Journal of Racial and Ethnic Health Disparities最新文献

Women and racial/ethnic minorities living with HIV are less likely than White men to be engaged in HIV treatment when entering US jails. Few studies have examined the intersection of gender and race/ethnicity among incarcerated populations. The "Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative" (EnhanceLink) was a 10-site prospective cohort study of 1,270 people living with HIV in correctional facilities between 2008 and 2011. Using data from this study (N = 1,096), we assessed the likelihood of having a usual source of HIV care, utilizing ART, and viral suppression (HIV-1 RNA < 200 copies/ml) within 30 days of incarceration among the following groups, stratified by current gender and race/ethnicity, relative to non-Hispanic White men: Non-Hispanic Black women, non-Hispanic Black men, Hispanic/Latina (Hispanic) women, Hispanic men, and non-Hispanic White women. Compared to non-Hispanic White men, non-Hispanic Black women were 20% less likely to report that they had access to HIV care before incarceration after adjusting for age, sexual orientation, incarceration history, and medical comorbidities (prevalence ratio (PR) = 0.8, 95% CI: 0.7-0.9, p = 0.0002). Non-Hispanic Black, Hispanic, and Non-Hispanic White women were 30% less likely to utilize ART (respectively) than White men after adjusting for the same potential confounders (PR = 0.7, 95% CI: 0.6-0.9, p = 0.002; PR = 0.7, 95% CI: 0.5-0.9, p = 0.02; PR = 0.7, 95% CI: 0.5-1.0, p = 0.03). Our findings underscore the importance of culturally informed, community-based HIV interventions that promote equitable access to HIV care.

The COVID-19 pandemic disproportionately impacted minoritized individuals. This study examined the relationships between pandemic-related stressors/distress and bodily pain in 79 Native American (NA) and 101 non-Hispanic White (NHW) participants from the Oklahoma Study of Native American Pain Risk. Online surveys were administered in May/June 2020 (wave 1), March/April 2021 (wave 2), and Sept/Oct 2021 (wave 3). Pandemic-related stressors (e.g., resource loss and added responsibilities) and distress were assessed from a custom-built questionnaire. Bodily pain was assessed from pain items on the Patient Health Questionnaire-15 (PHQ-15). The results indicate NAs and NHWs reported similar pandemic-related stressors and distress at wave 1, which remained at similar levels across all waves in NHWs. By contrast, stressors and distress increased in NAs at waves 2 and 3. Moreover, bodily pain was higher in NAs than NHWs across all waves. Regression-based multilevel analyses predicting bodily pain found that NHWs with more pandemic-related stressors/distress experienced more bodily pain, but stress/distress did not predict bodily pain in NAs. Findings demonstrated that NAs experienced more bodily pain and pandemic-related stressors/distress than NHWs. However, pandemic-related stressors/distress did not further exacerbate NA pain as observed in NHWs. This implies NAs may have demonstrated resiliency that buffered the pronociceptive effects of pandemic-related stress.

Background: Herein, we report the characterization of four cohorts of breast cancer patients including (1) non-Hispanic Whites in Florida, (2) non-Hispanic Blacks in Florida, (3) Hispanics in Florida, and (4) Hispanics in Puerto Rico.

Methods: Data from female breast cancer patients were collected from cancer registry (n = 9361) and self-reported patient questionnaires (n = 4324). Several statistical tests were applied to identify significant group differences.

Results: Breast cancer patients from Puerto Rico were least frequently employed and had the lowest rates of college education among the groups. They also reported more live births and less breastfeeding. Both Hispanic groups reported a higher fraction experiencing menstruation at age 11 or younger (Floridian Hispanics [38%] and Puerto Ricans [36%]) compared to non-Hispanic Whites (20%) and non-Hispanic Blacks (22%). Non-Hispanic Black and Puerto Rican women were significantly older at breast cancer diagnosis than their non-Hispanic White and Floridian Hispanic counterparts. The Puerto Rican and non-Hispanic Black groups more frequently had pathology stage T2 or higher primary breast tumors at diagnosis (non-Hispanic Whites [29%], non-Hispanic Blacks [39%], Floridian Hispanics [33%], Puerto Ricans [46%]). The Puerto Rican (73%, 95% CI [66, 82]) and non-Hispanic Black (79%, 95% CI [75, 84]) groups demonstrate reduced 5-year survival compared to non-Hispanic Whites (89%, 95% CI [86, 92]) and Floridian Hispanics (89%, 95% CI [86, 90]).

