Journal of Racial and Ethnic Health Disparities最新文献

Objectives: We sought to examine the burden and correlates of depression and anxiety among Ethiopian and Eritrean American emerging adults. African immigrants and their children constitute a large and growing proportion of the Black population but are largely overlooked in research focusing on either Black or immigrant youth. As they transition to adulthood, youth of Ethiopian and Eritrean origin must navigate a multitude of challenges including the impacts of traumatic immigration experiences, acculturation, racism, and discrimination.

Methods: We conducted a cross-sectional survey study with N = 200 youth (ages 18-25 years) in Atlanta, GA, in 2022-2023. The 287-item self-administered online survey included measures of depressive symptoms, anxiety symptoms, sociodemographic indicators, and stressor- and resilience-related constructs. We conducted descriptive statistical analysis and estimated multivariate logistic regression models to determine factors associated with symptoms of depression and anxiety.

Results: Forty-nine percent (49.2%) of the sample endorsed depressive symptoms above the threshold for clinical significance, and 57.4% of the sample met symptom criteria for either mild, moderate, or severe anxiety. In adjusted logistic regression analyses, adverse immigration experience (OR 5.45; 95%CI 1.55-19.14), fear of failure (OR 9.15; 95% CI 1.32-63.59), and discrimination (OR 1.48; 95%CI1.07-2.06) were significantly associated with higher odds of depressive symptoms. Higher food security (OR 0.20; 95%CI 0.05-0.85) and normal (OR 0.18; 95%CI 0.06-0.58) or high (OR 0.09; 95% CI 0.01-0.66) levels of resilience were associated with a lower likelihood of depression. Fear of failure (OR 7.34; 95%CI 1.67-32.2) and discrimination (OR 1.68; 95%CI 1.14-2.46) were associated with higher odds of anxiety symptoms, and normal (OR 0.21; 95% CI 0.06-0.68) or high (OR 0.12; 95%CI 0.02-0.77) levels of resilience were associated with lower odds of anxiety.

Conclusions: Stressors related to immigration and discrimination were associated with depression and anxiety among Ethiopian and Eritrean American emerging adults. Our findings point to a role for resilience-supporting interventions with cultural tailoring to address the unique needs of this growing demographic.

Background: Although disparities in access to COVID-19 testing and infection rates were identified in civilian literature, it is unclear whether the universally-insured U.S. Military Health System (MHS) experienced similar inequities. We examined whether there were disparities by race, sex, and rank within the MHS' direct care sector during the early pandemic period.

Methods: Retrospective study of adult TRICARE beneficiaries from March 1, 2020 to February 28, 2021. Likelihood of COVID-19 testing and infection, among eligible beneficiaries, for each exposure variable was assessed using logistic regression.

Results: 697,769 beneficiaries received COVID-19 testing during the study period with 56,037 testing positive. Women were more likely to be tested than men (OR: 1.23, 95% CI: 1.21-1.24), but less likely to test positive (OR: 0.87, 95% CI: 0.85-0.89). Compared to White beneficiaries, Black and Asian/Pacific Islander beneficiaries were more likely to be tested (OR: 1.07, 95% CI: 1.07-1.08; OR: 1.23, 95% CI: 1.21-1.24). Black beneficiaries were more likely to test positive (OR: 1.10, 95% CI: 1.07-1.13). Junior Enlisted members were less likely, while Junior Officers were more likely to be tested than Senior Enlisted members (OR: 0.73, 95% CI: 0.73-0.74; OR: 1.20, 95% CI: 1.18-1.21). Junior and Senior officers were less likely to test positive (OR: 0.92, 95% CI: 0.89-0.95; OR: 0.70, 95% CI: 0.67-0.74).

Conclusion: Despite universal healthcare coverage, disparities in COVID-19 testing and infection rates by race, sex, and sponsor rank were identified within the MHS. Further research of underlying factors of observed disparities and targeted outreach are necessary for equitable care.

Introduction: Racial and ethnic minorities experience a disproportionate burden of the type 2 diabetes (T2D) and are at a 2 to 5 times higher risk of developing macrovascular disease. The purpose of the study was to describe the perspectives of Haitian American immigrants' challenges to effective T2D self-management.

Methods: Utilizing a descriptive qualitative approach, purposive sampling was employed to recruit a subgroup of adult Haitian American immigrants from a parent cross-sectional study. Content analysis was used to identify themes describing participant perspectives. Lincoln and Guba's four criteria to assess the trustworthiness and ensure the rigor of the study were applied.

Results: A total of 36 participants were enrolled, with 54% being male, and age ranged from 34 to 63 years. The majority were married, and 77% reported using metformin. Three facilitators and two barriers to their T2D self-management were found. Facilitators included (1) family and social support, (2) optimism and hope, and (3) novel devices. Barriers included (1) psychosocial and (2) environmental factors.

