来自种族化社区的医疗工作者建立合作关系有助于重建信任。医疗保健系统需要不断实施战略,以恢复与土著和种族化人群的信任。
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引用次数: 0
Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review. 居住在美国的黑人移民妇女利用医疗服务的情况:系统回顾。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-28 DOI: 10.1007/s40615-024-01945-x
Jennifer J Lee, Joyline Chepkorir, Abeer Alharthi, Khadijat K Adeleye, Nicole E Warren

Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.

全面了解黑人移民妇女所使用的医疗服务对于满足这一人群的复杂需求非常必要。我们进行了一项系统性综述,目的是:(1)了解居住在美国的黑人移民妇女所使用的医疗服务类型;(2)研究使用医疗服务的障碍和动机。在以下数据库中找到了相关研究:PubMed、PsychInfo、CINAHL 和 Embase。截至 2022 年 10 月发表的文章均纳入审查范围。在总共 15,245 条记录中,有 47 篇报道了黑人移民妇女利用医疗服务的做法的文章被纳入综述。黑人移民妇女获得了各种不同的医疗服务,如肝炎筛查、生殖健康服务、癌症筛查、药物滥用治疗、心理健康服务、艾滋病服务、牙科服务、基因检测、心血管风险检测以及一般医疗服务/住院治疗。使用医疗服务的动机包括拥有医疗保险、对医疗资源和条件的了解以及与医疗服务提供者合作的积极经历。使用医疗服务的障碍包括在医疗系统中遇到的困难、语言障碍和文化信仰。必须在机构、社会和政策层面扩大对医疗服务利用率产生积极影响的因素,以改善黑人移民妇女获得医疗服务的机会。
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引用次数: 0
Association Between Changes in Racial Residential and School Segregation and Trends in Racial Health Disparities, 2000-2020: A Life Course Perspective. 2000-2020 年种族居住和学校隔离的变化与种族健康差异趋势之间的关系:生命历程视角》。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-29 DOI: 10.1007/s40615-024-01960-y
Michael Siegel, Vanessa Nicholson-Robinson

Introduction: Most studies of the relationship between racial segregation and racial health disparities have focused on residential segregation. School-based racial segregation is an additional form of segregation that may be associated with racial disparities in health. This study examines the relationship between both residential segregation and school segregation and racial health disparities among non-Hispanic Black compared to non-Hispanic White persons at the county level in the United States. It also examines the relationship between changes in residential and school segregation and subsequent trajectories in a variety of racial health disparities across the life course.

Methods: Using the CDC WONDER Multiple Case of Death database, we derived an annual estimate of race-specific death rates and rate ratios for each county during the period 2000-2020. We then examined the relationship between baseline levels of residential and school segregation in 1991 as well as changes between 1991-2000 and the trajectories of the observed racial health disparities between 2000 and 2020. We used latent trajectory analysis to identify counties with similar patterns of residential and school segregation over time and to identify counties with similar trajectories in each racial health disparity. Outcomes included life expectancy, early mortality (prior to age 65), infant mortality, firearm homicide, total homicide, and teenage pregnancy rates.

Results: During the period 1991-2020, racial residential segregation remained essentially unchanged among the 1051 counties in our sample; however, racial school segregation increased during this period. Increases in school segregation from 1991 to 2000 were associated with higher racial disparities in each of the health outcomes during the period 2000-2020 and with less progress in reducing these disparities.

Conclusion: This paper provides new evidence that school segregation is an independent predictor of racial health disparities and that reducing school segregation-even in the face of high residential segregation-could have a long-term impact on reducing racial health disparities. Furthermore, it suggests that the health consequences of residential segregation have not been eliminated from our society but are now being exacerbated by a new factor: school-based segregation. Throughout this paper, changes in school-based segregation not only show up as a consistent significant predictor of greater racial disparities throughout the life course, but at times, an even stronger predictor of health inequity than residential segregation.

