Journal of Racial and Ethnic Health Disparities最新文献

The COVID-19 pandemic led to substantial forgone care. However, relatively few studies have investigated the mental health consequences of forgone care experiences on older adults and how these associations vary by race and ethnicity during this period. This study analyzed US older adults aged 55 or older from the Health, Ethnicity, and Pandemic Survey (N = 883; average age = 65), a nationally representative survey conducted in late 2020. Weighted OLS regression was used to examine the association between measures of forgone care and mental health outcomes. Results showed that experiences of forgone care were prevalent and similar across racial and ethnic groups, with some variations across types of missed care. Furthermore, forgone care and missing various types of care during the COVID-19 pandemic were associated with higher psychological distress and poorer sleep quality, with some variations by race and ethnicity. Black older adults who had forgone care and missed more types of care showed even poorer sleep than their White counterparts. Additionally, missing chronic care, mental care, and preventative care, but not other types of care, was associated with greater psychological distress and poorer sleep for all racial and ethnic groups. However, Black older adults who missed chronic care had even poorer sleep than Whites. Findings emphasize the need to support all older adults' healthcare access of various types during the pandemic and the importance of focusing on specific racial and ethnic groups such as Black older adults who were more affected by forgone care.

Background: This review explores unique racial and trauma-related constructs associated with gastrointestinal conditions (GCs) in Black women, offering culturally relevant contemplative solutions for healing and holistic well-being. Additionally, we investigate the potential of mindfulness-based interventions (MBIs) in mitigating stress-induced GCs within this demographic. Guided by two theoretical frameworks, the Superwoman Schema (SWS) and critical feminist theory, the study unravels how cumulative stress, or allostatic load, intersects with socio-contextual factors, contributing to debilitating psychological and physiological health issues. Their intersectionality influences both individuals' presentation in clinical settings and the quality of care they receive.

Methods: Employing subject-related term searches alongside a coupling technique, we elucidated a unique progression of GCs in Black women, guided by their distinct experiences. The search resulted in 11 papers: 2 on the stress and trauma of Black women, 2 on external trauma and post-traumatic stress disorder (PTSD) risk, 2 on stressors affecting gut health, 2 on GCs in Black individuals, 2 on mindfulness and comorbidities, and 1 on incorporating mindfulness in the Black community.

Results: The findings underscore a relationship between psychological stress, trauma, and GCs, mainly affecting Black women. Moreover, MBIs have promising effects on relationships and self-worth, supporting trauma recovery among the population.

Conclusion: By merging frameworks addressing racism and trauma's impact on gut health, this review uncovers pathways for understanding how these factors specifically manifest in Black women. This highlights the potential of targeted MBIs as promising avenues for treating GCs in the population and for promoting overall well-being through culturally sensitive methods.

Objectives: Using a sociocultural coping framework, we examined stressors and coping strategies among N = 65 Black adults with varying levels of cultural mistrust, which is defined as an attitudinal response to racism.

Method: We conducted an abductive structural tabular thematic analysis on short-form qualitative responses to a Black mental health survey.

Results: Participants reported several stressors (e.g., family, finances, occupation) and primarily active coping strategies including institutional mechanisms, such as religion.

Conclusion: Findings suggest that Black adults, regardless of cultural mistrust levels, actively cope despite stressors informed by their sociocultural context (e.g., race, gender, socioeconomic status) and barriers to treatment. Considering these factors, providers can work to enhance the established coping mechanisms, while integrating them into culturally responsive care, rather than remove them.

Due to limited information and published research, health disparities among bi and multiracial (B/MR) groups are not as understood as other racial groups. Without this knowledge and ability to allocate resources as needed, this is another racial group that could suffer from poorer health outcomes. As a result, participants (n = 15) were placed in focus groups or individual interviews with ten qualitative questions. Each participant then completed an anonymous quantitative survey assessing their health-related behaviors. Quantitative results included 40% (n = 6) of participants who tried cigarettes, 53% (n = 8) who tried electronic vapor products, and only 20% (n = 3) of participants who got the recommended hours of sleep nightly. Qualitative results include themes of situational identity, White assimilation, and pressure to explain their identity. Many participants dealt with the insensitivity that one side of their family exhibited towards the other side of their identity through inappropriate jokes and comments. Lastly, there were expectations from both family and friends to act a certain way. Researchers identified three major categories that the participant's influences fell into. Genetics, Culture/Heritage, and the Environment are the aforementioned categories that can work together or stand alone to influence behaviors that can ultimately affect health outcomes. While these results are based on a small sample size (n = 15) of undergraduate B/MR students, it does suggest that researchers should complete a more extensive survey on this racial group to verify these findings.

