Ethnicity & Health最新文献

Background: Racial disparities in treatment and mortality were widely studied among prostate cancer patients; however, few studies considered the prevalence of hypertension and diabetes and their treatment status.

Objectives: To determine whether there are racial discrepancies in the use of anti-cancer, antihypertensive, and antidiabetic drugs in a cohort of long-term survivors of prostate cancer diagnosed in 2007-2015; and to examine racial disparities in mortality after adjustments for their differences in those treatments.

Methods: We used the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database and included records for patients with prostate cancer at age 65 years or older diagnosed from 2007 to 2015 in 17 SEER areas (n = 244,468).

Results: Among non-Hispanic Blacks with prostate cancer, 86.2% were affected by hypertension, with 62.1% taking antihypertensive medications. Additionally, 45.3% of individuals in this group had diabetes, and 41.1% of them received antidiabetic drugs to manage their respective health conditions. Non-Hispanic Blacks were less likely to receive antihypertensive drugs (adjusted odds ratio [aOR]: 0.94, 95% confidence interval [CI]: 0.89-0.99) and antidiabetic drugs (aOR:0.86, 95% CI:0.80-0.92) compared with non-Hispanic Whites. Hispanic and non-Hispanic Asians were significantly less likely to receive chemotherapy and hormone therapy, compared with non-Hispanic Whites. After adjusting for all factors including treatments, the risk of all-cause and cancer-specific mortality was significantly higher for non-Hispanic Blacks (hazard ratio: 1.22, 95% CI: 1.24-1.51 and 1.22, 95% CI:1.17-1.27) than that of non-Hispanic Whites.

Conclusions: There were substantial racial disparities in the receipt of cancer treatments and antihypertension and antidiabetic drugs. Non-Hispanic Black patients with prostate cancer still had a considerably higher risk of all-cause and cancer-specific mortality than non-Hispanic Whites after accounting for demographic, therapy, and tumor factors.

Objective: Chronic Kidney Disease (CKD) disproportionately impacts African American and Latinx populations in the United States. This study utilized a participatory photo-elicitation approach to explore how African American and Latinx individuals with CKD perceive and navigate their disease journeys.

Method: In this qualitative study, remote semi-structured interviews were conducted with a total of 20 African American and Latinx individuals with CKD, and the data were analyzed using reflexive thematic analysis.

Results: Participants' ages ranged from 30 to 67, with 60% identifying as women and 30% reporting annual incomes <$20,000. Data analysis uncovered four key themes: (1) 'The Burden of CKD,' highlighting the physical, social, and emotional toll on patients; (2) 'Navigating CKD with Positivity and Support,' showcasing strategies to cultivate psychological well-being; (3) 'Systemic Difficulties,' addressing barriers within the healthcare system; and (4) 'Building Bridges in the Kidney Community,' illustrating advocacy efforts to combat CKD.

Discussion: This study highlights the nuanced experiences of African American and Latinx individuals with CKD, highlighting their challenges and resilience. These findings emphasize the need for inclusive healthcare strategies that address these racially/ethnically diverse populations' unique needs to improve health outcomes.

Objectives: Black men in the U.S. experience disproportionately high rates of diabetes, cardiovascular disease, and prostate cancer - conditions closely linked to chronic stressors such as racial discrimination, economic precarity, and gender role strain. In response, the Men of Color Health Awareness (MOCHA) program was developed to promote the physical, mental, social, and spiritual well-being of men of color through culturally grounded discussions on structural violence, coping, and masculinity. This paper presents findings and key implementation lessons from the MOCHA Moving Forward study, which tested two intervention models: the original MOCHA program (MO) and MOCHA+, an enhanced version incorporating culturally adapted narrative dialogue.

Design: This community-academic feasibility trial randomized 210 men aged 35-70 into MO or MOCHA+ groups. Both participated in a 10-week program focused on stress and chronic disease prevention.

Results: Among participants who completed the program, statistically significant reductions were found in self-reported stress, BMI, anxiety, and depression in the MO group. When combining MO and MOCHA+ participants, reductions in stress and BMI remained significant. However, high attrition and loss to follow-up (final sample: 38) posed challenges to feasibility and scalability.

