Health Equity最新文献

Introduction: Levonorgestrel-releasing intrauterine devices (LNG-IUDs) can be effective treatments for benign gynecological conditions, but there may be ethno-racial differences in how patients receive treatment.

Methods: Data were from a health care system in the U.S. South (April 2014-September 2019). We identified 783 female patients aged 18-44 years with an LNG-IUD for a benign gynecological condition (455 White, 208 Black, and 120 Hispanic patients). Abstraction of medical notes preceding insertion gave symptom severity scores for uterine bleeding, pelvic pain, and uterine bulk. Linear and negative binomial regression models assessed differences in patients' age and symptom severity scores, respectively. Covariates included insurance status, parity, prior treatments, and fibroid and endometriosis diagnoses.

Results: White patients' mean age was 32.4 years. Black patients were similarly aged (+0.9 years [95% confidence interval: -0.4 to 2.1]), whereas Hispanic patients were older (+3.4 years [2.0-4.9]), and adjustment attenuated this difference (+0.7 [-0.7 to 2.0]). Estimated ratios indicated more severe bleeding and bulk symptoms for Black and Hispanic than White patients (bleeding: Black: 1.7[1.5-2.0], Hispanic: 1.7[1.4-2.1]; bulk: Black: 1.5[1.3-1.9], Hispanic: 1.5[1.2-1.9]). Adjustment for covariates attenuated estimates, especially for Hispanic patients (bleeding: Black: 1.4[1.2-1.6], Hispanic: 1.2[1.0-1.4]; bulk: Black: 1.3[1.1-1.6], Hispanic: 1.2[1.0-1.6]).

Discussion: At the time of LNG-IUD insertion, Hispanic patients were older than White patients. Black and Hispanic patients had more severe symptoms than White patients. Differences in age and symptom severity were associated with lack of insurance coverage, higher parity, presence of fibroids, and prior medical management, potentially indicating barriers to early LNG-IUD treatment for Black and Hispanic patients.

Background: The COVID-19 pandemic disproportionately affected African American communities. Informational toolkits have emerged as a strategy to address such inequities. Community-driven approaches to toolkit design may enhance their relevance and impact in underserved communities.

Methods: Using a human-centered design approach, we developed COVID-19 testing toolkits tailored to health care, faith-based, and public housing settings in rural and urban communities. A group of community stakeholders representing each setting was recruited to co-create the toolkits. The design process began with an intensive two-day workshop to deliberate on content, format, and dissemination channels, followed by virtual meetings and iterative prototyping cycles that incorporated stakeholder feedback. Given the complexity of implementing such toolkits in health care settings, additional measures were taken to support and assess implementation at the participating health facility sites.

Results: The toolkits included core resources, such as training modules, testing guidelines, and maps, and setting-specific content, such as appointment reminders, pulpit announcements, and emergency contact sheets. Materials were provided in both digital and print formats. Onboarding and technical training facilitated implementation in health care settings. Pre/post implementation surveys showed high perceived usefulness and feasibility of the health care toolkits. Implementation patterns favored print resources, with appointment reminders being most utilized. Leadership support enhanced toolkit credibility and adoption. Implementation challenges included COVID-19 fatigue, technology limitations, and leadership transitions.

Conclusion: Informational toolkits co-developed with community stakeholders provide a model for translating research into solutions that enhance health equity. Prioritizing community perspectives can improve preparedness for future crises. Successful implementation requires adaptability, multimodal delivery, and sustained leadership buy-in.

Background: Each year, thousands of pregnant or postpartum women enter prison and jails across the U.S. During the COVID-19 pandemic, pregnant people who were incarcerated were at increased risk of infection and health complications. Little is known about the role of national public health, medical, and carceral organizations in promoting the health and well-being of pregnant and postpartum people who are incarcerated during the COVID-19 pandemic. The objectives of this study were to assess publicly available COVID-19 communications and guidance from national organizations to better understand guidance for pregnant and postpartum people who were incarcerated during the COVID-19 pandemic.

Methods: This study used documentary qualitative analysis to review publicly available COVID-19 guidance and communications from public health agencies and professional organizations. A total of 27 documents were reviewed, coded, and analyzed across eight organizations.

Results: In the 338 pages reviewed, "pregnancy/postpartum" was coded just 17 times among four organizations. Our review found that mentions of the unique needs of pregnant and postpartum people during the COVID-19 pandemic were mostly absent from organizational guidance.

Conclusion: This analysis calls attention to the gaps in the consideration for pregnant and postpartum people who are incarcerated, particularly in the context of the COVID-19 pandemic. We conclude with a series of recommendations to strengthen the care of pregnant and postpartum people who are incarcerated and promote health equity.