Discussion: The facilitators underscore the pivotal role of close familial relationships, communal influence, and the potential utility of innovative devices like continuous glucose monitoring in enhancing T2D management, whereas the barriers delineate the unique challenges posed by discrimination, lack of provider/client decision-making and communication, the compounding effects of COVID-19, concerns about safety, mistrust in healthcare systems, and financial constraints, which collectively exacerbate the complexities of ineffective T2D management. Collaboration between clinicians, clients, and policymakers is imperative to emphasize the urgent necessity for a multifaceted approach in addressing the complex healthcare landscape of Haitian American immigrants managing T2D in the United States.

Reducing racial/ethnic disparities in vaccination rates is a significant goal of Healthy People 2030. This study aims to examine adult vaccination rates by race/ethnicity and sex in the United States. We evaluated the vaccination rate of influenza, tetanus-diphtheria (Td), hepatitis A, hepatitis B, pneumococcal, shingles, and human papillomavirus (HPV) using 2018 National Health Interview Survey (NHIS) data by race/ethnicity. Our sample included 53,647 participants, and we categorized race/ethnicity as White (n = 36,245), Black (n = 5,861), Hispanic (n = 8,219), and Asian (n = 3,322). Multivariate logistic regression was used to determine the association between race/ethnicity and vaccination coverage, controlling for demographic, socioeconomic, and health-related variables. We also stratified the multivariate logistic regressions by race/ethnicity and sex. Influenza, Td, hepatitis A, pneumococcal, and shingles vaccination coverage differed by race/ethnicity. After adjusting for key covariates, racial/ethnic disparities in vaccination persisted for all vaccines examined. Racial disparities in vaccination coverage persisted when stratifying by sex for all vaccines. Black males had lower odds of receiving the HPV and Td vaccine than White males (OR range: 0.53-0.78). Black females had lower odds of receiving the HPV, pneumococcal, and Td vaccine than White females while Hispanic and Asian females had lower odds of receiving the Td vaccine than White females (OR range: 0.52-0.76). Racial/ethnic and sex differences in vaccination levels narrow when adjusting for factors analyzed in the NHIS but are not eliminated, suggesting the need for efforts to achieve equity in immunization rates as well as increasing vaccination rates across all populations.

Background: Although the COVID-19 vaccination has been shown to be safe and effective during pregnancy, pregnant and postpartum populations continue to experience higher rates of vaccine hesitancy than the general population. The experience of discrimination is associated with vaccine hesitancy, but this association has not yet been examined within a pregnant population, which is a particularly vulnerable group for adverse COVID-19 outcomes.

Methods: Pregnant individuals receiving prenatal care at a Midwestern academic institution were approached between June 2021 and March 2022 to complete a web-based discrimination questionnaire. The validated survey- the Brief Perceived Ethnic Discrimination Questionnaire - Community Version (BPEDQ-CV) - measures perceived interpersonal racial and ethnic discrimination through four domains, with questions rated on a five-point Likert scale ranging from "never" to "very often". All four domains were summarized in a lifetime discrimination score ranging from 1 to 5. The primary outcome was receipt of COVID-19 vaccination in pregnancy or within the first 180 days postpartum. A multivariate logistic regression model was used to examine the association between "lifetime discrimination score" and COVID-19 vaccination.

Results: Of the 274 pregnant individuals who met inclusion criteria for this analysis, 211 (77.0%) received the COVID-19 vaccine and 63 (23.0%) declined. For each domain of BPEDQ-CV, and for the combined score of lifetime discrimination, a higher score was associated with a higher rate of declining the COVID-19 vaccine. After adjusting for potential cofounders, each unit increase in lifetime exposure to perceived discrimination was associated with 1.25 higher odds of not receiving the COVID-19 vaccine during pregnancy or within in the first 180 days postpartum (aOR 1.25, 95% CI 1.01 - 1.55).

Conclusion: We found that higher lifetime exposure to perceived discrimination was associated with higher risk of declining COVID-19 vaccination during pregnancy and within six months postpartum.

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.

Objective: Examine the association between social determinants of health (SDOH) (cultural, neighborhood, and physical factors) and blood pressure (BP) in Black women 1-3 years following delivery.

Methods: Cross-sectional data collected from N=204 adult Black women who had a live delivery between 2013 and 2022 in Milwaukee, Wisconsin, USA, were analyzed. Sequential linear and logistic regression models were run to test associations between SDOH variables and systolic and diastolic BP. SDOH were the independent variables; systolic and diastolic BP were the outcome variables. Stepwise linear and logistic regression with forward selection were run to assess the independent associations between SDOH and BP in Black women 1-3 after pregnancy.

Results: Mean systolic and diastolic BP were 120.1 (± 17.4 SE) and 82.0 (± 13.2 SE), respectively. In final stepwise regression models, age (β 0.61, 95% CI 0.20, 1.02), income (β 5.45 95% CI 0.35, 10.56), chance health locus of control (β -0.78, 95% CI -1.37, -0.19), depression (β 0.59, 95% CI 0.10, 1.08), BMI (β 0.33, 95% CI 0.08, 0.57), family history of preeclampsia (β 7.92, 95% CI 1.49, 14.35), and kidney disease (β 60.32, 95% CI 38.71, 81.93) were associated with systolic BP. Age (β 0.53, 95% CI 0.23, 0.83), depression (β 0.55, 95% CI 0.22, 0.87), BMI (β 0.45, 95% CI 0.28, 0.63), family history of preeclampsia (β 5.71, 95% CI 0.97, 10.45), and kidney disease were significantly associated with diastolic BP.