Conclusion: Despite retention challenges, findings suggest MOCHA is a promising intervention for stress and chronic disease risk reduction among men of color. The significant outcomes observed among completers highlight the program's potential and provide critical insights for improving the feasibility of future community-based interventions. Future research should explore scalable adaptations and further refine MOCHA's culturally tailored content to better support structurally marginalized populations.

Importance: To assess potential misclassification or exclusion of American Indian and Alaska Native (AI/AN) individuals within the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8, we compared differences between aggregated and self-reported race variables and their impact on maternal comorbidities.

Methods/design: We utilized several CDC-provided ethnoracial identity variables alongside a disaggregated variable we created. We then estimated comorbidity prevalences between these groupings to determine the impact of these methodological differences.

Results: PRAMS variables, MRACE_AMI and MAT_RACE_PU, included 13,341 (no distinction between AI and AN) and 7,494 AI (excluded AN altogether), respectively. Our constructed variable (n = 13,383) included 19 ethnoracial-subgroups and 42 tribal members not selecting AI/AN race. We found significant differences in the prevalence of comorbidities by these variables. For instance, the prevalence for diabetes with MAT_RACE_PU was 4.93%, with MRACE_AMI was 4.04%, but our subgroup AI (alone) was 5.46%, and AN (alone) was 1.37%.

Conclusion: Our results highlight significant disparities in maternal comorbidities among AI/AN women when different racial classification strategies are employed. Disaggregating these data revealed differences that are crucial for understanding the unique health challenges faced by various subgroups.

Introduction: The rural Veteran population is becoming more racially and ethnically diverse, with Hispanic/Latino (H/L) Veterans representing a growing proportion of rural Veterans. Despite experiencing similar challenges to those of other rural Veteran populations, rural H/L Veterans face additional health-related challenges due to sociocultural factors. A gap in knowledge for rural H/L Veterans exists; thus, research on this population is warranted.

Objective: We conducted a scoping review to examine literature on rural H/L Veterans. We synthesized health-related issues, needs, and services for rural H/L Veterans, including health disparities, tailored interventions to address health disparities, and whether studies employed an intersectional approach to understand and address challenges for rural H/L Veterans.

Methods: We followed Arksey and O'Malley's framework. Inclusion criteria were limited to English language articles published between 2007-2024 focusing on rural H/L Veterans in the United States and U.S. state equivalents. Two reviewers assessed selected articles.

Results: Sixteen articles were included. Most articles (75%) were retrospective cohort or retrospective cross-sectional studies. Studies examined health disparities related to diabetes, suicide, depression, traumatic brain injury, PTSD, chronic pain, COVID-19 vaccination, primary care access, goals of care documentation, and multimorbidity. 'Hispanic' and/or 'Latino' terms were often used as descriptive characteristics and/or covariates and lacked clear definitions. Few studies thoroughly highlighted the intersectionality of geographic location and H/L ethnicity for Veterans. Additionally, limitations in data were noted by some studies.

Conclusions: Increased research on health-related challenges experienced by rural H/L Veterans is needed. Of specific importance is research that emphasizes the intersectionality of rural H/L Veterans, acknowledges intra-ethnic diversity and cultural influence, prioritizes culturally relevant interventions, addresses data limitations, and focuses on providing equitable care. Knowledge gained can inform the development of Veteran-centric and culturally appropriate policies and practices to improve the health outcomes of rural H/L Veterans and achieve health equity.

Objectives: This study explores the lived experiences of Ghanaian and Nigerian youth in London's mental health system, highlighting systemic barriers, cultural misalignment, and practitioner perspectives on care models. Standardised approaches, such as Cognitive Behavioral Therapy (CBT), often fail to accommodate the cultural and systemic needs of these communities, contributing to disparities in access and engagement.

Design: A qualitative study employing Interpretative Phenomenological Analysis (IPA) was conducted with 12 participants, including Ghanaian and Nigerian youth (n = 5), parents (n = 2), and mental health practitioners (n = 5). Semi-structured interviews facilitated an in-depth exploration of personal and shared experiences, analysed using idiographic and group-level thematic approaches.

Results: Three overarching themes emerged: (1) 'They didn't really help me' - highlighting system-level barriers such as long wait times, unfulfilled referrals, and marginalisation; (2) Cross-racial therapeutic dynamics and practitioners' observations - revealing tensions between cultural differences in therapy, mixed practitioner experiences, and challenges in building rapport; (3) There hasn't been enough in the model of care - illustrating the rigidity and cultural insensitivity of standardised therapeutic approaches, particularly within NHS Talking Therapy (formerly IAPT).

