Journal of Racial and Ethnic Health Disparities最新文献

Background: Compared to other racial/ethnic groups, Black Americans show accelerated brain aging beginning in midlife and exhibit higher rates and earlier onset of dementia. While these patterns are often viewed as evidence that Black Americans are more vulnerable to Alzheimer's disease, another possibility is that their high risk for chronic vascular pathologies such as high blood pressure and diabetes compromises their brain health. This hypothesis was tested in the present study.

Methods: Participants included 252 middle-aged Black Americans enrolled in the Family and Community Health Study and living in Iowa or Georgia who had ascertainment of diabetes and hypertension in 2008 and blood drawn in 2008 and 2019. Linear regression models assessed whether hypertension and diabetes were associated with change in neurofilament light chain (NfL), a non-specific biomarker of brain pathology including vascular dementia, and phosphorylated tau181 (p-Tau181), a biomarker of underlying Alzheimer's disease (AD) pathology.

Results: Having a diagnosis of either hypertension or diabetes during middle age was not associated with levels of either p-Tau181 or NfL. However, having a diagnosis of both hypertension and diabetes was robustly associated with higher levels of NfL and increases in NfL over an 11-year period.

Conclusions: Among Black Americans, comorbid hypertension and diabetes contribute to higher levels of serum NfL, our indicator of neurodegeneration, during late middle age but not with p-Tau181, our indicator of Alzheimer's disease. Rather than being instances of AD, elevated rates of dementia among Black Americans may be largely vascular pathology caused by high rates of diabetes and high blood pressure.

Background: Racial disparities have historically existed regarding HIV care outcomes, including linkage to care. This study aims to explore the contribution of contextual features (e.g., socioeconomic and structural environmental factors) to the temporal change of county-level racial disparities in linkage to care.

Methods: This is a statewide population-based retrospective cohort study. The patient-level variables in the South Carolina HIV registry system were used to calculate the aggregated county-level linkage to care percentage. Then, we used four indices to measure racial disparities in the county-level percentage of timely linkage to care, i.e., the Black-White ratio, index of disparity (ID), weighted ID, and Gini coefficient. Linear mixed-effect models were used to estimate the relationship between a variety of contextual features and disparity indexes. The analysis included data from 2013 to 2020, with 2013 as the start year due to the availability of key contextual features and 2020 as the end year based on the most recent HIV registry data available at the time of this study.

Results: Across 46 counties in South Carolina, racial disparity in linkage to care persisted between 2013 and 2020, as indicated by all four indices. When using ID, weighted ID, and Gini as outcomes, counties with lower degrees of racial residential segregation and stronger family structure were at higher risk of racial disparities in linkage to care. For weighted ID only, counties with fewer primary care providers (β =  - 4.22; 95% CI, - 7.23 ~ 1.23) had larger racial disparities in linkage to care. Furthermore, for Gini only, counties with higher income inequalities (β = 0.01; 95% CI, 0.00 ~ 0.02) had larger racial disparities in linkage to care.

Conclusion: Efforts to address racial disparities should continue, and innovative approaches, specifically those that focus on social and structural factors, should be developed and implemented for populations that have poor HIV outcomes in the USA.

Background: Cardiovascular diseases (CVD) are the leading cause of death globally, with a significant burden on the Asian and Central Asian populations. Ethnic discrimination is an emerging determinant of CVD risk, yet comprehensive analyses in these populations are sparse.

Objectives: This systematic review aimed to assess the association between ethnic discrimination and CVD among Asian and Central Asian populations, quantifying risks and examining contributing factors.

Methods: Following the PRISMA guidelines, we reviewed 23 studies across PubMed, Scopus, and the Web of Science, including 10 on Central Asian and 13 on broader Asian populations. Risk measures such as odds ratios (ORs) and hazard ratios (HRs) were extracted where available.

Results: The findings indicate a robust association between ethnic discrimination and increased CVD risks. Among Kyrgyz and Kazakh populations, discrimination was linked to hypertension with an OR of 2.4, while ethnic Kazakhs experiencing discrimination had a 70% higher risk of all-cause mortality (HR 1.7). In South Asians, discrimination was associated with a 30% higher prevalence of premature cardiovascular events, while Chinese populations exposed to everyday discrimination demonstrated a 15.2% higher prevalence of hypertension. Rural populations in Central Asia showed clustering of CVD risk factors with an OR of 1.9.

Conclusions: Discrimination is a significant contributor to CVD disparities, with its effects varying across ethnic groups and regions. These findings underscore the need for culturally tailored public health interventions and policies addressing social determinants of health. Future research should explore longitudinal impacts and the efficacy of targeted community-based programs to mitigate these risks.