Background: Racial bias in healthcare settings can manifest as biased communication, discriminatory treatment, lower quality of care, and a lack of empathy toward women of color [WoC; Nong et al. in JAMA Netw Open 3:e2029650-e2029650, 1; McLemore et al. in Soc Sci Med 201:127-135, 2; Hagiwara et al. in Patient Educ Couns 102:1738-1743, 3]. Despite a large body of research on racial bias, more research is needed to understand how bias translates into specific communication behaviors to develop interventions that reduce racial mistreatment in communication with WoC (Hagiwara et al. in Patient Educ Couns 102:1738-1743, 3). This study contributes to the existing research by exploring the impact of colorblind racial ideology (i.e., the denial and minimization of racism) and ethnocultural empathy (i.e., the ability to understand and relate to others from different ethnic or cultural groups) on health providers' observed empathic communication behaviors.

Methods: Providers were recruited through US hospital listservs. Inclusion criteria required that participants work in the field of maternal health. A total of 65 healthcare providers completed a survey, which included measures of colorblindness and ethnocultural empathy, and simulated interaction over HIPAA Zoom with trained actors playing patients. Participants were randomly assigned to administer the Edinburgh Postpartum Depression Scale to a Black, Asian, or White patient in a simulated postpartum 4-week checkup.

Results: Path analyses were conducted using Mplus. Findings indicated that colorblind racial ideology and ethnocultural empathy were associated with racially biased reasoning, which in turn was related to a lack of providers' empathic communication behaviors.

Conclusion: Study findings suggest racial bias can lead to less empathic patient-provider communication interaction and support changes aimed at both reducing racial bias and increasing empathic interaction.

Evidence in the literature suggests an association between Type 2 Diabetes Mellitus (T2DM) and dementia, but this relationship has not been studied in the most recently available nationally representative datasets. This retrospective, observational, cross-sectional study of adults (60+ years of age) seeks to investigate this association across racial and ethnic groups in the most recently available National Ambulatory Medical Care Survey (NAMCS) datasets. A multivariable logistic regression model is employed to investigate the association between T2DM and the diagnosis of dementia and assess disparities in racial and ethnic groups, while controlling for available covariates of interest. The analysis found no evidence of a relationship between T2DM and dementia even after adjusting for available covariates of interest (OR 1.13, 95% CI = 0.81-1.57). However, evidence of differences in the proportion with dementia was observed between ethnicities and race groups. Hispanic/Latinos were found to have more than double the odds of dementia compared to Non-Hispanic/Latinos (OR 2.08, 95% CI = 1.05-4.14), while the Other race group had 74% lower odds of dementia compared to the White race group (OR 0.26, 95% CI = 0.10-0.64). This study suggests that disparities in the risk of dementia remain for ethnic/racial groups. As minority populations continue to grow, educational and preventative measures for both diabetes and dementia are vital public health priorities. Perceptions of cognitive impairment, its association with T2DM, and the interventions needed to address the deficits may vary by culture and ethnic background; therefore, specific characteristics relevant to these populations should be further evaluated.

Background: The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background.

Methods: An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated.

Results: Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity.

Conclusions: The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity.

Registration: PROSPERO registration number: CRD42022379584.

