Ethnicity & Disease最新文献

Introduction: Highly effective antiretroviral therapy has increased the life expectancy of people living with HIV (PLWH), resulting in an increase in noncommunicable diseases, including cognitive and mental health disorders. Published literature on cognitive performance in older PLWH is scarce in low- and middle-income countries, including Georgia. Our study aimed to assess mental health and cognitive performance and identify associated factors among PLWH aged ≥40 years.

Methods: Primary mental health and behavior assessments included the Drug Use Disorder Identification Test, the Alcohol Use Disorder Identification Test, the Beck Depression Inventory (BDI), and the General Anxiety Disorder 7 (GAD-7). Cognitive assessments included the Montreal Cognitive Assessment (MoCA); Trail Making Tests A and B; verbal fluency; Stroop 1, 2, and 3; and Grooved Pegboard. Univariate and multivariable regression analyses were performed to identify factors associated with cognitive performance.

Results: Our sample included 125 PLWH (78 men, 47 women). Drug use-related problems or drug dependence was observed in 36% and hazardous or harmful alcohol consumption among 23%. Mild to extreme depressive symptoms were observed among 51% and mild to severe anxiety among 47%. A MoCA score <26 was observed among 89%. Multivariable regression analyses showed higher mean scores on the Stroop Test 3 associated with higher scores on the GAD-7 (β=.40; 95% CI, 0.12-0.68) and BDI (β=.70; 95% CI, 0.17-1.2). No other associations were observed.

Conclusion: This study shows high percentages of psychiatric and cognitive morbidities among older PLWH in Georgia. Longitudinal studies should be conducted to evaluate cognitive performance and associated factors among older PLWH in Georgia.

Objective: This study was conducted to quantify the prevalence of metabolic syndrome and depressive symptoms across racial/ethnic and socioeconomic strata in a nationally representative U.S. sample.

Methods: We used National Health and Nutrition Examination Survey 2017-March 2020 data for participants aged 18 years and older. Prevalence of depressive symptoms and metabolic syndrome alone and in combination was measured across racial/ethnic, sex, age, and income strata. Chi-square tests were used for between-group comparisons.

Results: Over 7% of sampled adults had comorbid depressive symptoms and metabolic syndrome, representing 18.3 million Americans. These conditions were not equally distributed across racial/ethnic groups (χ²=124.28, P<.0001). The non-Hispanic Asian group was least likely to have either condition. Differences by economic status were also significant (χ²=86.61, P<.0001). Those in the highest economic group were least likely to have either or both conditions.

Conclusions: Disparities in comorbid conditions exist across socioeconomic and demographic strata. Achieving optimal and equitable health outcomes for people with these comorbidities will require "whole-person-in-context" interventions. Integrated approaches to coexisting medical, psychological, and social complexities are needed.

The aim of this study was to estimate and compare the age-specific and sex-adjusted case-fatality rates (CFRs) among Arab Americans to Hispanic, non-Hispanic Black, non-Hispanic White, and Asian adults living in Michigan. Data from Michigan's vital records, surveillance data (March 2020-July 2021), and an Arab/Chaldean surname algorithm were used. We used χ² tests to determine statistically significant differences between groups. Logistic regression was used to estimate age-specific and sex-adjusted CFRs. Arab Americans had a lower CFR of 1.54% compared with Asian (1.97%), non-Hispanic White (2.17%), and non-Hispanic Black adults (3.36%), regardless of sex. For those 80 years of age or older, Arab American (30.72%) and Asian adults (31.47%) had higher CFR compared with the other racial or ethnic groups, with non-Hispanic White adults displaying a lower CFR of 18.28%. An Arab American ethnic identifier would likely increase the visibility of this population so that they can be included in the efforts to increase awareness, testing, and prevention strategies of COVID-19 or similar pandemics that might be facing us in the future.

Objectives: Limited social connection places individuals at greater risk for chronic conditions; however, there is limited research examining the association between chronic conditions and barriers to disease self-management on social connections. Our study addresses this gap in the empirical literature by examining these issues among Black men aged 40+ years with 1 or more chronic conditions.

Methods: Data came from a national sample of 1200 Black men. We conducted 3 multivariate logistic regression models examining social connection domains (did not have people to call for help, felt isolated from others, and were not content with relationships/friendships) on 3 independent variables: the number of chronic health conditions, cut down or skipped social activities because of health problems, and self-reported barriers to disease self-management. Sociodemographic covariates for all regression models included age, education, partner status, and annual household income.

Results: Men were aged 56.7 (±9.7) years and self-reported 4.0 (±2.9) chronic conditions. Approximately 1 in 4 participants reported that they did not have enough people to call for help (25.2%), felt isolated from others (26.0%), and were not content with friendships/relationships (23.8%). Across multivariate models, men who reported more barriers to disease self-management were significantly more likely to report a social connection domain challenge. The number of chronic conditions and cutting down or skipping social activities because of health problems were also associated with a greater likelihood of social connection challenges.