Conclusions: These findings demonstrate that Puerto Rican breast cancer patients suffer significant breast cancer health disparities relative to non-Hispanic Whites and Hispanics from Florida similar to the disparities observed for non-Hispanic Blacks. Future work must seek to better understand and address these disparities.

Previous studies have suggested that COVID-19 led to an increase in stigma towards the Asian population with a negative impact on their health. This study aims to explore this phenomenon and its impact on health through the qualitative analysis of semi-structured interviews conducted with 26 people of Asian origin living in Spain from September 2020 to September 2021. Among the results, it was found that, prior to the pandemic, discrimination was mostly verbal. After the outbreak of the pandemic, some participants, who were blamed and referred to as "COVID", experienced fear and physical aggression. Among the health effects, mental and social disturbances such as feeling like "permanent foreigners", worrying about being stigmatized or fear of interacting with others were prominent. The main protective factor was the support network, including education and community cohesion as main determinants. Future research is needed to analyse the evolution of this stigma after the pandemic and to explore in detail its impact on health.

Background: Lack of access to reliable transportation is a barrier to utilizing healthcare and other resources related to type 2 diabetes mellitus (T2DM). Little research has evaluated race/ethnicity-based differences in access to reliable transportation among persons with T2DM.

Purpose: To examine whether access to reliable transportation for persons with T2DM differed by race/ethnicity.

Methods: Analysis was conducted among persons with T2DM using 2022 Behavioral Risk Factor Surveillance System data. The outcome was access to reliable transportation (yes/no) for medical appointments, meetings, work, or getting things needed for daily living in the last year. The independent variable was race/ethnicity (White, Black/African American, Asian, American Indian or Alaskan Native (AI/AN), Hispanic, Native Hawaiian or Other Pacific Islander, or multi-racial). Weighted logistic regression models examined the association between access to reliable transportation and race/ethnicity controlling for covariates.

Results: Persons with T2DM (n = 24,964) who identified as Black (adjusted odds ratio (AOR) = 1.42 (95% confidence interval (CI) = 1.10, 1.84), AI/AN (AOR = 2.03 (95% CI = 1.22, 3.36), or multi-racial (AOR = 1.99 (95% CI = 1.18, 3.5) were significantly more likely to indicate they did not have reliable access to transportation in the past year compared to whites. Persons who were females, older, married, had higher income, employed, no mobility issues, no depression, and rated their health status fair to very good were significantly less likely to report transportation issues.

Conclusions: Access to reliable transportation may differ by race/ethnicity among persons with T2DM. Initiatives are needed to improve racially/ethnically equitable access to transportation for people with T2DM.

Black communities in the United States (U.S.) have faced stark inequalities in COVID-19 outcomes. The underrepresentation of Black participants in COVID-19 testing research is detrimental to the understanding of the burden of the disease as well as the impact of risk factors for disease acquisition among Black Americans. Prior scholarship notes that the reluctance to engage in medical research among Black people is, in part, due to the exploitation and abuse this community has seen from the medical field and other social institutions. To better understand the barriers and motivations for COVID-19 testing among Black Americans, this study utilized intersectionality as methodological and theoretical frameworks to examine and investigate the barriers and motivations influencing participation in COVID-19 serosurveys (blood test and interview) among the metro-Atlanta Black communities. From May to October 2021, we took a community-based participatory research approach and conducted 52 semi-structured interviews to uncover different Black communities' feelings and opinions towards COVID-19 testing. Key reasons participants agreed to the blood test include (1) curiosity; (2) health upkeep; (3) family/community/social responsibility; and (4) importance of research. Participants' reasons for rejecting the blood test were (1) unnecessary/no benefit; (2) fear (of the known and unknown); (3) fear of needles and/or blood; and (4) discomfort with test setting/procedure. Our findings show that perspectives on willingness to engagement in testing or to not participate varied across gender and age for Black individuals.

Disparities in autism research and practices based on race and ethnicity are evident across many outcomes and life course stages. However, most of the research has focused on outlining differences and not the underlying systemic inequities driving these disparities. In this conceptual paper, we aim to shift the focus by outlining mechanisms of structural racism within the institutions of science, healthcare, and residential segregation and educational systems in the United States (U.S.). We argue that these and other forms of institutional racism constitute structural racism that are influencing the racial and ethnic disparities we see in autism services and care. For each of these institutions, we identify institutional racism related to autism and offer an example of how it shapes interpersonal racism and adverse outcomes, including misdiagnosis, delayed diagnosis, unequal access to educational services, and differential treatment in clinical encounters. We then provide anti-racism approaches in autism research and practice for each of these institutions that addresses institutional and interpersonal racism shaping autism inequities among racial and ethnic minorities. We conclude with a call to action to clinicians, researchers, and others to prioritize and disrupt the impacts of structural, institutional, and interpersonal racism through targeted anti-racism approaches.

