Health Equity最新文献

Stakeholders in biomedicine are evaluating how race corrections in clinical algorithms inequitably allocate health care resources on the basis of a misunderstanding of race-as-genetic difference. Ostensibly used to intervene on persistent disparities in health outcomes across different racial groups, these troubling corrections in risk assessments embed essentialist ideas of race as a biological reality, rather than a social and political construct that reproduces a racial hierarchy, into practice guidelines. This article explores the harms of such race corrections by considering how the technologies we use to account for disparities in health outcomes can actually innovate and amplify these harms. Focusing on the design of wearable digital health technologies that use photoplethysmographic sensors to detect atrial fibrillation, we argue that these devices, which are notoriously poor in accurately functioning on users with darker skin tones, embed a subtle form of race correction that presupposes the need for explicit adjustments in the clinical interpretation of their data outputs. We point to research on responsible innovation in health, and its commitment to being responsive in addressing inequities and harms, as a way forward for those invested in the elimination of race correction.

There is growing attention to how unfounded beliefs about biological differences between racial groups affect biomedical research and health care, in part, through race adjustment in clinical tools. We develop a case study of the Eighth Joint National Committee (JNC 8)'s 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, which recommends a distinct initial hypertension treatment for Black versus nonblack patients. We analyze the historical context, study design, and racialized findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) that informed development of the guideline. We argue that ALLHAT's racialized outcomes emanated from a poor and artificial study design and analysis weakened by implicit assumptions about race as biological. We show that the acceptance and utilization of ALLHAT for race correction arises from its historical context within the "inclusion-and-difference paradigm" and its indication of the inefficacy of angiotensin-converting-enzyme inhibitors for Black patients, which follows from the enduring, yet, refuted slavery hypertension hypothesis. We demonstrate that the JNC 8 guideline displays the self-fulfilling process of racial reasoning: presuppositions about racial differences inform the design and interpretation of research, which then conceptually reinforce ideas about racial differences leading to differential medical treatment. We advocate for the abolition of race adjustment and the integration of structural competency, biocritical inquiry, and race-conscious medicine into biomedical research and clinical medicine to disrupt the use of race as a proxy for ancestry, environment, and social treatment and to address the genuine determinants of racialized disparities in hypertension.

Background and objective: There is extensive literature to support eliminating race-based risk stratification. The National Institute of Child Health and Human Development (NICHD) calculator, used to predict risk of bronchopulmonary dysplasia (BPD), includes race as a variable. We sought to investigate how utilizing race in determination of risk for BPD may lead to inequitable care.

Methods: The study included a retrospective cohort of infants born <30 weeks gestation between January 2016 and February 2022. The primary outcome was the difference in predictive risk of BPD for non-Hispanic Black compared to non-Hispanic White infants. The secondary outcome was the disparity in theoretical administration of post-natal corticosteroids when the calculator was applied to the cohort. Analysis included paired T-tests and Chi-Square.

Results: Of the 273 infants studied, 154 were non-Hispanic Black (56%). There was no difference between the groups in gestation or respiratory support on day of life (DOL) 14 or 28. The predicted risk of moderate or severe BPD in non-Hispanic White babies was greater than non-Hispanic Black babies on both DOL 14 and 28 (p<0.01). When applied retrospectively to the cohort, the calculator resulted in differences in corticosteroid administration (risk >40%-non-Hispanic White 51.3% vs. non-Hispanic Black 35.7%, p=0.010; risk >50%-non-Hispanic White 42.9% vs. non-Hispanic Black 29.9%, p=0.026).

Conclusion: When applied to our study cohort, the calculator resulted in a reduction in the predicted risk of BPD in non-Hispanic Black infants. If utilized to guide treatment, the calculator can potentially lead to disparities in care for non-Hispanic Black infants.

Background: Scientifically, there is little genetic variation among humans and race has no biological basis. However, medical school preclinical curricula tend to misrepresent race and reify biologically essentialist explanations for disease. The social construct of race is, therefore, used to inform health care providers' treatment decisions. Use of race-based medicine has been identified as a contributor to racial health disparities, spurring a growing movement to challenge race essentialism and race-based medicine. The current research tested an intervention that educates college students about the historical construction of racial categories in the United States.

Methods: Participants who were randomly assigned to the intervention condition read an article highlighting the history of the sociopolitical construction of race. They were then prompted to discuss in dyads how racial categories were created and changed over history, and-in light of all this-the appropriateness of race-based medicine. Those assigned to the control condition advanced directly to the outcome measures.

Results: Participants in the intervention condition reported less race essentialism, less support for race-based medicine, and greater belief that race-based medicine contributes to racial health disparities. Findings were not moderated by premed status.

Discussion: Our data provide initial evidence that our interactive intervention could effectively reduce biological essentialism and support for race-based medicine in both premed and non-premed students.

Health equity implications: This intervention has the potential to shape the way health care providers in-training understand race, their internalization of biologically essentialist explanations for disease, and willingness to adopt race-based treatment plans.

Introduction: The purpose of this study was to examine associations between social gender affirmation and mental health outcomes. The resulting relationships were explored within the context of childhood sexual abuse (CSA) and intimate partner violence (IPV) trauma history.

