Health Equity最新文献

Background: Minoritized racial and ethnic groups in the United States face long-standing disparities in a variety of health outcomes, owing to inequitable distribution of social and structural determinants of health along racial and ethnic lines. Although the existence of such disparities has long been a topic of scientific inquiry, there has been a dearth of investigations regarding their underlying mechanisms and potential remedies. This presents a challenge to those creating evidence-based and equity-focused health policy.

Methods: We conducted an evidence-based, equity-focused narrative review about living kidney donor eligibility using salient literature about donor eligibility and racial and ethnic disparities in kidney transplantation and donation in the United States. We sought to examine the rigor and reproducibility of the evidence base regarding race- and ethnicity-based living kidney donation policies.

Results: Our review identified several threats to scientific validity in the evidence base, including ambiguity in the operationalization of race and ethnicity variables, instances of type III error and racial essentialist biases, and causal inferences made using underpowered or scientifically unsubstantial subgroup analyses. We also identified structural barriers to the interpretation of this evidence to advance health equity, including barriers to the practices of clinical equipoise and shared medical decision-making.

Conclusions: Threats to scientific validity and inferential errors in the evidence base about health inequities may forestall progress toward equity. We provide recommendations for addressing such barriers using standards applied in other clinical and research domains.

Background: Compared with the general public, people with HIV (PWH) experience more psychological trauma and higher rates of post-traumatic stress disorder (PTSD), yet limited research explores how PWH may uniquely experience trauma. The primary goal of this study was to investigate trauma exposure typologies and sequelae among PWH to inform trauma screening and interventions.

Methods: Qualitative interviews were conducted with a convenience sample of 20 PWH with PTSD, receiving services from an urban, Tennessee-based HIV Service Organization. Interview guides were conducted to gain a rich understanding of exposure types from the Life Events Checklist-5 (LEC-5), explore potential social determinants of trauma, and uncover effects of chronic trauma or traumata. Thematic content analysis was used to examine typologies and effects.

Results: Exposure typologies appeared as social determinants of trauma, including molestation as the most common followed by racial trauma, community violence, incarceration, addiction, interpersonal violence, poverty cycles, and stigma. Standard PTSD symptoms were reported in addition to emerging effects of complexity, synergism, and resilience. Complex effects spanned socioecological contexts and included sequelae of affective dysregulation, negative self-concept/self-organization, and disturbances in relationships.

Conclusion: Many typologies were not well accounted for in the LEC-5, underscoring the potential to miss exposure types and thus treatment indication. Similarly, effects expanded beyond standard PTSD symptoms, suggesting that nuanced treatment needs may also be overlooked. Findings are consistent with literature indicating the need for updated trauma screening and assessment measures to most comprehensively and accurately direct treatment needs.

Although most cancers are sporadic, a significant proportion are related to inherited cancer-causing genes called pathogenic germline variants (PGVs). There are recommended measures for prevention and earlier diagnosis of cancers in patients identified as BRCA1 and BRCA2 PGV carriers, which are the most common cancer-predisposing PGVs. For example, published guidelines recommend that patients with BRCA1/2 PGVs undergo bilateral oophorectomies to prevent ovarian cancer and regular magnetic resonance imaging to screen for breast cancer. Also, those same measures are recommended for family members identified by cascade testing as BRCA1/2 carriers. Here, reports of the significant disparities between groups in which patients diagnosed with breast cancer are offered and undergo testing for BRCA1/2 PGVs are reviewed. Expanding the current standard of care guidelines for BRCA1/2 testing to all patients diagnosed with breast cancer and enacting the Cancer Moonshot 2.0 Initiative measures that should mitigate these disparities are discussed as well.

Introduction: Children with a language for care other than English (LOE) are at risk for inequitable care. We examined the association of isolation precautions in the care of hospitalized children with LOE through the frequency of professional interpreter use and timing of in-person consultation.

Methods: Retrospective cohort study of children in a strict isolation unit (SIU) between 2/2020 and 12/2021. Negative binomial regression was used to assess both differences in interpretation rates between SIU and non-SIU, and within 72-h/in-person consultation rates within the SIU between English-speaking and LOE encounters.

Results: We identified 487 encounters in the SIU; 126 (26%) involved patients with LOE. The median interpretations per day were 4.5 (Interquartile Range [IQR]: 2.0-6.7). Among patients with LOE, there was an observed difference in median interpretations per day in the SIU (3.9, IQR: 1.7-6.4) versus encounters in non-SIU acute care units (5.0, IQR: 1.2-8.2). However, this difference was not statistically significant (Incidence Rate Ratio [IRR]: 0.89; 95% confidence interval [CI]: 0.70-1.13). Sub-specialty consultations were requested for 410 (84%) encounters within the SIU; 282 (69%) were completed in person within 72 h. A small difference between the percentage of completed consultations for encounters with LOE (n = 61, 64%) and English-speaking patients' encounters (n = 221, 70%) was noted, which again was not statistically significant (IRR: 0.93; 95% CI: 0.71-1.21).

Conclusion: Despite the increased barriers of strict isolation, we exceeded institutional standards for interpretations per day and had similar rates of interpretation for encounters with LOE admitted to medical units regardless of isolation status.

Introduction: A community coalition is an effective strategy for addressing complex health challenges. A citywide coalition of community and academic experts was formed to address Detroit's persistent health disparities. To foster collaborative synergy, we explored hyperlocal perspectives on health equity by applying rapid qualitative analysis (RQA) as a time-efficient and rigorous approach.

