Journal of Racial and Ethnic Health Disparities最新文献

Background: Black birthing people in the United States face disproportionately high risks and adverse experiences during childbirth compared to their White counterparts. These challenges are shaped by a complex interplay of factors across individual, interpersonal, organizational, community, and policy levels.

Objective: This systematic review explores the lived experiences of Black birthing people in the United States, using the Social Ecological Model to identify and analyze factors contributing to disparities in Black birthing health experiences.

Methods: Eighteen qualitative studies, published between 2017 and 2024 and encompassing a sample of 570 participants, were systematically reviewed. A comprehensive search was conducted across PubMed, CINAHL, PsycINFO, and Scopus databases between March and May 2024. Studies were selected based on stringent inclusion criteria, and thematic analysis was applied to identify recurring factors that shape Black birthing experiences in the United States.

Results: Key themes include personal health beliefs, psychological stress, medical distrust, interactions with healthcare professionals, family and peer influences, and the pervasive effects of systemic racism and healthcare policies. Together, these factors contribute to ongoing disparities in Black birthing healthcare experiences for Black birthing people in the United States.

Conclusion: The findings underscore the importance of culturally competent care, equitable healthcare policies, and strong community support systems in addressing the unique challenges faced by Black birthing people. Targeted interventions, policy reforms, and continued research are essential for improving Black birthing experiences and outcomes.

Impact: This review provides crucial insights into the multifaceted challenges in Black birthing experience emphasizing the need for culturally sensitive practices, policy changes for equity, and strengthened community resources. These steps are vital for ensuring respectful, equitable, and supportive experiences for Black birthing people in the United States.

Hidradenitis suppurativa (HS) is a debilitating and understudied inflammatory skin disease that disproportionately impacts Black Americans. The objective of this study was to explore the role that race and ethnicity may play in HS patients' perceptions of physician bias and their care quality. We administered a cross-sectional anonymous online survey to individuals with HS from June 13 to 30, 2021. Items from the Commonwealth Fund 2001 Health Care Quality Survey were employed to evaluate whether participants felt they were judged based on their race or ethnicity. Data was analyzed utilizing the test of equal or given proportions for assessing statistical significance with a threshold p-value < 0.05. The survey received a total of 1040 responses. The cohort was majority female and racially and ethnically diverse, with participants from six continents. Overall, 15.2% (136/894) of respondents reported feeling that they would receive better care if they were of a different race/ethnicity, and 13.6% (122/894) felt their primary HS provider treated them unfairly based on their race. Participants who belonged to minority groups more often reported feeling that they would receive better medical care if they were of a different race/ethnicity and felt that they were treated unfairly due to their race/ethnicity compared to White participants. These findings highlight the need to better understand the complex systemic and interpersonal factors at play in interactions between HS patients and healthcare providers to ensure that patients can receive much-needed care.

The COVID-19 pandemic was associated with decreases in moderate-to-vigorous physical activity and increases in sedentary time for children and adults, and there is some evidence that Latino populations were particularly affected. This article leverages a two-wave panel, mixed-method social network dataset collected before and during the pandemic with Mexican American immigrants living in New York City to examine social networks and other factors associated with physical activity and explore participants' perceptions about how the pandemic affected their physical activity. Participants (n = 49) completed in-person, egocentric social network interviews between January and June 2019 and virtual follow-up egocentric social network interviews between May and November 2021. Qualitative data collection with a subsample (n = 25) occurred between October and December 2022. Social network quantitative analyses found that age and female sex were negatively associated with participants' baseline physical activity level, but the proportion of alters (important persons identified by the participant) with whom the participant did physical activity at baseline was positively associated. Baseline physical activity level was inversely related to the change in physical activity, and the change in the proportion of alters who were close to the participant was negatively associated with physical activity change at follow-up. Qualitative results supported the quantitative findings, providing rich narratives regarding the importance of social support for physical activity during the pandemic. Social networks among Mexican American immigrants in New York City provided motivation and support for physical activity but became harder to sustain during a pandemic. The findings can inform strategies to create environments that are conducive to physical activity while also protecting public health.

Purpose: To identify barriers to breast cancer screening in BIPOC/immigrant populations in the Twin Cities metropolitan area and to hear women's voices in these communities regarding interventions that may improve participation in breast cancer screening.

Methods: The study had two components: surveys and focus group discussions. Participants were women by birth, over 30 years of age, and from Black, Indigenous, and People of Color (BIPOC) communities living or working in Minnesota.