Introduction: Black, Indigenous, and People of Color (BIPOC) have lower rates of traditional medication use and compliance in comparison to their white counterparts. Documented mistreatment and systematic oppression of BIPOC patients in the healthcare system have led to perpetual consequences for this population, including lower rates of medication adherence. This systematic review of the current literature aims to examine the impact of patient-provider race-concordant relationships on medication adherence in BIPOC patients.

Methods: A comprehensive and systematic search of published literature was conducted using eight databases, yielding 412 results, each of which was screened by two independent authors. Nine articles met the specified inclusion criteria. After a full-text review, five articles were retained for qualitative synthesis.

Results: Four studies found that patient-provider race concordance was associated with higher cardiovascular and dermatological medication adherence rates in BIPOC patients. One study observed higher rates of medication adherence in Black-Black racially concordant dyads; however, this finding was not significant.

Discussion: While increased medication adherence rates were observed in patient-provider race concordant dyads, this systematic review did not account for any complex confounding factors that influence an individual's adherence to medication, such as cost, access, or polypharmacy. Increasing diversity in healthcare allows for greater opportunity for patients to be in race-concordant dyads with their providers, thereby enhancing the potential for improved medication adherence.

Conclusion: Patient-provider race concordance was associated with higher medication adherence rates for BIPOC patients.

Protocol registration: PROSPERO: CRD42023459428.

Background and aims: To identify demographic predictors, with a focus on race and socioeconomic status, for advanced treatment modality, mortality, and increased length of stay (LOS) in upper gastrointestinal (GI) hemorrhage treatment.

Methods: Hospitalizations with acute upper GI hemorrhage from 2016 to 2021 were identified in the Healthcare Cost and Utilization Project's National Inpatient Sample. Cases were divided into interventional radiology (IR) and non-IR (endoscopic) treatments. Statistical analyses calculated significant odds ratios via 95% confidence intervals. The primary outcome of interest was mortality rate. The secondary outcome of interest was the mean LOS. Confounding factors affecting mortality were also examined.

Results: There was no significant difference in likelihood of an IR procedure or mortality between White patients and both Non-Hispanic (NH) Black and Hispanic patients. NH Black patients had significantly longer LOS in days compared to White patients (12.61 vs 9.57) that persisted when matching for age and sex (13.78 vs 9.92), socioeconomic status (12.94 vs 10.07), chronic comorbidities (11.33 vs 8.88), blood transfusions (14.46 vs 10.21), and vasopressor use (14.43 vs 10.29) (p < 0.001). These LOS differences were not seen under matching conditions post-COVID-19.

Conclusion: This study presents racial disparities in LOS following acute upper GI hemorrhage, but no differences in advanced treatment utilization or mortality. Confounders were responsible for LOS differences in non-IR treatment, but NH Black patients had persistently longer LOS than White patients after IR treatment.

Background: Misperceptions of hospice persist in communities of color. This study explored what Black Americans understand about and how they describe hospice care. The goal was to determine if older Black Americans can accurately describe hospice and to explore potential barriers and facilitators to hospice enrollment.

Methods: A content analysis of qualitative data collected in a larger mixed-methods study. Participants responded to the written prompt, "In your own words describe hospice care" with no further instructions. Recruitment occurred from community settings between May 2019 to March 2020. We recruited 144 participants who were at least 65 years old and self-identified as Black or African American. The written narratives were analyzed to determine how accurately participants described: (1) hospice care and eligibility, (2) location of services, (3) services provided, and (4) goals of care.

Results: Participant ages ranged from 65 to 97 years (M = 74.62, SD = 6.94). Participants were predominately female (81%) and widowed (33%). Participants accurately described hospice care and eligibility (80%), goals of hospice (89%), and services hospice provides (83%). Only 39% of participants correctly identified locations of hospice services. Additionally, some participants (8%) reported certain myths and conspiracies pertaining to hospice.

Conclusions: This study found that older Black Americans accurately describe hospice care and eligibility, goals of care, and the services provided by hospice. However, most were unable to accurately describe the location of hospice services and a few reported myths and conspiracies. The study highlights areas to improve communication about hospice which may reduce some of the barriers to hospice enrollment in Black Americans.

Trial registration: ClinicalTrials.gov Identifier: NCT04458090.

Objectives: People from ethnic minority backgrounds are exposed to greater risk of patient safety events (such as healthcare-acquired infections and medication errors) occurring in their healthcare. However, evidence of the type and frequency of patient safety events occurring in cancer care among patients from ethnic minority background is lacking. This study sought to address this evidence gap.

