Journal of Racial and Ethnic Health Disparities最新文献

Autism spectrum disorder (ASD) occurs within all racial, ethnic, and demographic pediatric groups. However, Black children with ASD are diagnosed at later stages of their development, and as a result may not receive or may age out of early intervention services, and demonstrate poorer long-term outcomes, across a range of factors. African American parent's perceptions regarding access to and utilization of healthcare services for their autistic children vary. Research examining autism spectrum disorder and parental perceptions of service utilization among African American (AA) families is limited. This qualitative study aimed to understand the challenges African American parents face when initiating healthcare services for their autistic children. Eleven AA mothers of autistic children participated in individual semi-structured interviews. Six themes related to pediatric treatment needs, interactions with providers, and parents' roles as experts and advocates were generated. Implications for pediatric treatment needs of autistic children and areas of opportunity for providers working with AA autistic children are discussed.

Objective: This study examined the association of e-cigarette use status and history of depression among American Indian (AI) adults who smoke.

Method: We conducted a secondary data analysis using survey data from 375 AI adult smokers collected in 2016 at a tribally operated healthcare facility in northeast Oklahoma. Multivariable logistic regression was used to estimate the association between e-cigarette use and self-reported history of depression while adjusting for potential confounders.

Results: In the adjusted analyses, compared to never users, current and former e-cigarette users had higher estimated odds of depression history (adj. OR 2.66; 95% CI 1.25-5.72 and adj. OR 2.38; 95% CI 1.36-4.26, respectively). Additional factors independently associated with a history of depression included having strong cravings to smoke (adj. OR 2.28; 95% CI 1.13-4.88) and having a history of chronic disease (adj. OR 2.09; 95% CI 1.20-3.70) after controlling for confounding variables.

Conclusions: E-cigarette use among AI adult smokers was independently associated with a history of depression. Whether e-cigarette use among people who smoke results from depression or whether depression results from the combined use of e-cigarettes and cigarettes requires future research using a prospective cohort design.

Background: Missed clinic appointments disproportionately affect Medicaid-insured patients and residents of socioeconomically deprived neighborhoods. The role of the recent telemedicine expansion in reducing these disparities is unclear. We analyzed the relationship between census tract (CT) poverty level, residential segregation, missed appointments, and the role of telemedicine.

Methods: This retrospective cohort study used electronic health records (EHR) data merged with population datasets and restricted to adult patients (≥ 18 years) with completed or missed internal or family medicine outpatient clinic visits (03/2020-12/2022). Using generalized estimating equations, we analyzed the association between missed appointments, CT poverty level, CT residential segregation (operationalized using the isolation index), and appointment modality.

Results: Sample size was 125,229 appointments for 68,471 unique patients (Hispanic [46.6%], White [9.4%], Black [18.7%], Asian [2.6%], Native American [1.9%], and "other race/ethnicity" [0.8%]; 18-39 years [38.2%], 40-64 years [56.4%], and > = 65 years [5.36]). There was an increased likelihood of missed appointments with increasing Hispanic isolation index (OR 1.12; 95% CI 1.03, 1.23) and decreased likelihood with increasing Black isolation index (OR 0.71; 95% CI 0.61, 0.83). The protective effect of telemedicine on missed appointments decreased with increasing Black and Hispanic isolation index.

Conclusion: Our results suggest that further studies are needed to understand the potential impact of telemedicine on healthcare use inequities among residents of residentially segregated areas. Targeted interventions that aim to identify and address structural factors that could limit the benefits of telemedicine use are also needed.

Home visiting programs (HVPs) provide services to pregnant individuals and parents of young children to improve families' health and well-being. However, little is known about these families' social contexts. This study explores the social networks and dietary intake of mothers enrolled in a HVP, focusing on health support and health undermining. Cross-sectional data from 76 mothers enrolled in a HVP in Los Angeles County were collected by interview, using validated measures. Almost all mothers (95.7%) had one or more health supporters, while 55.1% had one or more health underminers. Some key findings related to health support were that mothers with higher income had more health supporters in their network (b = 1.36, p = 0.03), and network members were more likely to be health supporters if they were a romantic partner (OR = 3.41, p < 0.001), a resource-based connection (OR = 3.46, p < 0.01), or if they lived in the same neighborhood as the mother (OR = 1.68, p < 0.05). Further, having a health supporter who lived in the same neighborhood was associated with consuming more (1 + daily servings) vegetables (OR = 3.0, p < 0.05) and no sugar-sweetened beverages (OR = 0.29, p < 0.05). There were fewer findings related to health undermining: network members more likely to be underminers were romantic partners (OR = 8.93, p < .0001), and those perceived as having overweight or obesity (OR = 3.98, p < 0.001), but health undermining did not predict dietary intake. Overall, a broad set of network features were linked with health support, and given that some types of support were linked with better diet, network-based diet interventions leveraging health support may be effective in this priority population.