The gap in fatal opioid overdose rates has been closing between non-Hispanic Black and non-Hispanic White individuals. The rising opioid-involved mortality rates among non-Hispanic Black adults has been identified by SAMHSA as a critical public health issue. However, further research is needed that utilizes comprehensive surveillance data on both fatal and non-fatal opioid-involved overdoses to better assess the changing trends and evaluate factors contributing to changing disparities. We conducted an analysis of medical examiner and hospital data for years 2016-2021 from the largest county in Illinois (Cook) to (1) evaluate disparities in non-fatal and fatal opioid-involved overdoses between middle-aged non-Hispanic Black adults and Black adults of other age groups stratified by sex, (2) to assess if disparities exist across middle-aged adults of different race-ethnicities specifically non-Hispanic White and Hispanic-Latino adults, and (3) evaluate factors contributing to the disparities. Fatal opioid overdose rates among middle-aged Black men 45-64 years old were on average 5.3 times higher than Black men of other age groups, and 6.2 times higher than middle-aged non-Black men. Similarly, fatal opioid overdose rates among middle-aged Black women were on average 5.0 times higher than Black women of other age groups, and 4.9 times higher than middle-aged non-Black women. Hospital utilization rates for opioid-involved overdoses showed similar disparities between age groups and race-ethnicities. Findings indicate that stark disparities in rates of opioid-involved overdoses among middle-aged Black men and women are likely attributed to exposure to more lethal opioids, drug variability in local markets, differences in concurrent drug exposures, and lower access to harm reduction, emergent and preventative health services.

Background: Studies showed disparities in management and outcomes of African American when compared to Caucasian population. The presence of chorioamnionitis may affect the decision to have a cesarean delivery (CD); however, it is not known if such a decision is affected by the mothers' race/ethnicity.

Objective: To assess the interaction between African American race/ethnicity and CD in women with chorioamnionitis.

Methods: Utilizing the National Inpatient Sample dataset, we examined the association of CD with chorioamnionitis in the overall population and within Caucasian and African American. Logistic regression models were used to control for confounders.

Results: The study included 6,648,883 women who delivered 6,925,920 infants. The prevalence of chorioamnionitis was 0.78 and 1.1 in Caucasian and African American, respectively. CD with and without chorioamnionitis was 41.2% and 32.4%, respectively (aOR 1.46 (1.43-1.49), p < 0.001), in Caucasian population and 45.0% and 36.6% in African American population aOR 1.42 (1.37-1.47), p < 0.001. African American population had significantly higher CD after controlling for chorioamnionitis and other confounding variables (aOR of 1.18 (1.17-1.18), p < 0.001).

Conclusion: Chorioamnionitis is associated with increased rate of CD. Ethnic disparities exist in CD rates regardless of the chorioamnionitis status. Such findings warrant further investigation to explore factors associated with this discrepancy.

Purpose: The demographic proportions of plastic surgery trials approximating real-world disease have not well been studied. Judicious trial representation is essential in evaluation of treatments across diverse patient populations. Herein, we investigate sex, racial, and ethnic disparities in patient enrollment across burn trials.

Methods: Cross-sectional analysis of participants enrolled in high-quality, with reduced risk of bias, randomized controlled trials (RCT) on burns registered on clinicaltrials.gov under the query "burn." Completed RCTs reporting at least two demographic groups, employing double masking or greater, and with results accessible through the registry or publications were included. Trial characteristics (sponsor country, site location, initiation year, study phase, masking) and demographic data (sex, race, ethnicity per US reporting guidelines) were collected. The Global Burden of Disease database provided sex-based burn disease burdens. The primary outcome was the population-to-prevalence ratio of enrolled female participants. Secondary outcomes included representation of racial and ethnic populations as related to study blinding, phase, and study/sponsor locations.

Results: Of 546 records, 39 trials met the inclusion criteria (2919 participants). All trials reported sex demographics, with females comprising 37.02% of all participants (PPR = 0.71, 95% CI [0.59, 0.82], likely indicating underrepresentation against their empiric disease burden). Only 7 and 9 trials reported ethnicity and race, respectively, although not comprehensively. Among trials reporting race or ethnicity, Caucasians and Black persons comprised 57.52% and 21.80% of participants, respectively, while only 9.80% had Hispanic/Latino ethnicity. Severe underreporting of race and ethnicity precluded much of secondary significance testing across study variables.

Conclusions: Females are likely underrepresented in high-quality, US-registered burn trials, unreflective of their real-world disease burden. Further, severe underreporting of race and ethnicity was noted. Future trials should enroll diverse demographics and equitable populations for promotion of study generalizability.