Conclusions: Efforts to improve the self-management of illness symptomology may mitigate challenges to social connection among middle-aged and older Black men.

Background: Health disparities in cardiovascular disease (CVD) risk factors persist among racially, ethnically, and sex diverse civilian populations. Little is known about whether these disparities persist in US military populations. The aim of this study was to examine and describe differences in CVD risk factors by sex, race, and ethnicity among US service members and veterans of Operation Enduring Freedom/Operation Iraqi Freedom conflicts.

Method: Sex, racial, and ethnic differences in CVD risk factors (self-reported diagnoses of hypertension, high cholesterol, and diabetes, obese body mass index, and current smoking) were examined in 2014-2016 among 103,245 service members and veterans (age [years], M=40, SD=11; 70.3% men; 75.7% non-Hispanic White adults) enrolled in the Millennium Cohort Study. A series of ordinal regressions were conducted sequentially adjusting for sociodemographic, military, behavioral, and psychosocial factors.

Results: Overall, 59% of participants reported at least 1 CVD risk factor. Men had greater odds of screening positive for CVD risk factors than did women. Non-Hispanic Asian or Pacific Islander adults had lower odds of screening positive for CVD risk factors than did non-Hispanic White adults. Although unadjusted models showed non-Hispanic Black, Hispanic/Latino, and non-Hispanic American Indian/Alaska Native individuals had greater odds of screening positive for CVD risk factors, these associations were attenuated or reversed after adjusting for sociodemographic, military, behavioral, and/or psychosocial factors.

Conclusion: Due to differences in CVD risk by sex, race, and ethnicity among service members and veterans, studies are needed to understand the potential mechanisms that explain persistent disparities. Implementation of CVD prevention interventions should be considered.

Purpose: Previous research indicates a higher prevalence of glaucoma in Black individuals of African descent. However, the association between race and glaucoma in Brazil's multiracial population remains underexplored. This study examines this association and seeks to identify preventable factors potentially influencing prevalence differences among racial groups in Brazil, should such difference be found.

Methods: Employing a cross-sectional design, data were analyzed from 10,696 participants in the multicenter Brazilian Longitudinal Study of Adult Health (2008-2010) who self-identified their race as White, Black, mixed race (pardo), Asian, or Indigenous and completed an ophthalmological questionnaire including their self-reported glaucoma status (yes or no). Poisson regression was used to estimate prevalence ratios (PRs) with robust SEs and adjustments for sociodemographic characteristics and the presence of diabetes, hypertension, and obesity.

Results: The prevalence of glaucoma was 5.8% in Black (86/1483), 3.8% in mixed race (101/2688), 3.8% in indigenous (4/106), 3.5% in Asian (10/288), and 2.4% in White (145/6131) populations. Compared with Whites, Blacks and mixed-race individuals were younger. Age-adjusted prevalence was 175% higher in Black individuals (PR=2.75, 95% confidence interval [CI]: 2.12, 3.56) and 85% higher in mixed-race individuals (PR=1.85, 95% CI: 1.44, 2.36) compared with Whites. The strength of these associations was reduced in models including the comorbidities of obesity, hypertension, and diabetes, which are more prevalent in Black and mixed-race individuals.

Conclusions: Our results reveal a higher prevalence of self-reported glaucoma in non-White groups, especially among Black and mixed-race individuals. Although causality cannot be conclusively established, our data suggest that the increased prevalence of glaucoma in these groups, compared with their White peers, is partially influenced by preventable health conditions.

Background: Domestic and international migrants along the United States-Mexico border are at increased risk for diabetes due to structural and psychosocial adversities.

Objectives: This study assessed the prevalence of diabetes and prediabetes in a low-income United States-Mexico border community; examined the relationships between depression, anxiety, andadverse childhood experiences (ACEs) and diabetes prevalence and glucose regulation; and explored indirect effects of social support on these relationships. Results. Participants were 220 adults ages 19-83 years (M.47.2, SD.11.9) of majority Mexican nationality (89.1%). Over 70% reported history of migration to the United States; 56.8% reported deportation from the United States to Mexico. Prevalences of clinically significant depression and anxiety symptoms were 36.9% and 33.3%, respectively. Prevalences of diabetes and prediabetes were 17.3% and 29.1%, respectively. Psychological variables were not associated with diabetes or glucose regulation. Indirect effects were found from depression and ACEs through social support to hemoglobin A1c.

Conclusions: Results suggest the need for diabetes prevention interventions with an integrated biopsychosocial approach.