Conclusion: Depression was associated with increased systolic BP and chance health locus of control was associated with decreased systolic BP. Depression was significantly associated with increased diastolic BP. Future research should explore causal mechanisms between depression and hypertension risk.

Background: Obesity is an epidemic that affects individuals of all races. Literature reports reoperation rates from 0.1 to 6.5% and non-operative reintervention rates from 1.1 to 3.6% after metabolic and bariatric surgery (MBS). Despite discordant rates among ethnic groups being described, results are still inconclusive.

Objective: To compare reoperation and reintervention causes among ethnic MBS cohorts (setting-Academic Hospital).

Methods: Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy (SG) cases were identified from the 2015-2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases. Regression analyses were performed to determine predictors of reoperation and reintervention. Reoperation and reintervention causes were compared among racial/ethnic cohorts using Pearson chi-square or Kruskal-Wallis tests. A p-value < 0.05 was considered significant.

Results: In total, 550,671 cases were analyzed. Reoperation and reintervention rates for all-cause and bariatric-related causes were 1.3%, 1.05%, 1.3%, and 1.2%, respectively. The NHB population was identified as an independent predictor of reoperation and reintervention. The most common bariatric-related causes of reoperation were bleeding (22.67%) and leaks (18.07%). NHB had an increased proportion of reoperation due to IO and reintervention due to NVP. For Hispanics and NHW, an increased proportion of bleeding and leaks were significantly increased for both reoperation and reintervention, respectively. After propensity matching, NHB patients undergoing SG had higher odds of reoperation and reintervention due to leaks and bleeding compared to other populations.

Conclusion: MBS reoperation and reintervention causes differ by ethnic groups. Studies on optimizing care quality based on these disparities should be conducted.

Objective: To evaluate the association of race and ethnicity with urine testing for febrile children in the emergency department and to measure trends in urine testing from 2002 to 2021.

Study design/methods: We conducted a cross-sectional analysis of children aged 2-24 months with a recorded temperature of ≥ 38 °C who presented to an emergency department in the United States from 2002 to 2021 using the National Hospital Ambulatory Medical Care Survey. We assessed trends in urine testing stratified by sex, race, and ethnicity over two decades and performed univariate and multivariate analyses.

Results: Between 2002 and 2021, there were 31,552,201 estimated emergency department visits by febrile children aged 2-24 months with recorded temperature ≥ 38.0 °C. In 2002-2012, Hispanic females and non-Hispanic Black females had significantly lower frequencies (13-19% vs. 26%; p < 0.001) compared to non-Hispanic White females. However, urine testing frequencies significantly increased over the study period for Hispanic and non-Hispanic Black females (coefficients of 1.10 and 0.74, respectively; multivariate linear regression tests for trend, p < 0.05). By 2021, there were no racial and ethnic differences in urine testing (p > 0.05). There were no differences among males (p > 0.05).

Conclusions: Nationally, Hispanic and non-Hispanic Black females had disproportionately lower frequencies of receiving urine tests at the beginning of the study period but had equivalent frequencies to non-Hispanic White females by 2021, suggesting that racial and ethnic disparities have decreased over time. Future research will examine the impact of these trends on disparities in health outcomes.

Background: Healthcare providers' knowledge and perceptions significantly influence the quality of the treatment provided to the patients and thereby, effective implementation of healthcare programs. Hence, this study attempted to explore the knowledge and perceptions of the healthcare providers related to Sickle Cell Disease and effectiveness of the interventions.

Methods: This qualitative study was conducted during evaluation phase of the quasi-experimental study at Chhotaudepur district, Gujarat. It included 26 healthcare providers of four cadres, namely peripheral health workers (PHWs), lab technicians (LTs), pharmacists, and medical officers (MOs) from two intervention Primary Health Centres. Data was collected through in-depth interviews.

Results: Most of the respondents were aware of the correct cause, etiology, and symptoms of SCD. They had knowledge of management as well, although it was mainly focused on symptomatic treatment delivered through this intervention study. Respondents shared that the disease can be prevented by mass screening, awareness generation, and counselling. Almost all respondents unanimously believed that this intervention study had positive impacts on community by establishing three tier screening mechanism and strengthening health system capacities.

Conclusion: Study findings revealed adequate knowledge and positive attitude among healthcare providers related to SCD. They also perceived positive impacts of the interventions on the community in terms of improved knowledge, and awareness related to SCD diagnosis and treatment. Thus, it underscores the significance of knowledge and positive attitude in the primary healthcare providers to deal with the burden of the disease on the ground level.