导言:关于种族隔离与种族健康差异之间关系的大多数研究都集中在居住隔离方面。基于学校的种族隔离是可能与种族健康差异有关的另一种隔离形式。本研究探讨了美国县一级的居住隔离和学校隔离与非西班牙裔黑人与非西班牙裔白人的种族健康差异之间的关系。研究还探讨了居住隔离和学校隔离的变化与整个生命过程中各种种族健康差异的后续轨迹之间的关系:方法:我们利用美国疾病预防控制中心的 WONDER 多例死亡数据库,得出了 2000-2020 年期间每个县的种族特定死亡率和比率的年度估计值。然后,我们研究了 1991 年住宅和学校隔离的基线水平以及 1991-2000 年间的变化与 2000-2020 年间观察到的种族健康差异轨迹之间的关系。我们使用潜在轨迹分析来确定在不同时期具有相似居住和学校隔离模式的县,并确定在每种种族健康差异方面具有相似轨迹的县。研究结果包括预期寿命、早期死亡率(65 岁之前)、婴儿死亡率、枪支凶杀案、凶杀案总数和少女怀孕率:在 1991-2020 年期间,我们抽样调查的 1051 个县中,种族居住隔离基本保持不变;但在此期间,种族学校隔离有所增加。从 1991 年到 2000 年,学校隔离的增加与 2000-2020 年期间各项健康结果的种族差异增大以及在缩小这些差异方面的进展较小有关:本文提供了新的证据,证明学校隔离是种族健康差异的一个独立预测因素,减少学校隔离--即使面对高度的居住隔离--也会对减少种族健康差异产生长期影响。此外,它还表明,居住隔离对健康造成的影响并没有从我们的社会中消除,而是因为一个新的因素--学校隔离--而加剧。在整篇论文中,学校隔离的变化不仅在整个生命过程中持续显著地预示着更大的种族差异,有时甚至比住宅隔离更能预示健康不平等。
{"title":"Association Between Changes in Racial Residential and School Segregation and Trends in Racial Health Disparities, 2000-2020: A Life Course Perspective.","authors":"Michael Siegel, Vanessa Nicholson-Robinson","doi":"10.1007/s40615-024-01960-y","DOIUrl":"10.1007/s40615-024-01960-y","url":null,"abstract":"<p><strong>Introduction: </strong>Most studies of the relationship between racial segregation and racial health disparities have focused on residential segregation. School-based racial segregation is an additional form of segregation that may be associated with racial disparities in health. This study examines the relationship between both residential segregation and school segregation and racial health disparities among non-Hispanic Black compared to non-Hispanic White persons at the county level in the United States. It also examines the relationship between changes in residential and school segregation and subsequent trajectories in a variety of racial health disparities across the life course.</p><p><strong>Methods: </strong>Using the CDC WONDER Multiple Case of Death database, we derived an annual estimate of race-specific death rates and rate ratios for each county during the period 2000-2020. We then examined the relationship between baseline levels of residential and school segregation in 1991 as well as changes between 1991-2000 and the trajectories of the observed racial health disparities between 2000 and 2020. We used latent trajectory analysis to identify counties with similar patterns of residential and school segregation over time and to identify counties with similar trajectories in each racial health disparity. Outcomes included life expectancy, early mortality (prior to age 65), infant mortality, firearm homicide, total homicide, and teenage pregnancy rates.</p><p><strong>Results: </strong>During the period 1991-2020, racial residential segregation remained essentially unchanged among the 1051 counties in our sample; however, racial school segregation increased during this period. Increases in school segregation from 1991 to 2000 were associated with higher racial disparities in each of the health outcomes during the period 2000-2020 and with less progress in reducing these disparities.</p><p><strong>Conclusion: </strong>This paper provides new evidence that school segregation is an independent predictor of racial health disparities and that reducing school segregation-even in the face of high residential segregation-could have a long-term impact on reducing racial health disparities. Furthermore, it suggests that the health consequences of residential segregation have not been eliminated from our society but are now being exacerbated by a new factor: school-based segregation. Throughout this paper, changes in school-based segregation not only show up as a consistent significant predictor of greater racial disparities throughout the life course, but at times, an even stronger predictor of health inequity than residential segregation.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":"1278-1297"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139990402","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}
引用次数: 0
Racial Disparities in Breastfeeding Rates in Patients with Heart Disease. 心脏病患者母乳喂养率的种族差异。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-03-20 DOI: 10.1007/s40615-024-01933-1
Ayamo G Oben, Christina T Blanchard, Ashton Robinson, Isabel Girling, Joanna M Joly, Marc Cribbs, Alan Tita, Brian Casey, Rachel Sinkey

Objective: To evaluate racial disparities in breastfeeding rates in patients with heart disease.