Introduction: Incidence of endometrial cancer (EC) in Hispanic/Latina (H/L) women are higher compared to other race/ethnicities in the United States. EC is the third most common cancer and the fourth cause of cancer-related deaths in Puerto Rican women, yet demographic and clinical information is limited. High rates of EC risk factors such as obesity, diabetes mellitus type 2 (DM2) and hypertension (HTN) have been documented in the Puerto Rican population.

Objective: To describe the demographic, clinical history, lifestyle, obstetrical-gynecological, pathologic, and molecular profiles of women with EC predominantly from Southern/Central Puerto Rico.

Methods: We conducted a retrospective secondary analysis of data abstracted from the Puerto Rico Central Cancer Registry (PRCCR), self-administered questionnaires and medical records of EC cases. Descriptive statistics were conducted using SPSS V28 and RStudio.

Results: We identified 105 EC cases aged 28-82. The major risk factors were BMI ≥ 30 (72%), HTN (33%), and DM2 (20%). Endometrioid adenocarcinoma was the main histological tumor type (80%), of which 74% were Type I. Obesity and nulliparity were associated with younger age at diagnosis. Older age at diagnosis (> 65 y/o) was associated with more advanced disease.

Conclusions: This study defined the clinical-demographic profile of women with EC from Puerto Rico and identified risks factors that are associated with younger or older age at diagnosis.

Impact: Profiling the risk factors for EC may help improve diagnostic accuracy and clinical management and result in better outcomes for this under-served, under-researched cancer patient population.

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.

Efforts to understand and respond to the opioid crisis have focused on overdose fatalities. Overdose mortality rates (ratios of overdoses resulting in death) are rarely examined though they are important indicators of harm reduction effectiveness. Factors that vary across urban communities likely determine which community members are receiving the resources needed to reduce fatal overdose risk. Identifying communities with higher risk for overdose mortality and understanding influential factors is critical for guiding responses and saving lives. Using incident reports and mortality data from 2018 to 2021, we defined overdose mortality ratios across Milwaukee at the census tract level. To identify neighborhoods displaying higher mortality than predicted, we used Integrated nested Laplace approximation to define standardized mortality ratios (SMRs) for each tract. Geospatial and spatiotemporal analyses were used to identify emerging hotspots for high mortality risk. Overall, mortality was highest in Hispanic and lowest in White communities. Communities with unfavorable SMRs were predominantly Black or Hispanic, younger, less employed, poorer, less educated, and had higher incarceration rates and worse mental and physical health. Communities identified as hotspots for overdoses were predominantly non-White, poorer, and less employed and educated with worse mental and physical health, higher incarceration rates, and less housing stability. The findings demonstrate that overdose mortality rates vary across urban communities and are influenced by racial disparities. A framework that enables identification of challenged communities and guides community responses is needed.

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.

Ethnic prejudice in healthcare has been widely examined, yet little is known about its intersection with stigma and prejudice based on one's health status. The present study investigates the intersections of ethnic prejudice and stigma of chronic disease in a healthcare setting as shaping unique forms of disadvantage. From an intersectional perspective, we examined whether ethnically diverse patients affected by stigmatized health conditions would be differentially perceived and cared for by prospective medical doctors. In a within-subjects, experimental design, preclinical medical students read, and evaluated clinical vignettes describing patients, who were presented as either White Italian or Middle Eastern migrants and were affected by visible and concealable stigmatized chronic conditions. Emotional reactions, attributions about disease-onset, caretaking attitudes, and meta-beliefs about patient disclosure behavior were assessed. Results showed that when reading of patients affected by visible compared to concealable stigmatized conditions medical students experienced stigma-related emotions (e.g., disgust, pity, fear) and attributed patients a higher tendency to be embarrassed, to hide, and to avoid disclosure for fear of others' negative reactions. However, Middle Eastern migrants when affected by conditions with visible and behavioral manifestations were attributed a lesser tendency to feel embarrassed, to hide, and to avoid illness disclosure for fear of others' negative reactions compared to White Italian patients with the same conditions. These findings indicate that at the intersection of ethnic prejudice and health-related stigma, multiply stigmatized patients may become invisible and not fully considered in the eyes of medical students. Present results underscore the need to enhance diversity representation in higher medical education for a more inclusive healthcare curriculum and practice.