Methods: Twenty coalition members completed a key informant interview addressing five key areas: health equity meanings, Detroit's most pressing health problems, social ecological domains that influence health equity and outcomes, and strategies to achieve health equity. We used RQA to interpret interview data.

Results: Participants were majority female, Black/African American, and over 60 years old. Participants defined health equity as equal access to opportunities for a healthy life and emphasized the importance of individual choice in pursuing those opportunities. As an indication of their awareness of social determinants of health, participants articulated connections between various social ecological factors and health outcomes.

Discussion: This study highlights participants' recognition of both systemic factors and personal agency in achieving health equity, indicating their nuanced understanding of the complex interplay between social structures and individual health, which is crucial for community-driven multilevel health interventions. Furthermore, by fostering better communication and alignment, RQA is an efficient and effective method to enhance coalition synergy.

Health equity implications: By facilitating a shared understanding of health equity and its determinants, RQA can help coalitions ensure inclusion and integration of diverse perspectives in intervention planning and delivery, particularly in urban settings facing similar challenges.

Introduction: Disasters have disproportionately impacted nursing home (NH) residents. COVID-19 impacted NH more so than the community-dwelling population, but there was much variation in mortality rates among NH residents. These disparities have been studied, but place-based disparities have received less attention. Place-based disparities are differences in health due to physical location, including factors like rurality, local socioeconomic conditions, and the physical environment.

Methods: We searched three databases for peer-reviewed studies of place-based factors associated with mortality in U.S. NHs during the COVID-19 pandemic, ending in January 2024. Data were organized using the National Institute on Minority Health and Health Disparities research framework.

Results: We identified 27 articles that included individual, interpersonal, community, and societal place-based factors associated with mortality during the pandemic. Differences in mortality were related to local community socioeconomic factors, staff neighborhood socioeconomic factors, urbanity, community viral spread, and state-level factors, including political leaning and social distancing policies. Rurality was associated with lower mortality but was also associated with racial disparities.

Discussion: Place-based disparities at the individual, organizational, community, and societal levels were identified. Rurality and local COVID-19 spread were the most commonly studied place-based factors associated with NH deaths during the pandemic. Neighborhood factors may be most impactful through the impact on NH staff. Racial disparities were linked with location, highlighting the effects of historical systemic racism on NHs. Policies to protect NH residents during disasters must be sensitive to local characteristics.

Introduction: Our institution launched a large-scale virtual training program called "Stepping Stones" that uses allegories to provide an increased understanding of concepts, such as interpersonal, internalized, and structural racism. The goal of this project was to implement facilitated discussions with trained leaders and determine the impact of these sessions in improving the experience of the modules and boosting comfort in discussing race and racism.

Methods: We developed facilitated discussions as a complimentary intervention for colleagues who participated in the virtual system-wide intervention. Our intention was to create a safe space to foster reflection and collaborative learning on how racism shows up in our work environment. We conducted 22 sessions across Massachusetts General Hospital between December 2021 and February 2023. Each session included between 5 and 30 participants who were asked to complete a survey regarding their experience.

Results: We collected post-session surveys from 102 out of 350 participants. Participants found the sessions to be informative and valuable. Over 97% of respondents rated the quality of the discussions as "Excellent" or "Very Good." Similarly, 95% of participants felt "Very" or "Somewhat" comfortable with discussing issues of race and racism in the workplace after the session.

Discussion: Participants reported that the facilitated discussions were valuable, enhanced their ability to talk about racism in clinical environments, and provided an opportunity for reflection. Giving the hospital staff a common language and the ability to discuss such challenging topics may contribute to a culture of equity within our hospital.

While a focus on intersectional oppression elucidates important structural influences on health, it also obfuscates elements of how oppressed communities view themselves and their experiences. Black queer intersectional joy is one such element, and exploring this concept provides different openings for researchers to build solidarity with and produce relevant research alongside communities facing class oppression, heterosexism, racism, and cissexism. This article provides examples of Black queer intersectional joy, as well as potential problems and opportunities for engaging this concept.

Background: Underrepresented minority (URM) patients enroll in cancer clinical trials at low rates. We studied the perspectives of health care professionals to better understand the challenges and potential facilitators of recruiting URM patients into clinical trials.

Methods: A purposeful sampling approach was utilized to recruit health care professionals and clinical research staff who recruited and cared for URM patients in a therapeutic cancer clinical trial at any Mayo Clinic site, from July 2018 through October 2021.Data were gathered using a semistructured qualitative interviews. Participants were interviewed about the challenges of recruiting URM patients into cancer clinical trials and possible strategies for improving URM patient enrollment. Data were analyzed using a thematic analysis.

Results: Of the key themes that emerged from participant interviews (n = 28), perceived barriers to recruiting URM patients into clinical trials included lack of workforce diversity, underutilization of patient navigators, ineffective community outreach and patient recruitment, restricted access to diverse patient populations, and restrictive clinical trial eligibility criteria. Other barriers reported were lack of insurance and access to care and transportation, low socioeconomic status, and mistrust of health care and research. Strategies suggested for improving the recruitment of URM patients into clinical trials included: diversifying and adding research staff, increasing and improving community outreach and advocacy, partnering with clinics closer to patients, increasing monetary and logistical support for patient participation, creating opportunities that build and enhance trust, and systematically examining and modifying clinical trial eligibility criteria.

Conclusions: Our findings reveal barriers that have limited URM patient inclusion in cancer clinical trials and highlight strategies to overcoming these barriers.