Study design: Retrospective cohort of pregnant patients with maternal cardiac disease managed by a Cardio-Obstetrics program. Patients self-identifying as Non-Hispanic Black (NHB) and Non-Hispanic White (NHW), who attended ≥ 1 prenatal visit at the Cardio-Obstetrics Program and delivered at the same hospital between March 2015 and June 2019 were included. The primary outcome was breastfeeding rate at discharge from the delivery-associated hospitalization. Secondary outcomes included breastfeeding intent on admission and breastfeeding rates at the postpartum visit among patients who initiated breastfeeding.

Results: 138 pregnant patients with cardiac disease were included: 58 (42%) NHB and 80 (58%) NHW patients. Parity, marital status and insurance were statistically different between groups. NHB patients were more likely to have government insurance compared to NHW patients (77.6% vs. 40%; p < 0.001). There was a significant difference in the intent to breastfeed upon admission for the delivery-associated hospitalization (74.2% NHB vs. NHW 91.3%; p = 0.01), but not at hospital discharge (84.5% NHB vs. 93.8% NHW; p = 0.08). However, breastfeeding rates were significantly lower among NHB patients at the postpartum visit among the entire cohort (38.2% in NHB vs. 61.1% in NHW women; p = 0.036) and among those who initiated breastfeeding (35.3% NHB vs. 61.1% NHW, p = 0.018).

Conclusions: Despite similar breastfeeding rates at hospital discharge, NHB patients with maternal cardiac disease were less likely to intend to breastfeed at admission and/or continue breastfeeding by the postpartum visits. Qualitative studies understanding these differences are crucial to improve breastfeeding rates, especially for NHB patients with maternal cardiac disease.

目的:评估心脏病患者母乳喂养率的种族差异:评估心脏病患者母乳喂养率的种族差异:研究设计:由心外科项目管理的患有母体心脏病的孕妇的回顾性队列。研究纳入了自认为是非西班牙裔黑人(NHB)和非西班牙裔白人(NHW)的患者,这些患者在2015年3月至2019年6月期间在心外科接受了≥1次产前检查,并在同一家医院分娩。主要结果是分娩相关住院病人出院时的母乳喂养率。次要结果包括入院时的母乳喂养意愿和开始母乳喂养的患者产后就诊时的母乳喂养率:共纳入 138 名患有心脏病的孕妇:结果:共纳入 138 名患有心脏病的孕妇:58 名(42%)NHB 患者和 80 名(58%)NHW 患者。各组间的胎次、婚姻状况和保险有统计学差异。与国家卫生福利保险公司的患者相比,国家卫生福利保险公司的患者更有可能拥有政府保险(77.6% 对 40%;P 结论:尽管在分娩时母乳喂养率相似,但国家卫生福利保险公司的患者更有可能拥有政府保险:尽管出院时的母乳喂养率相似,但患有心脏病的非华裔孕产妇在入院时打算母乳喂养和/或在产后就诊时继续母乳喂养的可能性较低。了解这些差异的定性研究对于提高母乳喂养率至关重要,尤其是对于患有产妇心脏病的非黑体婴儿患者。
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引用次数: 0
Ethnic Group Differences in the Timing of Autism Diagnosis, Intellectual Disability, and Educational Placement of Autistic Children in Singapore. 新加坡自闭症儿童在自闭症诊断时间、智力障碍和教育安置方面的种族群体差异。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-03-15 DOI: 10.1007/s40615-024-01957-7
Taralyn Teo, Hwan Cui Koh, Nurhafizah Mohd Zambri, Michele L Zaccario, K Mark Sossin, Chui Mae Wong

Aim: Given Singapore's distinct multicultural identity, this study examined the hypotheses that there may be ethnic group differences in diagnosis and outcomes in autistic children in Singapore.

Methods: Retrospective data were obtained from medical records of all children born between 2008 and 2011 who were diagnosed with clinical or confirmed autism. One-way ANOVAs and regression analyses were used to analyze data.