Collecting accurate and consistent sociodemographic data is needed to improve health measurement and public health interventions. Missing or inaccurate data hinders the adequate assessment of the state of access, quality, and coverage in the overall population and communities experiencing social marginalization. Health measurement requires data labels that humanize all populations living, working, and residing across the United States and territories. Humanization is fundamentally grounded in the concepts of human dignity and ethical identity integrity. An often-overlooked form of exclusion in health care is the long-standing use of dehumanizing language, including its use in health measurement and data collection efforts, to refer to immigrant populations. In this perspective, we delineate ethical concerns regarding the use of dehumanizing language when referring to immigrant populations. We provide recommendations for health providers, researchers, and policy makers in improving humanizing language in health equity data collection and reporting through engagement of community experts, use of alternative language, implementation, and monitoring.

Community-based participatory research (CBPR) is essential for addressing health care inequities; however, it is unclear to what extent articles published in high-impact medical journals use CPBR. We reviewed original research articles in nine journals across 4 years to determine how frequently CBPR was used and, for articles using CBPR, details about partnerships. Of 5,624 articles, only 6 (0.1%) used CBPR. Five identified community partners and whether partners were involved in research planning/implementation, one reported that partners were involved in dissemination, and none reported adherence to CBPR principles. Improving integration of CBPR is an urgent priority for funders, institutions, journals, and researchers.

Introduction: Obesity and chronic hypertension are well-known risk factors for maternal morbidity and mortality. Evidence suggests racism contributes to the development of these chronic conditions.

Methods: We conducted a secondary analysis of the Nulliparous Pregnancy Outcomes: monitoring mothers-to-be (nuMoM2b) cohort, which recruited nulliparous pregnant participants in the United States in 2010-2013. Using logistic regression, we assessed the relationship between experiences of racial, ethnic, and color-based (REC) discrimination (categorized as high, low, or no REC discrimination) and prevalence of a composite outcome of obesity and/or chronic hypertension.

Results: Among 8,554 participants, the composite outcome was unequally distributed by race and ethnicity (p < 0.001), present in 19.9% of non-Hispanic White, 23.1% of Hispanic, and 39.0% of non-Hispanic Black participants. Self-reported REC discrimination was similarly unequally distributed (p < 0.001), with high REC discrimination reported by 17.5% of non-Hispanic Black, 10.6% of Hispanic, and 2.1% of and non-Hispanic White participants. In multivariable analyses, high self-reported REC discrimination was associated with a 1.75 adjusted odds ratio (95% confidence interval: 1.43-2.14) of the composite outcome compared with those reporting no REC discrimination. When stratified by race and ethnicity, the odds ratios for the composite outcome among those reporting high REC discrimination were only statistically significant among the Hispanic subgroup.

Conclusion: We observed a positive, dose-dependent association between self-reported REC discrimination and our outcome of obesity and/or chronic hypertension. By demonstrating this relationship in an obstetric cohort, we aim to highlight the role of racism over the life course in contributing to chronic health conditions and associated maternal outcomes.

Maternal mortality and morbidity are enduring public health crises disproportionately affecting Black, Indigenous, Hispanic, and other marginalized populations. This inequity highlights the necessity for a comprehensive, equity-driven framework to address systemic failures within maternal healthcare. Although the Maternal Mortality Review Information Application (MMRIA) provides valuable retrospective insights into maternal deaths, its capabilities must be expanded by integration with real-time interventions. Innovative approaches, including obstetric decompensation scoring tools like the Obstetric Early Warning Score and Maternal Early Warning Score (OEWS) and Maternal Early Warning Trigger systems, are strongly advocated. These predictive technologies, when integrated into electronic medical records, generate real-time alerts that enable clinicians to proactively mitigate complications before they escalate. Simulation-based training further complements these technologies, immersing healthcare teams in realistic, high-stress scenarios drawn directly from maternal mortality case studies. Such immersive programs effectively address implicit biases, enhance diagnostic accuracy, and foster cultural humility, particularly benefiting marginalized populations. Additionally, the establishment of Maternal Morbidity Review Committees (MMORCs) is proposed as a critical advancement, enabling multidisciplinary, immediate interventions during acute maternal events. Collectively, these innovations aim to transition maternal health care from a reactive to a proactive model, significantly improving maternal outcomes. Highlighted is the urgency for systemic reforms and data-driven interventions to eliminate inequities, prioritizing prevention, equity, and cultural humility to ensure maternal healthcare is equitable, accesible and inclusive.

Introduction: Conventional race and ethnicity categories and analysis are reductive and prone to inaccuracy. Because race and ethnicity data validity is essential to health equity efforts, we measured the accuracy of race and ethnicity data in a pediatric electronic health record (EHR) to identify areas for improvement in data collection and use.