Results: Forty-one participants from BIPOC communities participated. Common themes of barriers to breast cancer screening across all communities were: psychosocial, finances, lack of knowledge, healthcare system, community and culture, and logistics.

Conclusion: Addressing barriers to breast cancer screening in Twin Cities BIPOC populations requires a multipronged approach that addresses knowledge gaps, psychosocial barriers, and logistical and financial barriers, delivered in a culturally acceptable format and in convenient locations.

Young Black men who have sex with men (BMSM) in the USA face disproportionate rates of HIV incidence. Mental health vulnerabilities, including depression, anxiety, substance use, and trauma, further exacerbate the HIV epidemic among this population. Internalized homophobia, discrimination, and depression contribute to elevated rates of suicidal behavior among young BMSM, which in turn may influence engagement in HIV prevention behaviors, such as HIV testing. However, limited research has examined the interplay among suicidal behaviors, internalized homophobia, depression, and HIV testing among young BMSM. This study utilized syndemic theory to explore the relationships among these factors in a sample of 400 young BMSM ages 18-29. Results indicate alarming rates of suicidal behavior among young BMSM, with significant associations among internalized homophobia, depression symptoms, suicidal behavior, and HIV testing. The findings underscore the urgent need for targeted mental health interventions and HIV prevention services tailored to address the unique challenges faced by young BMSM. Comprehensive, multi-level, community-centered interventions are essential to address the syndemics affecting young BMSM, promoting holistic health and well-being while improving outcomes across the HIV prevention continuum.

Background: The Charlson Comorbidity Index (CCI) is a frequently used mortality predictor based on a scoring system for the number and type of patient comorbidities health researchers have used since the late 1980s. The initial purpose of the CCI was to classify comorbid conditions, which could alter the risk of patient mortality within a 1-year time frame. However, the CCI may not accurately reflect risk among American Indians because they are a small proportion of the US population and possibly lack representation in the original patient cohort. A motivating factor in calibrating a CCI for American Indians is that this population, as a whole, experiences a greater burden of comorbidities, including diabetes mellitus, obesity, cancer, cardiovascular disease, and other chronic health conditions, than the rest of the US population.

Methods: This study attempted to modify the CCI to be specific to the American Indian population utilizing the data from the still ongoing The Strong Heart Study (SHS) - a multi-center population-based longitudinal study of cardiovascular disease among American Indians. A 1-year survival analysis with mortality as the outcome was performed using the SHS morbidity and mortality surveillance data and assessing the impact of comorbidities in terms of hazard ratios with the training cohort. A Kaplan-Meier plot for a subset of the testing cohort was used to compare groups with selected mCCI-AI scores.

Results: A total of 3038 Phase VI participants from the SHS comprised the study population for whom mortality and morbidity surveillance data were available through December 2019. The weights generated by the SHS participants for myocardial infarction, congestive heart failure, and high blood pressure were greater than Charlson's original weights. In addition, the weights for liver illness were equivalent to Charlson's severe form of the disease. Lung cancer had the greatest overall weight derived from a hazard ratio of 8.31.

Conclusions: The mCCI-AI was a statistically significant predictor of 1-year mortality, classifying patients into different risk strata χ² (8, N = 1,245) = 30.56 (p = 0.0002). The mCCI-AI was able to discriminate between participants who died and those who survived 73% of the time.

Background: Racial disparities in mortality rates have been well-documented in the last century. Intersectionality theory has helped to identify the root causes of these health disparities. Few studies have examined disparities using the latest data for the state of Mississippi.

Methods: Mortality data for the state of Mississippi (MS) were obtained from the vital statistics program of the Centers for Disease Control & Prevention for years 1999-2020. The age-adjusted mortality rate (AAMR) for ages 35-84 years was calculated by county, gender-male (M) vs female (F), and race-black (B) vs white (W), among non-Hispanics (NH) for all causes of death.

Results: In 2020, MS had the highest AAMR per 100,000 among states in the US: 1624.76 (1605.61-1643.91) for age group 35-84. In 1999-2020 combined, AAMR varied among counties for each gender-race group. High AAMR was concentrated in the delta region for NH black males (NHBM) and females (NHBF). This was less so for NH white males (NHWM) and not so for females (NHWF). The Black/White AAMR ratio among males and females was highest (1.42, 1.36) in the small metropolitan areas and lowest (1.18, 1.05) in the large fringe metropolitan areas. In 1999-2020 for NH males, the ratio of AAMR in NHB to NHW varied from 0.9 to 1.8. In NH females, the ratio varied from 0.9 to 2.2. In both genders, the ratio was significantly correlated with the percent of the population that was NH black.