Results: Data from 2577 medical records were extracted. There were more boys (82.5%) and ethnic group distribution was Chinese (67%), Malay (14%), Indian (10%), and Others (10%). Chinese children were more likely to present at a developmental clinic with concerns 3-4 months younger compared to Malay children and those from Other Races (F(3, 2038) = 9.58, p < .001, Cohen's F = 0.12). Chinese children were also more likely to receive an autism diagnosis approximately 3 months younger compared to Malay children. Fewer autistic Chinese children were diagnosed with co-occurring intellectual disability (13.1%) while there were almost twice more Malay children than expected with co-occurring intellectual disability (29.9%) (χ2 (3) = 55.17, p < .001). There are correspondingly more Malay children on the autism spectrum who attend special education schools. Possible confounding variables such as household income level and mother's level of education were identified in some of these findings.

Conclusion: Several significant ethnic group differences in autistic children in Singapore exist that warrant more investigation into possible causes and support systems needed, with implications for other ethnically diverse nations.

目的:鉴于新加坡独特的多元文化特征,本研究探讨了新加坡自闭症儿童的诊断和治疗结果可能存在族群差异的假设:研究人员从 2008 年至 2011 年期间出生并被诊断为临床或确诊患有自闭症的所有儿童的医疗记录中获取了回顾性数据。数据分析采用单因素方差分析和回归分析:从 2577 份医疗记录中提取了数据。其中男孩较多(82.5%),族裔分布为华裔(67%)、马来裔(14%)、印度裔(10%)和其他族裔(10%)。与马来儿童和其他种族儿童相比,华裔儿童更有可能在3-4个月大时到发育诊所就诊(F(3, 2038) = 9.58, p 2 (3) = 55.17, p 结论:与马来儿童和其他种族儿童相比,华裔儿童更有可能在3-4个月大时到发育诊所就诊:新加坡的自闭症儿童存在几个明显的种族群体差异,需要对可能的原因和所需的支持系统进行更多的调查,这对其他种族多元化的国家也有借鉴意义。
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引用次数: 0
Social Determinants of Health and Allergic Disease Prevalence Among Asian American Children. 亚裔美国儿童健康的社会决定因素与过敏性疾病的流行。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-05 DOI: 10.1007/s40615-024-01918-0
Austin Le, Vivian Bui, Richie Chu, Anna Chen Arroyo, Meng Chen, Adrian Matias Bacong

Background: Although racial and ethnic disparities in allergic diseases have previously been observed, the relationship between social determinants of health (SDoH) and allergic disease prevalence among disaggregated Asian American (AsA) subgroups is poorly understood.

Objective: To examine the association of SDoH with allergic disease prevalence among disaggregated AsA subgroups.

Methods: Using the 2011-2018 National Health Interview Survey, we examined caregiver-reported race and ethnicity, SDoH, and allergic diseases. We compared survey-weighted allergic disease prevalence by AsA subgroup. Subgroup-stratified multivariable logistic regression accounting for age, sex, child/parent nativity, and survey year modeled the association between SDoH and allergic disease prevalence. We provide predicted probabilities of having each allergic disease based on exposure to each SDoH.

Results: We examined data from 5042 non-Hispanic AsA children representing 3,264,768 AsA children. Approximately 25% of all AsA children reported at least one allergic disease, ranging from 20% of Asian Indian children to 30% of Filipino/a children. The number of unfavorable SDoH was lowest among Asian Indian and Chinese children (mean 0.7) and highest among "other Asian" children (mean 1.2). In stratified analyses, financial instability and inaccessible healthcare were associated with greater probability of allergic diseases among some, but not all AsA subgroups. Lower parent education level, food insecurity, and rent/other housing arrangement were associated with lower probability of allergic disease among some AsA children.

Conclusion: There was heterogeneity in the association of SDoH and allergic disease prevalence among AsA children. Further study of SDoH may inform modifiable environmental factors for allergic disease among AsA children.