Background: Strokes are a leading cause of death and disability among African Americans in the United States. Biological markers to predict stroke remain elusive; thus, our objective was to investigate whether inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP), was associated with stroke incidence among African Americans enrolled in the Jackson Heart Study (JHS).

Methods: Baseline hs-CRP levels were categorized in quintiles: quintile 1 (0.0084 mg/L); quintile 2 (0.0085-0.0189 mg/L); quintile 3 (0.0190-0.036 mg/L); quintile 4 (0.037-0.0675 mg/L); quintile 5 (≥0.0676 mg/L). Nonfatal stroke incidence was ascertained from passive community surveillance through annual phone calls and adjudicated via hospital records. At baseline, stroke risk factors/covariates were compared across quintiles using a one-way analysis of variance and a chi-square test. The association between baseline hs-CRP levels and stroke incidence was determined using a Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CI).

Results: In the unadjusted model, hs-CRP levels in quintile 2 (HR, 1.48; 95% CI, 0.96-2.29), quintile 3 (HR, 1.44; 95% CI, 0.93-2.24), and quintile 4 (HR, 1.09; 95% CI, 0.68-1.74) were not associated with stroke incidence when compared with quintile 1 (reference). However, individuals within quintile 5 (HR, 1.78; 95% CI, 1.17-2.72) exhibited a significantly increased risk for stroke compared with those in the reference quintile. This risk persisted after adjusting for stroke risk factors (demographics, anthropometrics, health condition covariates, health behavioral risk factors, and cardiovascular disease history) for quintile 5 (HR, 1.87; 95% CI, 1.17-2.98) compared with reference quintile 1.

Conclusions: An increased and independent risk of nonfatal stroke appears at the highest quintile of hs-CRP values (≥0.0676 mg/L) among JHS participants.

Objective: To assess the absence of diabetic foot examination in Brazil and how ethnicity affected this outcome.

Design: This is an analysis of a nationwide survey held in Brazil in 2019. Participants with diabetes and that were 15 years of age or older were eligible for inclusion in the analysis. Adjusted Poisson regression with robust variance was used to calculate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) of never having had the foot examined, with separate models according to ethnicity. Stata 14.2 was used for all calculations.

Results: We included 6216 individuals with diabetes; 52.1% (95%CI: 50.0%-54.2%) reported never having had their feet examined by a health care professional and 61% self-declared as Black (Black and Brown [Brazilian mixed race]). A higher frequency of negligence was observed among Black individuals (55.3%; 52.5%-58.1%) than among White individuals (48.2%; 45.0%-51.5%). Negligence was higher between 15- to 39-year-old participants (PR = 1.34, 1.14-1.57), lower educational level (PR = 1.37, 1.13-1.65), higher alcohol consumption (PR = 1.18, 1.06-1.31), fair health status (PR = 1.11, 1.01-1.21), and diabetes diagnosis of up to 10 years (PR = 1.42, 1.28-1.57). Among Blacks, tobacco use and other factors increased the frequency of the outcome, whereas participation in the Brazilian Unified Health System primary care program was a protection factor (P<.05).

Conclusion: Black Brazilians with diabetes had higher negligence of foot examination by health care professionals. Strengthening primary care would help mitigate systemic racism in Brazil.

Objectives: To examine the relationship between acculturation, cultural perceptions surrounding mental health (MH) burden and utilization of MH services among South Asian (SA) adults in the United States.

Design: Cross-sectional study.

Setting: Online survey.

Participants: Four hundred five SA adults (≥18 years old) residing in the United States.

Methods: Cross-sectional study of acculturation, attitudes toward MH burden, and MH service utilization was conducted via online survey. Multivariate logistic regression models were employed to understand how these factors were associated with MH service utilization.

Main outcome measure: Utilization of MH services.

Results: Among the 405 participants, 49.0% identified as immigrants (75.1% Indian, 8% Bangladeshi, 5.5% Pakistani, and 3.8% from other SA countries). Current utilization of MH services was associated with comfort conversing in English (odds ration [OR]=5.99; 95% confidence interval [CI]=1.63, 27.02), having English-speaking peers (OR=3.80; 95% CI=1.12, 12.93), and having family (OR=2.37; 95% CI=1.21, 4.64) and peers (OR=5.64; 95% CI=1.71, 18.66) who used MH services. Participants with mostly SA peers (OR=0.48; 95% CI=0.23, 0.97) reported lower lifetime MH service utilization, and those with positive perceptions about MH burden reported higher lifetime utilization (OR=1.04; 95% CI=1.01, 1.09).

Conclusions: Comfort expressing emotions in English, knowledge of family/peer MH service use, and type of social connections were associated with MH service utilization among SA immigrants. Interventions should aim to increase SA languages in which MH services are offered and to engage with SA communities to increase acceptance of MH service utilization.