Conclusions: The AAMR in MS varied greatly among counties as did the Black/White ratio of AAMR. Further research is needed to explain this geographic variation in racial disparity.

This study highlights how the intersection of multiple factors shapes the experiences of Scotland's Black, African, and Caribbean communities in their access and uptake of COVID-19 vaccines in the vaccination programme's first, second, and booster stages. There was particular interest in understanding the vaccination journey, from scheduling an appointment to attending the appointment. Data in this study was collected between the 1 and 30 April 2022 using a triangulated approach, including a survey (with 408 responses), interviews (26), and focus group discussions (5 groups involving 30 participants). The study shows that 62% of respondents found scheduling a COVID-19 appointment easy, with less than 1% of respondents indicating that the process was complex. Online booking, appointment letters, and walk-in appointments were the most common ways of securing vaccination appointments. Letter appointments, specifically the blue envelope, were beneficial reminder mechanisms. It also provided information about COVID-19 vaccines and what to expect when attending the appointments. Other forms of securing vaccination appointments, such as through GP surgeries, were less commonly used. Around 21.5% of participants felt that receiving an appointment letter provided useful pre-vaccination information and a helpful reminder for their appointment. The accessibility of the vaccination centre, professionalism of the staff, and friendly approach enhanced the vaccine user access, use, and experience of COVID-19 vaccination.

Objective(s): To identify trends in HIV diagnosis disparities among subpopulations of Black/African American and White persons by selected characteristics (i.e., sex assigned at birth, age group, and region of residence) in the United States during 2017‒2021.

Methods: Four-year estimated annual percent change (EAPC) during 2017‒2021, 2020 was excluded due to the impact of COVID-19 on HIV diagnoses, was used to assess temporal trends in diagnosis rates and disparities by selected characteristics for Black and White persons aged ≥ 13 years with a diagnosis of HIV infection. Data reported through December 2022 to the National HIV Surveillance System (NHSS) were used.

Results: Among 74,161 Black persons and 44,641 White persons with HIV diagnosed during 2017-2021, there was an overall increase in HIV diagnosis rates among White females (EAPC = 2.0; CI = 0.3, 3.8), White males aged 35‒44 years (EAPC = 1.8; CI = 0.2, 3.5) and whose infection was attributed to injection drug use (EAPC = 7.5; CI = 4.6, 10.4), White females aged 35‒44 years (EAPC = 5.3; CI = 1.9, 8.9) and residing in the Midwest (EAPC = 5.5; CI = 1.4, 9.7). Among both Black and White males, we observed increases in relative disparities in HIV diagnosis for males aged 13‒24 years (EAPC = 7.4; CI = 7.0, 7.7) and residing in the West (EAPC = 2.0; CI = 1.1, 2.9).

Conclusions: Efforts should prioritize eliminating disparities in treatment and prevention services by taking a comprehensive approach and actively mitigating the social determinants contributing to HIV disparities.

Background: This study aimed to examine the moderating effect of ethnic patient-physician similarity versus dissimilarity on the relationship between physicians' stigma towards ethnicity and physicians' communication behaviors during medical encounters and patients' post-meeting anxiety.

Methods: A prospective nested study design with 146 encounters, including 146 patients with cancer and 32 oncology/surgery physicians, was conducted between November 2019 and July 2022 in two medical centers. Before the medical encounters, physicians were asked to complete sociodemographic, professional and the Perceived Ethnic Discrimination Questionnaires (PEDQ-CV). Patients completed sociodemographic, clinical characteristics and State-Trait Anxiety Inventory (STAI) questionnaires before and following the encounters. During the medical encounters, structured "real-time" observations of the physicians' behaviors were assessed using the Four Habits Coding Scheme (4HCS).

Results: The mixed linear analysis model revealed that the two-way interaction effects between physicians' stigma toward ethnicity and the ethnic similarity between the physician and patient on physician communication behaviors (b = - .822, p < .05) and patients' post-meeting anxiety (b = .580, p < .05) were significant. In ethnic dissimilar medical encounters, physician stigma towards ethnicity was associated with poor communication behaviors and higher post meeting patients' anxiety. However, in ethnic similar medical encounters, physician ethnic stigma was associated with improve communication behaviors and stable levels of anxiety.

Conclusions: Our study highlights the significant role of similar versus dissimilar ethnic medical encounters on the effect of ethnic stigma on health outcomes. These findings call for implementing a climate of diversity management to limit the additive effect of stigma towards ethnicity and to provide fair and equal care.