背景:尽管过敏性疾病的种族和民族差异以前就已被观察到,但人们对健康的社会决定因素(SDoH)与亚裔美国人(AsA)亚群过敏性疾病患病率之间的关系知之甚少:研究亚裔美国人亚群中 SDoH 与过敏性疾病患病率之间的关系:利用 2011-2018 年全国健康访谈调查,我们研究了护理人员报告的种族和民族、SDoH 和过敏性疾病。我们比较了各 AsA 亚群的调查加权过敏性疾病患病率。考虑了年龄、性别、儿童/父母出生地和调查年份的亚组分层多变量逻辑回归模拟了 SDoH 与过敏性疾病患病率之间的关系。我们提供了基于暴露于每种 SDoH 的每种过敏性疾病的预测概率:我们研究了 5042 名非西班牙裔 AsA 儿童的数据,他们代表了 3,264,768 名 AsA 儿童。在所有亚裔儿童中,约有 25% 的儿童报告至少患有一种过敏性疾病,从 20% 的亚裔印度儿童到 30% 的菲律宾/a 族儿童不等。亚裔印度儿童和华裔儿童的不利 SDoH 数量最少(平均为 0.7),而 "其他亚裔 "儿童的数量最多(平均为 1.2)。在分层分析中,经济不稳定和无法获得医疗保健与某些亚裔亚群(而非所有亚裔亚群)患过敏性疾病的概率较高有关。父母受教育程度较低、食物无保障和租房/其他住房安排与部分AsA儿童过敏性疾病发生概率较低有关:结论:SDoH 与 AsA 儿童过敏性疾病发病率的关系存在异质性。对SDoH的进一步研究可能会为AsA儿童过敏性疾病的可改变环境因素提供信息。
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引用次数: 0
Multimorbidity Patterns, Hospital Uses and Mortality by Race and Ethnicity Among Oldest-Old Patients. 按种族和民族划分的高龄患者多病模式、医院使用情况和死亡率。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-21 DOI: 10.1007/s40615-024-01929-x
Jinmyoung Cho, Heather Allore, Gelareh Rahimighazikalayeh, Ivana Vaughn

Backgrounds: Adults aged 85 years and older ("oldest-old") are perceived as survivors resilient to age-related risk factors. Although considerable heterogeneity has been often observed in this population, less is known about the unmet needs in health and healthcare service utilization for diverse patients in healthcare systems. We examined racial-ethnic variation in patterns of multimorbidity associated with emergency department (ED), clinic visits, and mortality among the oldest-old patients with multimorbidity.

Methods: Administrative and clinical data from an integrated healthcare system for five years included 25,801 oldest-old patients with two or more chronic conditions. Hierarchical cluster analysis identified patterns of multimorbidity by four racial-ethnic groups (White, Black, Hispanic, & Other). Clusters associated with ED and clinic visits, and mortality were analyzed using generalized estimation equations and proportional hazards survival model, respectively.

Results: Hypothyroidism, Alzheimer's disease and related dementia, bone & joint conditions, metabolism syndrome, and pulmonary-vascular clusters were commonly observed across the groups. While most clusters were significantly associated with ED and clinic visits among White patients, bone & joint conditions cluster was the most significantly associated with ED and clinic visits among Black (RR = 1.32, p <.01 for ED; RR = 1.67, p <.0001 for clinic) and Hispanic patients (RR = 1.36, p <.0001 for ED; RR = 1.39, p <.0001 for clinic). Similar patterns were observed in the relationship between multimorbidity clusters and mortality.

Conclusions: Patterns of multimorbidity and its significant association with the uses of ambulatory and emergency care varied by race-ethnicity. More studies are needed to explore barriers when minoritized patients are faced with the use of hospital services.