Background: Increased mortality in rural southern areas has persisted and worsened among older Black adults due to high prevalence of chronic conditions combined with limited healthcare access resulting from social and structural factors.

Objective: Our objective was to examine the relationship between general health perceptions, social functioning, mental health, and demographic characteristics among Black adults living in the rural south.

Methods: This cross-sectional study examined health perceptions in older Black Americans residing in four rural towns within Alabama (Clayton, Fort Deposit, Hobson City, and York). Participants completed a self-report survey exploring general health, social functioning, mental health, and demographic characteristics. Linear regression was used to examine the relationship between these variables and the primary outcome of general health.

Results: The average age of participants (N = 119) was 64.8 years (SD = 9.4). Social functioning, depressive symptoms, age group, and town of residence were all significantly associated with general health (p < 0.05). A one unit increase in social functioning was associated with a .28 unit increase in general health scores, p = 0.002. General health scores decreased by 19.4 units for participants reporting depressive symptoms (p < 0.0001) and by 9.8 units for those aged 65 and older (p = 0.003).

Conclusion: These findings support the need for targeted health resources in rural communities based on population needs and replicates prior studies that have shown increases in social networks may help improve physical and emotional health among the aging adult population.

Introduction: As artificial intelligence (AI) continues to permeate various sectors, concerns about disparities arising from its deployment have surfaced. AI's effectiveness correlates not only with the algorithm's quality but also with its training data's integrity. This systematic review investigates the racial disparities perpetuated by AI systems across diverse medical domains and the implications of deploying them, particularly in healthcare.

Methods: Six electronic databases (PubMed, Scopus, IEEE, Google Scholar, EMBASE, and Cochrane) were systematically searched on October 3, 2023. Inclusion criteria were peer-reviewed articles in English from 2013 to 2023 that examined instances of racial bias perpetuated by AI in healthcare. Studies conducted outside of healthcare settings or that addressed biases other than racial, as well as letters, opinions were excluded. The risk of bias was identified using CASP criteria for reviews and the Modified Newcastle Scale for observational studies.

Results: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 1272 articles were initially identified, from which 26 met eligibility criteria. Four articles were identified via snowballing, resulting in 30 articles in the analysis. Studies indicate a significant association between AI utilization and the exacerbation of racial disparities, especially in minority populations, including Blacks and Hispanics. Biased data, algorithm design, unfair deployment of algorithms, and historic/systemic inequities were identified as the causes. Study limitations stem from heterogeneity impeding broad comparisons and the preclusion of meta-analysis.

Conclusion: To address racial disparities in healthcare outcomes, enhanced ethical considerations and regulatory frameworks are needed in AI healthcare applications. Comprehensive bias detection tools and mitigation strategies, coupled with active supervision by physicians, are essential to ensure AI becomes a tool for reducing racial disparities in healthcare outcomes.

Objective: The purpose of this review was to identify relationships between social determinants of mental health service utilization and outcomes among Asian American cancer survivors in the United States (U.S.).

Methods: We performed a systematic literature search in PubMed, PsycINFO, CINAHL, and Embase for peer-reviewed studies between January 2000 and May 2024. Based on the Healthy People 2023 framework, social determinants of health (SDOH) were categorized into five SDOH domains. We extracted data using a table of evidence, and we assessed study quality using the Johns Hopkins Evidence-Based Practice.

Results: Ten non-experimental studies, with either "High" or "Good" quality, met eligibility criteria. Two examined mental health service utilization, and nine reported mental health outcomes. Seventy percent of the studies recruited samples from the health systems. The rest were from community settings. Seventy percent included the Asian American subgroup, mainly Chinese Americans. Higher education, English proficiency, more years residing in the U.S., and having social support correlated with better psychological quality of life. Higher-income and education levels were associated with more psychotropic medication use. However, zip code levels were used to estimate actual income and education.

Conclusion: We identified significant SDOH factors that influenced mental health outcomes among Asian American cancer survivors. More research is needed to understand the social determinants of mental health service utilization barriers in this population. Allocating more funding to health research tailored to Asian American cancer survivors, along with data disaggregation, standardizing socioeconomic status measures, and diversifying sampling sources, is essential to enhancing their mental health outcomes.