Journal of Racial and Ethnic Health Disparities最新文献

Heart failure (HF) remains a significant health challenge globally, placing a heavy burden on individuals, families, and healthcare systems. The prevalence of HF continues to rise, posing substantial public health concerns. This burden is particularly pronounced among the Black Population, who face higher prevalence, earlier onset, and greater severity of HF compared to other racial and ethnic groups. This review explores the multifaceted landscape of HF in Black individuals by examining epidemiological patterns, pathophysiological mechanisms, clinical presentations, treatment disparities, and clinical outcomes. Black individuals exhibit distinct pathophysiological characteristics, such as genetic variations contributing to heightened susceptibility and severity of HF. Social determinants of health, including socioeconomic status, education, and healthcare access, further exacerbate these disparities. Despite advancements in medical science, Black individuals receive less optimal HF care, reflected in lower rates of guideline-directed medical therapy and cardiac rehabilitation. Addressing these disparities requires targeted interventions and a holistic approach that emphasizes social determinants of health, improved healthcare access, and health equity. This review synthesizes existing literature to illuminate the unique challenges faced by Black HF patients and advocates for evidence-based strategies to enhance management and outcomes, aiming to reduce disparities and improve the well-being of this vulnerable population.

Historical instances of medical racism and the impact of ongoing disparities are an understudied determinant of Black women's sexual health. Here, we use a Black feminist approach to engage Black women in a qualitative exploration of the impact of medical racism on their health-related decision-making. Specifically, we explore the question, how does exposure to information on medical racism impact Black women today and inform their perceptions of healthcare? This qualitative study uses Black feminist approaches to study design including advisory boards, interviewer concordance, and focus group data collection with Black female college students who were in the developmental phase of emerging adulthood, ages 18-25. We also led seven virtual focus groups that focused on dialogue around agents of sexual socialization including knowledge of historical and ongoing medical racism. Four themes emerged from our thematic analysis. The first theme was compromised mental health. The second theme was a wealth and health paradox whereby income and education did not mitigate the impact of racism on health. The third theme was medical racism and distrust. And the fourth theme was around the role of Black Americans as guinea pigs, autonomous actors, and advocates in healthcare. Medical racism, whether it is experienced firsthand, vicariously, or as a part of one's history, is a source of anxiety for Black women. This barrier to care must be addressed to promote health equity in the USA.

There are racial disparities in access and outcomes of assisted reproductive technology treatment in the USA; however, the effect of the pandemic on racial disparity within reproductive healthcare has not been extensively studied. This study aimed to identify how the pandemic has affected patient decision-making regarding fertility planning and treatment among Black versus non-Black women. The decision-making parameters that were assessed included discontinuing or changing the fertility treatment plans as well as visits to the clinic. This is a cross-sectional questionnaire study that was conducted at a university-affiliated fertility clinic between January and December 2021. A link to a survey was emailed to patients who were asked to fill out a questionnaire regarding fertility plans prior to and during the pandemic, in particular, the choice of the type of fertility treatment, exposure to COVID-19, and acceptability of the vaccine while trying to conceive, canceling or postponing the fertility treatment, and the use of telehealth during the pandemic. Out of 223 patients, the majority reported that the pandemic did not change their plans, and the minority reported either postponing or canceling their treatments with financial instability being the most reported reason. Fewer Black women were vaccinated compared to non-Black women. When asked whether the pandemic was well-handled by major healthcare systems, Black women were less likely than non-Black women to think that it met expectations. Additionally, Black women were less likely to be comfortable visiting fertility clinics in person and less interested in future at-home monitoring, if available, compared to non-Black women. Thus, among women undergoing fertility treatments during the pandemic, Black individuals were associated with a lower percentage of being vaccinated, a lower percentage of being satisfied with major healthcare systems handling the pandemic, and lesser comfort in visiting the fertility clinic physically. There is a clear need to understand the underlying reasons as to why the pandemic contributed to a racial disparity in fertility treatments.

The tribal population in India faces unique socioeconomic challenges and health disparities, which significantly impact their reproductive health outcomes. The age at first birth is a critical determinant of maternal and child health, educational attainment, and economic stability, yet limited research has focused on tribal women, a marginalized group with distinct cultural and socioeconomic contexts. This study aims to identify the sociodemographic factors influencing the age at first birth among tribal women in India. Using data from the National Family Health Survey-5 (NFHS-5, 2019-2021), logistic regression analysis was employed to examine key predictors, including education, wealth, marital status, health facility accessibility, and media exposure. The findings reveal that higher education levels, greater household wealth, and media exposure are significantly associated with delayed first births. For instance, women with secondary or higher education are more likely to delay their first birth compared to those with no education. Similarly, mothers from middle and rich households are more likely to have their first birth after the age of 18 compared to those from poor households. Media exposure, particularly reading newspapers at least once a week, also increases the likelihood of delaying first birth. These findings highlight significant sociodemographic disparities and underscore the need for targeted policy interventions to improve reproductive health outcomes among tribal women. The study concludes that enhancing education, economic conditions, and access to media and health facilities can play a pivotal role in delaying the age at first birth, thereby promoting better maternal and child health in this marginalized population.

Aim: Examine racial and ethnic inequities in hepatitis C and B virus (HCV and HBV) screening across high-risk populations.

Subject and methods: Chronic HCV and HBV infections can lead to cirrhosis, hepatocellular carcinoma (HCC), and death. Despite universal screening recommendations, < 50% of US adults are tested for these viruses. Populations with lower socio-economic status experience higher rates of viral-related cirrhosis and HCC, which may be reduced through screening and treatment. This study analyzed data from 91,875 patients (2019-2021) at the Health Choice Network, a federally qualified health center in Florida. Logistic regression assessed the determinants of HCV and HBV screening, considering factors such as age, sex, language, and race/ethnicity.

Results: The study population was predominantly female, Hispanic, uninsured, and living below the federal poverty line. Overall, 61.7% had HCV screening, and 43.7% had HBV screening. Haitian Creole-speaking patients (aOR 1.67; 95% CI, 1.50-1.85), Asian (aOR 1.41; 95% CI, 1.26-1.58), Spanish-speaking Hispanic (aOR 1.38; 95% CI, 1.32-1.44), and English-speaking Hispanic patients (aOR 1.12; 95% CI, 1.07-1.18) had higher odds of HCV screening, compared to NH-Whites. Similarly, Haitian Creole-speaking (aOR 1.91; 95% CI, 1.73-2.12), Asian (aOR 1.50; 95% CI, 1.33-1.68), and Spanish-speaking Hispanic patients (aOR 1.23; 95% CI, 1.17-1.29) had higher odds of HBV screening.

Conclusion: For an underserved population context, screening rates were above average, with higher prevalence among historically disadvantaged populations. However, rates remained suboptimal, particularly among NH-Whites, who account for the largest number of HCV-related liver cancers, often linked to injection drug use. Increasing screening, especially among NH-Whites and English-speaking Hispanics for HCV, is crucial for early diagnosis, treatment, and reducing severe liver disease risk, including cirrhosis and HCC.

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.