Journal of Racial and Ethnic Health Disparities最新文献

Introduction: Effective July 2022, kidney transplant centers were required to adjust waiting time for Black candidates using a new race-neutral eGFR (estimated glomerular filtration rate) calculation. Little has been reported about the impact and limitations of this policy change on transplant access for Black patients.

Methods: A retrospective, single-center, cross-sectional study was performed in 04/2024 on adult (> 18 years) kidney transplant candidates who were eligible for wait-time modification. Clinicodemographic data and adjusted dialysis start dates were extracted from the medical record. Descriptive statistics were performed.

Results: A total of 274 Black patients were eligible for a wait-time modification. Of these, 26 (9.5%) had been delisted, nine (3.3%) were deceased, 26 (9.5%) were already transplanted, and 104 (38.1%) did not have the required laboratory documentation available. In total, 109 (39.8%) candidates ultimately received wait-time modifications. Of the 109, mean age was 56 years old and 47 (42.7%) were female. Mean wait-time gained was 2.7 years (median, 1.7 years; range, 1 month-21 years). Total wait-time gained by Black patients at this center was 298.5 years. Patients who did not receive time back were more likely to have recent bloodwork from maintenance dialysis as the source of evaluated laboratory data (52.7% vs. 33.0%) (p < 0.001).

Conclusion: Removing race from the eGFR calculation expanded transplant access for Black patients with eligible patients receiving an average of 2.7 years of additional wait time at a large metropolitan center. However, wait-time recovery was limited by the availability of laboratory data, indicating that assistance with finding older lab values may help realize the full potential of this policy.

Asian American women in women-majority service and care occupations frequently encounter gendered racial microaggressions. Guided by intersectionality theory, this study examined whether depressive and anxiety symptoms statistically mediate the association between gendered racial microaggressions and sleep quality in a cross-sectional sample. We conducted an online survey of 356 Asian American women in Minnesota (September-October 2024) via community-partner outreach. Gendered racial microaggressions were measured with the Gendered Racial Microaggression Scale for Asian American Women (GRMS-AAW) subscales (Ascribed Submissiveness, Asian Fetishism, Media Invalidation, Assumption of Universal Appearance). Using path models, we estimated direct and indirect paths: one model with a composite GRMS score and four with each subscale as the exposure. Higher composite GRMS scores were associated with poorer sleep and with elevated depressive and anxiety symptoms; both symptoms partially mediated the GRMS-sleep association. Across subscale models, mediation was generally partial, and anxiety emerged as a more consistent mediator than depression. Findings indicate that gendered racial microaggressions are linked to poorer sleep in part through worse mental health, while acknowledging that temporal ordering cannot be established with cross-sectional data. Screening for gendered racial microaggressions and related symptoms may inform integrated care addressing mood and sleep. Organizational practices aimed at reducing gendered racial microaggressions-especially in women-majority service and care settings-may support mental health and sleep among Asian American women. Longitudinal and intervention studies are warranted.