Journal of Racial and Ethnic Health Disparities最新文献

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.

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.

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.

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.

Background: Heightened anti-Arab/Middle Eastern and North African (MENA) xenophobia in the United States (US) coupled with the addition of a MENA category on the next US Census call into attention the health needs of this minoritized population. Targeted research is needed to better understand the factors that influence Arab/MENA American participation in US-based health research and health care.

Methods: A novel qualitative interview guide was constructed to better understand the health research experiences, health care experiences and needs of Arab/MENA patients nationally. Patients were recruited through the Arab American Health Network Alliance (AAHNA) community connections. Semi-structured interviews were conducted virtually in English and Arabic, and qualitative data was interpreted through iterative thematic analysis using inductive reasoning.

Results: A total of seventeen interviews (n = 17) were completed (14 in English, 3 in Arabic). Notably, the majority identified as female (82%) and have resided in the US for 18 years or longer (53%). Three main themes were identified (1) Individual-level Comfortability and Access to Research Participation, (2) Advancing Community Health Outcomes and Participation, and (3) Structural Barriers as Drivers of Health Disparities.

Conclusion: The health research and health care experiences explored in this project have the potential of informing future inquiries on Arab/MENA American health. For instance, we suggest building community trust, providing equitable compensation and support, increasing health workforce diversity, and advocating for affordable health care, all to improve Arab/MENA patient participation in health research.

Background: Depression is one of the significant public health concerns, accounting for about 800,000 suicides every year and affecting an estimated 300 million globally. Among the mental health issues students face, depression has become increasingly prevalent and detrimental to multiple factors that can either impact academic performance or overall health and well-being. This study aims to estimate the prevalence and identify factors associated with depression among students in higher education in Tamil Nadu.

Methods: The cross-sectional survey with a sample size of 4059 and logistic regression was performed.

Results: The results showed 51.2% of the students had depression. The risk for depression was greater in students between 23 and 24 years of age, with an odds ratio of 2.14 at p = 0.01 and a 95% confidence interval of 1.19-3.83. It was even more probable for pupils aged 25 and older, with an OR of 2.53 and p = 0.00, within the 95% CI: 1.66-3.86. Married students were less likely to suffer from depression compared to their non-married counterparts, with an OR of 0.22 and p = 0.014, within the 95% CI: 0.06-0.74. Those students who paid a high fee had a higher chance of suffering from depression, with an OR of 1.55 and p = 0.00, with a 95% CI: 1.20-2.00.

Conclusion: Age, marital status, and socioeconomic status showed significant associations with depression. These findings highlight the critical need for mental health support programs in higher education.

Objective: Rheumatic heart disease (RHD) is the most common acquired heart disease in children in the USA and worldwide. This study compares the diagnosis and outcomes of Indigenous and non-Indigenous youth with acute rheumatic fever (ARF) and RHD at a US children's hospital serving a several state catchment area with a large Indigenous population (>270 tribes representing 9.2% of the total US Indigenous population).

Methods: This study involved a retrospective analysis of patients presenting to a major children's hospital between 2008 and 2018. Individuals aged 4-17 with a diagnosis of ARF or RHD were identified using International Classification of Diseases, Ninth and Tenth Revision (ICD-9, 10) codes. Patients with congenital heart disease were excluded.

Results: Chart review was performed on 132 individuals with ARF/RHD. 61% of individuals with non-missing race identified as Indigenous (defined as American Indian, Alaska Native, Native Hawaiian, or Pacific Islander). Average age at diagnosis was found to be 10.3 years for Indigenous youth, compared to 9.1 years for non-Indigenous youth. Indigenous youth were more likely to have cardiac involvement at the time of diagnosis. Indigenous youth had higher rates of aortic regurgitation on initial echocardiography, but no other significant differences were found in incidence of echocardiographic findings.