背景:85 岁及以上的成年人("高龄老人")被认为是能够抵御与年龄有关的风险因素的幸存者。虽然在这一人群中经常观察到相当大的异质性,但对医疗系统中不同患者的健康和医疗服务利用方面未满足的需求却知之甚少。我们研究了在患有多种疾病的高龄患者中,与急诊科(ED)、诊所就诊和死亡率相关的多种疾病模式的种族-民族差异:一个综合医疗系统五年来的行政和临床数据包括 25,801 名患有两种或两种以上慢性病的高龄患者。层次聚类分析确定了四个种族-民族群体(白人、黑人、西班牙裔和其他)的多病模式。使用广义估计方程和比例危险生存模型分别分析了与急诊室和诊所就诊以及死亡率相关的聚类:结果:甲状腺功能减退症、阿尔茨海默病及相关痴呆症、骨关节疾病、新陈代谢综合征和肺血管疾病群在各组中很常见。在白人患者中,大多数疾病群与急诊室和门诊量有明显相关性,而在黑人患者中,骨关节疾病群与急诊室和门诊量的相关性最大(RR = 1.32,p 结论:多病共患的模式与患者的健康状况密切相关:多病模式及其与门诊和急诊使用的显著相关性因种族-民族而异。需要进行更多的研究来探讨少数族裔患者在使用医院服务时遇到的障碍。
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引用次数: 0
Using Geographic Disaggregation to Compare Tuberculosis Epidemiology Among American Indian and Alaska Native Persons-USA, 2010-2020. 利用地理分类比较美国印第安人和阿拉斯加原住民的结核病流行情况--美国,2010-2020 年。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-04-01 Epub Date: 2024-02-09 DOI: 10.1007/s40615-024-01919-z
Yuri P Springer, J Steve Kammerer, Derrick Felix, Katherine Newell, Megan L Tompkins, Jamie Allison, Louisa J Castrodale, Bruce Chandler, Kathryn Helfrich, Michelle Rothoff, Joseph B McLaughlin, Benjamin J Silk

Background: American Indian and Alaska Native (AIAN) populations are frequently associated with the highest rates of tuberculosis (TB) disease of any racial/ethnic group in the USA. We systematically investigated variation in patterns and potential drivers of TB epidemiology among geographically distinct AIAN subgroups.

Methods: Using data reported to the National Tuberculosis Surveillance System during 2010-2020, we applied a geographic method of data disaggregation to compare annual TB incidence and the frequency of TB patient characteristics among AIAN persons in Alaska with AIAN persons in other states. We used US Census data to compare the prevalence of substandard housing conditions in AIAN communities in these two geographic areas.

Results: The average annual age-adjusted TB incidence among AIAN persons in Alaska was 21 times higher than among AIAN persons in other states. Compared to AIAN TB patients in other states, AIAN TB patients in Alaska were associated with significantly higher frequencies of multiple epidemiologic TB risk factors (e.g., attribution of TB disease to recent transmission, previous diagnosis of TB disease) and significantly lower frequencies of multiple clinical risk factors for TB disease (e.g., diagnosis with diabetes mellitus, end-stage renal disease). Occupied housing units in AIAN communities in Alaska were associated with significantly higher frequencies of multiple measures of substandard housing conditions compared to AIAN communities in other states.

Conclusions: Observed differences in patient characteristics and substandard housing conditions are consistent with contrasting syndromes of TB epidemiology in geographically distinct AIAN subgroups and suggest ways that associated public health interventions could be tailored to improve efficacy.

背景:在美国,美国印第安人和阿拉斯加原住民(AIAN)是结核病(TB)发病率最高的种族/族裔群体。我们系统地调查了不同地理位置的美国印第安人和阿拉斯加原住民亚群中结核病流行模式的变化和潜在的驱动因素:我们使用 2010-2020 年期间向国家结核病监测系统报告的数据,采用地理数据分解法比较了阿拉斯加州亚裔美国人与其他州亚裔美国人的结核病年发病率和结核病患者特征频率。我们使用美国人口普查数据比较了这两个地理区域的亚裔美国人社区中不达标住房条件的普遍程度:阿拉斯加州亚裔美国人的年均年龄调整后肺结核发病率是其他州亚裔美国人的 21 倍。与其他州的亚裔亚麻人肺结核患者相比,阿拉斯加州的亚裔亚麻人肺结核患者具有多种肺结核流行病学风险因素(如肺结核病归因于近期传播、既往诊断为肺结核病)的频率明显较高,而具有多种肺结核临床风险因素(如诊断为糖尿病、终末期肾病)的频率明显较低。与其他州的亚裔美国人社区相比,阿拉斯加州亚裔美国人社区的已占住房单元与多种不达标住房条件相关的频率明显更高:观察到的患者特征和不达标住房条件的差异与地理位置不同的亚裔印第安人亚群的结核病流行病学综合征形成鲜明对比,并提出了相关公共卫生干预措施的调整方法,以提高疗效。
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引用次数: 0
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Journal of Racial and Ethnic Health Disparities
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