Journal of Racial and Ethnic Health Disparities最新文献

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.

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.

Background: Acknowledging patients' spiritual concerns can enhance well-being and is essential to patient-centered chronic illness care. However, unmet spiritual care needs remain a major area of suffering, particularly among under-resourced populations. Limited research exists on how spiritual concerns are acknowledged and integrated into the care of chronically ill older Black patients in these settings.

Purpose: This study aimed to explore the spiritual concerns and needs of chronically ill older Black patients from under-resourced areas and to identify available spiritual support resources for patients seeking healthcare through a community safety net health service.

Methods: Using a qualitative descriptive design, we interviewed 13 chronically ill, older Black patients and key clinicians (physicians, nurse practitioners, allied health, and clergy). The interview focused on patients' illness-related spiritual concerns, sources of distress, and desired spiritual support resources. Participants also reviewed the Spiritual Care and Assessment Intervention (SCAI), a spiritual care intervention, and provided feedback on its content, format, and delivery.

Results: Five themes emerged from qualitative interviews: (1) spirituality is integral to seriously ill Southern patients; (2) clinicians should strive to address spiritual health in encounters; (3) socioeconomic barriers and competing demands impact priority of accessing spiritual care services; (4) spiritual care interventions should be patient-driven, compassionate, and fully integrated into medical care as a comprehensive service; and (5) participants thought SCAI was appropriate for use but should be shortened and provided in-person to increase accessibility.

Discussion: Findings will inform the development and piloting of small-scale culturally responsive spiritual care intervention tailored for seriously ill older Black adults in an ambulatory care setting.

Depression tends to be experienced across generations and among racial/ethnic groups through various pathways. However, little is known about racial/ethnic variations in the transmission of adolescent depression among different racial/ethnic groups. This study aims to investigate the intergenerational transmission of adolescent depression across three generations among White, Black, and Hispanic groups. Data were drawn from the Future of Families and Child Wellbeing Study. This study used a nationally representative sample of 2,604 individuals. A multi-group serial mediation analysis was conducted using structural equation modeling. As hypothesized, adolescent depression was transmitted across three generations, from the maternal side. Furthermore, the intergenerational transmission of depression was identified as a sequential transfer from one generation to the next, as opposed to exhibiting a generation-skipping effect. However, no statistically significant racial/ethnic variation was found in the pathways of intergenerational transmission of adolescent depression. In conclusion, depression is a mental disorder that can be transmitted from one generation to the next, and its transmission pathway is shared and similar across White, Black, and Hispanic groups. Regardless of racial/ethnic group, the intergenerational transmission process of depression can be halted with the implementation of appropriate interventions and treatment.

Purpose: Native Americans (NAs) have the highest prevalence of diabetes mellitus (DM) of any racial group in the USA and are therefore at higher risk for diabetic retinopathy (DR) and diabetic macular edema (DME). This study estimated the prevalence of DR and DME among NAs receiving eye exams at the Citizen Potawatomi Nation (CPN) clinic, a tribal clinic in Oklahoma serving members of multiple tribes, and characterized risk markers associated with the presence and severity of DR.

Methods: A retrospective chart review identified tribal members with DM who received dilated retinal fundus exams at the CPN clinic between 2021 and 2023. The presence and stage of DR and DME among participants were recorded. Hypotheses of association between the presence or severity of DR and medical and socioeconomic factors were tested.

Results: Among the 504 participants, the prevalence of DR was 19.4% (95% CI 16.1-23.2%), including 16.3% (95% CI 13.2-19.8%) with non-proliferative DR and 3.2% (95% CI 1.8-5.1%) with proliferative DR, and 3.4% (95% CI 2.0-5.4%) with DME. Nephropathy, longer duration of DM, higher HbA1c, insulin use, and Medicaid insurance were associated with the presence of DR (p < 0.05).

Conclusions: This study found a lower prevalence of DR than did earlier studies of NAs with DM. The mean HbA1c in this cohort was lower than in earlier studies, suggesting that diabetes management has improved. Several medical or socioeconomic factors were associated with the presence and severity of DR.

Background: In the United States, COVID-related discrimination towards racial and ethnic minority populations is well documented; however, its impact on healthcare access during the pandemic has not been assessed.

Methods: We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native (AIAN), Asian, Black, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults conducted between 12/2020-2/2021 (baseline) and 8/2021-9/2021 (6-month follow-up; 35.1% response rate). At baseline, participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Participants were asked if they were unable to get needed health care (e.g., cancer screening), or COVID-19 testing at both time-points. Vaccine willingness was assessed at baseline and uptake at follow-up.

Results: Experiencing COVID-related discrimination was associated with not being able to get health care at baseline (OR = 3.66, 95% CI = 2.91-4.59) and follow-up (OR = 1.86, 95% CI = 1.16-2.97) and not being able to get a COVID-19 test at baseline (OR = 2.11, 95% CI = 1.68-2.65) and follow-up (OR = 4.12, 95% CI = 2.20-7.72). Experiencing discrimination was also associated with being less likely to have received a COVID-19 vaccine (OR = 0.52, 95% CI = 0.30-0.90), despite individuals who experienced discrimination being more willing to vaccinate at baseline (OR = 1.56, 95% CI = 1.10-2.22).

Conclusions: COVID-related discrimination was associated with an increased likelihood of being unable to get health care across all racial and ethnic populations, although associations were strongest among Asian, AIAN, and Latino adults. Healthcare providers should be aware of the impact of discrimination on healthcare utilization, delays, and health-seeking behaviors, especially among racial and ethnic minorities.