Design: A two-stage retrospective medical record review was conducted at four cancer services in two Australian states. Eligible medical records at each service that were identified as belonging to ethnic minority patients were reviewed by two clinician researchers in stage one, followed by authentication of extracted data by a site-specific cancer clinician in stage two. Descriptive statistics were used to report the frequency and type of safety events. Chi-square and independent sample T-tests were used to examine the association between safety events and patient socio-cultural indicators.

Results: A total of 628 patient records were included. Of the 628 patient records, 212 (33.75%) documented at least one safety event. A total of 410 safety events were documented in the 212 patient records. Medication-related safety events were most commonly documented (121/410, 29.5%), followed by clinical process/procedure-related safety events (76/410, 18.5%) and patient accidents (60/410, 14.6%). The occurrence of a safety event was associated with patient records that documented 'no interpreter was required'.

Conclusion: Patient safety events in cancer care occur frequently among patients from ethnic minority backgrounds. Unsafe cancer care for this population is associated with inadequate use of interpreters, lack of shared understanding and expectations of care processes linked to cultural and linguistic barriers. Approaches to enhance engagement are required.

Objective: To determine whether standardized mortality ratios (SMRs) for smoking vary with age, sex, and race/ethnicity differences in smoking intensity.

Methods: SMRs for current smoking were computed based on data of adult participants in the National Health Interview Surveys 2000-2003 separately by sex-age and sex-race/ethnicity subgroups. Mortality follow-up was through 2018.

Results: SMRs across sex-age subgroups were highest for men aged 50-59 years (SMR 3.22) and lowest for men aged 80 years or older (SMR 1.10). Variations in SMRs across sex-age subgroups were directly correlated with group differences in median daily cigarette use (Spearman r = 0.70). Across sex-race/ethnicity subgroups, the SMR was highest among White men (SMR 2.39) and lowest among Hispanic men (SMR 1.26) and was again directly correlated with median daily cigarette use (Spearman r = 0.79).

Conclusions: SMRs for smoking are not singular estimates but rather vary widely with demographic-related differences in smoking intensity. In resource-constrained settings, smoking reduction interventions that target subgroups with higher smoking intensity may be more efficient in reducing smoking-related mortality.

Introduction: Prior research has identified a link between discrimination and psychotic symptoms in community samples, yet less is known about potential protective factors particularly in the context of clinical samples of psychotic illness. The goal of this exploratory study was to examine the relationship between ethnoracial discrimination and symptom severity among U.S. Latinx people experiencing their first episode of psychosis (FEP). We were particularly interested in whether family support quality buffered the negative relationship between discrimination and symptomatology.

Methods: Data were taken from a longitudinal parent study assessing the effectiveness of a communication campaign on reducing duration of untreated illness among U.S. Latinx communities with FEP. A total of 43 participants with FEP were administered the study measures for the present study at baseline, including self-report survey on perceived discrimination, the Positive and Negative Symptoms Scale clinical interview, and a qualitative interview measuring family support, which was analyzed using deductive methods. Independent samples t-tests and multiple linear regression analyses were conducted.

Results: Endorsement of ethnoracial discrimination was associated with greater positive and general symptoms, but not negative symptoms. Among those endorsing ethnoracial discrimination, family support buffered the association with negative and general symptoms, but not positive symptoms.

Conclusion: Family support could be a relevant mechanism to target the negative symptoms of psychosis and general psychopathology among Latinx people with FEP, particularly in the context of racialized stressors.

Objective: To explore the relationship between low birthweight (LBW) and food insecurity across US counties and determine whether this relationship differs between Black and White women.

Methods: LBW data was derived from the 2013-2019 National Center for Health Statistics and National Vital Statistics System Birth Files. Food insecurity data was derived from Feeding America's 2013-2019 Map the Meal Gap project. Analyses included descriptive statistics and regression models.

Results: Data were available for 3037 US counties. Food insecurity significantly predicted county-level LBW (t(3035) = 44.48, P < .001) and explained 39.46% of the variance in LBW (F(13,035) = 1978.03, P < .001, R = .63). Food insecurity predicted LBW for both Black (t(1418) = 17.39, P < .001) and White women (t(1918) = 18.26, P < .001) and had a slightly larger effect size for Black women with fitted line plots also supporting a stronger relationship for Black women.

Conclusions: Food insecurity predicts LBW in US counties, and the relationship may be stronger for Black women. Increasing access to healthy food should be considered when planning county-level efforts for improving LBW.