Conclusion: Indigenous youth were diagnosed with rheumatic fever at a later age than non-Indigenous youth, and more likely to have cardiac involvement at time of diagnosis, indicating disparities between the two populations. This suggests a need for further study and development of screening tools.

Despite the fact that perceptions of racialized discrimination, health-related stigma, and pain-related injustice have been associated with worse patient functioning, little is known about their unique relationships in Black youth living with sickle cell disease (SCD). In this study, we (1) examined the prevalence of perceptions of racialized discrimination, perceptions of health-related stigma, and pain-related injustice appraisals and (2) investigated how the aforementioned variables were uniquely related to functioning (i.e., functional disability, depressive, and anxiety symptoms) in Black youth living with SCD. The study sample included 30 non-Hispanic Black or African American youth living with SCD (17 male, 13 female youths). The average age of the sample was approximately 11.3 years (SD = 2.73). Zero-order correlations and hierarchical regressions were used to examine and compare the multivariate relationships between perceived racialized discrimination, perceived health-related stigma, and perceived pain-related injustice and outcome variables (functional disability, anxiety symptoms, and depressive symptoms). For functional disability, perceived racialized discrimination and perceived pain-related injustice were significant predictors in the final model (F(3,26) = 11.00, p < .01). For depressive symptoms, health-related stigma trended toward significance (p = .09) as a predictor in the final model (F(2,26) = 6.69, p < .01). For anxiety symptoms, perceived pain-related injustice was the only significant predictor in the final model (F(3,26) = 10.25, p < .001). Results suggest that the youth living with SCD experience and perceive racialized discrimination, health-related stigma, and injustice surrounding their pain experience and these factors are associated with worse outcomes.

Background: The Afro-Peruvian population is one of the ethnic minorities most affected by cultural, socioeconomic, and health barriers; however, there is little evidence on health inequalities in this ethnic group. Therefore, We aimed to determine health inequalities among the Peruvian Afro-descendant population in comparison with non-Afro-descendants.

Methods: A cross-sectional study was conducted using data from the Demographic and Family Health Survey 2022. Twenty indicators related to the health, nutrition, and well-being of the Peruvian Afro-descendant population were included. Individuals identifying as native, as well as those who did not know or did not respond to the ethnicity question, were excluded from the analysis. To assess inequalities in these indicators, the difference in percentages between Afro-descendants and non-Afro-descendants was calculated, and the percentages of these indicators across the tertiles of wealth index and the slope index of inequality (SII) were analysed for each ethnic group.

Results: Of a total of 16,875 adults and 23,206 women included in the study, 16.9% and 17.3% were of African descent, respectively. Afro-descendant population had a lower proportion of self-reported diabetes (- 1.5 percetange points (pp); 95% confidence interval (CI), - 2.7 to - 0.3); alcohol consumption in the last 30 days (- 4.5 pp; 95% CI, - 7.2 to - 1.8); higher education (- 20.6 pp, 95% CI, - 23.2 to - 18.0); access to improved water (- 3.4 pp; 95% CI, - 4.6 to - 2.1) and sanitation (- 12.1 pp; 95% CI, - 14.2 to - 10.0); cesarean section (- 9.5 pp; 95% CI, - 12.6 to - 6.4); institutional delivery (- 6.3 pp; 95% CI, - 8.4 to - 4.1); early initiation of prenatal care (- 3.3 pp; 95% CI, - 5.8 to - 0.9); birth registration (- 1.8 pp; 95% CI, - 3.4 to - 0.2) and higher proportion of stunting (+ 4.8 pp; 95% CI, 3.0 to 6.6) and adolescent maternity (+ 5.0 pp; 95% CI, 1.4 to 8.6) compared to their non-Afro-descendant counterparts. In addition, a similar wealth gap between Afro-descendant and non-Afro-descendant populations was observed in various indicators.

Conclusions: In Peru, some indicators reflect the worse living conditions faced by the Afro-descendant population compared to their non-Afro-descendant counterparts in terms of health, nutrition, and well-being.