Materials and methods: A community sample of 138 Black trans women completed structured interviews assessing gender affirmation, mental health, and trauma history. Bivariate associations between gender affirmation scale and mental health measures were assessed using Pearson coefficients. Multiple linear regression models were used to generate adjusted estimates of association.

Results: Childhood sexual victimization and IPV were common. Depressive symptoms, anxiety, quality of life, and body image satisfaction were significantly associated with social gender affirmation. Recent IPV dampened this association to not significant. Gender affirmation and anxiety/panic and quality-of-life outcomes did not retain significance in models adjusted for lifetime IPV. CSA did not weaken the association.

Conclusion: Incorporating trauma-informed and gender-affirmative frameworks into medical care and evidence-based interventions is a crucial structural step toward protection of the mental health of Black trans women.

Objective: This study examined the health equity initiatives included in US hospitals' strategic plans.

Methods: Using data from the American Hospital Association (AHA) 2021 Annual Survey, the study described the types of health equity initiatives that US hospitals included in their strategic plans. The analysis focused on the following seven initiatives: (1) equitable and inclusive organizational policies; (2) systematic and shared accountability for health equity; (3) diverse representation in hospital and health care system leadership; (4) diverse representation in hospital and health care system governance; (5) community engagement; (6) collection and use of segmented data to drive action; and (7) culturally appropriate patient care. Logit and zero-truncated Poisson regression analysis was used to examine organizational and community-level characteristics of hospitals with the most comprehensive health equity strategic plans.

Results: Of the 4359 general medical and surgical hospitals that completed the AHA's 2021 survey, 45.1% provided complete information on their health equity strategies. The comprehensiveness of hospitals' health equity efforts varied across organizations. Regression analysis showed that larger hospitals, nonprofit hospitals, and hospitals affiliated with health systems tended to have more comprehensive health equity initiatives as did hospitals located in urban areas, hospitals in communities with higher household incomes, and hospitals in communities with greater proportions of Hispanic residents.

Conclusions: While improving health and health equity is a key aspect of many hospitals' missions, the extent to which hospitals include health equity initiatives into their strategic plans varied noticeably. Committing to a comprehensive set of efforts aimed at improving health equity requires human and financial resources as well as dedicated leadership.

Purpose: Continued high opioid overdose death rates in the United States and increasing New York State (NYS) Latino opioid overdoses make the facilitation of Latino access to NYS substance use disorder (SUD) treatment essential. SUD treatment facilities in NYS sustained an estimated 37% decrease in Latino enrollment during phase one of the pandemic. This study invited NYS SUD service providers to describe ways in which SUD organizations facilitated Latino SUD treatment prior to and during phase one of the pandemic.

Methods: Using an individual and community interaction framework of vulnerability and a description of organizational enabling resources in four domains, this study used a cross-sectional descriptive design to investigate the levels of organizational facilitators for Latino SUD treatment access and the impact of the pandemic on these organizational facilitators. A convenience sample of 470 NYS SUD clinicians participated in the study.

Results: The outcomes suggest an overall erosion of organizational enabling resources during the pandemic. Erosion was greatest in areas with a higher Latino population density in the domains of insured/immigration/legal information and culture. A pattern of strengthening resources in areas with lower Latino population density in the domains of language and telehealth access has defied the overall pattern of deterioration. The increase in telehealth did not cross the digital divide to stop the decrease in Latino enrollment and did not compensate for the overall erosion of access facilitators.

Conclusions: The overall outcomes suggest opportunities to explore local variations in resource health. Recommendations to improve health equity include the use of participatory research to assess community needs and the implementation of community partnerships to address systemic barriers and rebuild equitable addiction services.

Background: College students who identified themselves as Asians in the United States (i.e., Asian college students) are facing health inequalities and engaging in increasingly low levels of physical activity (PA). Although social support was found to be effective in increasing college students' PA and social media is an important channel for social support for Asian students, few studies have explored how to provide social support through social media interventions to promote Asian students' PA level. Thus, this study aimed to explore the effects of social support on social media on Asian college students' intention to participate in PA based on the theory of planned behavior.

Methods: We conducted an online Qualtrics survey among all undergraduate students at a university on the West Coast of the United States. Among 936 respondents, 337 (36%) were Asian college students. Descriptive analysis, regression models, and mediating effect tests were performed using SPSS 28.

Results: For Asian students, social support on social media has both direct effects and indirect effects through perceived behavioral control (PBC) on their intention to participate in PA.

Conclusion: Future interventions could consider encouraging Asian students to provide support to each other and form support groups using social media to increase their PBC.

The increasing availability of rapid diagnostic self-tests (RDSTs) for COVID-19 has played an important and increasing role during the pandemic. However, for many underserved communities, RDSTs potential benefits are offset by problems with usability, accuracy, and equity. Given the increased need for and interest in home testing for acute and chronic diseases, including COVID-19, this piece offers ways that regulatory agencies, federal public health agencies, and test developers should engage with diverse communities to ensure equity throughout test development, implementation, and evaluation. Such engagement will ensure maximum personal and public health benefits for current and future RDSTs under real-world conditions.