Methods: Patients and their caregivers reported patient race and ethnicity via in-person survey in four pediatric settings (inpatient, emergency room, urgent care, and primary care). Race and ethnicity data from the EHR were compared with survey data to calculate four measures of EHR data accuracy. The U.S. Census Bureau's novel categorization scheme was used to analyze racial and ethnic identities "alone" and "in combination" with ≥1 other identity.

Results: Caregivers for 561 patients completed the survey; 116 patients aged ≥12 years completed a patient version. For consolidated race and ethnicity fields, overall concordance between survey and EHR was 74.6%. Concordance differed by race and ethnicity category when alone (Black or African American 96.1%, Hispanic 90.6%, and White 92.5%) and in combination with another category (Black or African American 93.9%, Hispanic 88.6%, and White 84.4%). The EHR had low accuracy for patients with multiple racial or ethnic identities (overall sensitivity 35%). Such patients' identities were often oversimplified due to EHR design. Using "alone" and "in combination" analysis for race and ethnicity categories allowed all patient identities to be visible across categories, unlike in conventional race and ethnicity analysis.

Discussion: Identifying and eliminating health disparities depend on accurate race and ethnicity data, but current EHR design provides an unreliable data foundation for needed analyses. Conventional categorization used in race and ethnicity analysis is problematic, hiding identities in a reductive set of groupings. New approaches to validation, categorization, and analysis, as explored in this study, are urgently needed to advance health equity goals.

Introduction: Transgender and gender-diverse (TGD) health care professionals face significant burnout, yet evidence on system-level factors such as workplace discrimination that contribute to this issue among TGD nurses is limited. Responding to the U.S. Department of Health and Human Services' call for research on burnout among health care staff from diverse demographic backgrounds, this study aimed to examine the system-level factors affecting burnout and professional well-being among TGD nurses and identify strategies to enhance their well-being.

Methods: This qualitative descriptive study employed directed content analysis of responses of 6 different open-text survey questions from 66 TGD nurses, utilizing 2 nurse survey datasets collected pre-pandemic (December 2019-February 2020) and during the pandemic (April 2021-June 2021). To identify the system-level factors influencing burnout and well-being, the themes were developed using both inductive and deductive analytic approaches, guided by the Systems Model of Clinical Burnout and Professional Well-being.

Results: Three themes related to the system-level factors affecting burnout and professional well-being among TGD nurses were: (1) poor working conditions characterized by inadequate staffing and insufficient protective measures, (2) lack of leadership support and a non-inclusive culture highlighted by unsupportive leadership and workplace discrimination, and (3) non-patient-centered U.S. health care and LGBTQ+ stigma that create barriers to providing quality care for marginalized groups and receiving care for themselves. Recommendations from participants to enhance their professional well-being are also presented.

Conclusion: To support the well-being of TGD nurses and improve the quality of care for all patients, health care organizations should implement system-level changes that create a physically and psychologically safe and inclusive work environment.

Background: Racial/ethnic minority groups are underrepresented in clinical trials with American Indian and Alaska Native (AI/AN) people having the lowest representation. This article aims to contribute to the literature to address that gap by sharing the results of the use of anti-SARS-CoV-2 monoclonal antibodies among AI/AN people at risk for severe COVID-19.

Methods: This retrospective cohort study assessed data from ambulatory AI/AN patients enrolled in Cherokee Nation Health Services in Northeastern Oklahoma, who had a positive test for SARS-CoV-2, high risk for progression, and were offered anti-SARS-CoV-2 monoclonal antibody treatment active against the circulating SARS-CoV-2 strain from December 1, 2020, to April 16, 2021. The outcomes of interest were all-cause and COVID-19-related emergency department visits, hospitalizations, intensive care admissions, and deaths within 28 days of being offered treatment.

Results: Among 1,447 participants, 813 (56.2%) were treated and 634 (43.8%) were not. When adjusted for potential confounders, there was a significant difference in the odds of treated versus untreated patients experiencing a COVID-19-related emergency department visit (OR, 0.42; 95% CI, 0.27-0.63) and hospitalization (OR, 0.10; 95% CI, 0.03-0.31).

Discussion: Anti-SARS-CoV-2 monoclonal antibody treatment was associated with lower odds of COVID-19-related emergency department visits and hospitalization among high-risk AI/AN patients.

Health equity implications: To advance health equity, it is critical to have representation of AI/AN in clinical trials and other research. This project is an example of how community partnerships with AI/AN health systems can strengthen the evidence for new and emerging treatments, address past harm, and advance equity.