Conclusion: The study highlights the need for a shift from cultural competence to cultural humility in mental healthcare. Addressing systemic barriers requires integrating cultural humility in practitioner training, adapting care models to accommodate diverse experiences, and fostering inclusive mental health policies. These findings advocate for rethinking mental health service delivery to ensure equitable and effective care for Ghanaian, Nigerian and diverse youth in London.

Objectives: Diabetes poses a significant public health challenge. The Chinese community has unique cultural characteristics that can influence their understanding of the diabetes healthcare system and engagement with services. This study aims to explore the knowledge and awareness of the diabetes healthcare system and the uptake of healthcare services in the UK Chinese population.

Design: This study adopted a qualitative design. Three focus group discussions (FGDs) were conducted on Zoom with 22 Chinese participants with self-reported type 2 diabetes living in the UK. Participants ranged from 24 to 85 years (mean age = 66 years, SD = 17.1). A purposive sample was recruited through study adverts in Chinese community centres and snowball sampling. Data were analysed using Braun and Clarke's thematic analysis (TA).

Results: This paper discusses 4 themes: Awareness and understanding of diabetes, healthcare access and utilisation, attitudes towards diabetes prevention programmes and Chinese medicine vs. Western medicine. Limited knowledge and awareness of diabetes was highlighted, with cultural factors impacting this. Factors which impacted healthcare access and utilisation were linguistic/ communication challenges, and trust and perception of the NHS. Participants were unaware of diabetes prevention programmes and highlighted that these were culturally inappropriate. Generational preferences were noted in the way participants wished to receive diabetes education. The western medical system was viewed as medication focused, therefore the older Chinese community trusted familiar natural methods of illness management.

Conclusion: These findings highlight the importance of ensuring diabetes education is culturally appropriate. Generational differences in education preference should be recognised by healthcare professionals to increase healthcare engagement. These findings demonstrate the important need to educate UK healthcare professionals with the unique sociocultural contexts for this ethnic group. This study uncovers gaps in awareness and service uptake, highlighting the need for co-development of interventions that promote health equity and improve diabetes management within this population.

Objective: In 2015, chronic diseases accounted for approximately three-quarters of deaths in Ontario, with the most common conditions being cancer, cardiovascular diseases, diabetes, and chronic lower respiratory diseases. Despite Canada's diversity, there is limited health research on chronic disease prevalence among visible minority populations. This study aimed to examine the relationship between visible minority status and the prevalence of chronic diseases in Canada, with a focus on self-identified ethnoracial identity.

Design: Data were drawn from the 2017/18 combined cycle of the Canadian Community Health Survey (n = 113,290), accessed through the Statistics Canada Research Data Centre. Each enumerated visible minority group was analysed separately, except for Chinese, Korean, and Japanese participants, who were grouped into a single category due to sample size constraints. Chronic conditions were self-reported with binary 'yes/no' responses, with the exception of obesity, which was derived from reported weight and height data. Logistic regression was used to calculate bivariate and multivariable odds ratios (OR) with 95% confidence intervals (CI). Analyses were stratified by sex (male/female, as measured by the CCHS).

Results: Multivariable analyses indicated that visible minority males had higher odds of reporting high cholesterol, type II diabetes, and hypertension, but lower odds of arthritis and cancer, compared white males. Filipino males had the highest odds for hypertension (OR: 2.36; 95%CI: 1.40-3.99), while South Asian males had the lowest odds of cancer (OR: 0.09; 95%CI: 0.04-0.19). Indigenous males and females consistently reported higher odds of most chronic conditions.

Conclusion: Several ethno-racial groups exhibited elevated odds of specific chronic conditions, though not uniformly across all tested outcomes. These findings underscore the importance for healthcare providers, public health practitioners, and policymakers to consider the nuanced relationship between ethnoracial identity and chronic conditions. Culturally competent care and targeted health interventions should reflect this complexity.

Objectives: This study aimed to explore the perceived impact of ethnicity and race on perinatal care among parents from diverse ethnic minority backgrounds or who had a Black, Asian, or ethnic minority child born in the UK within the last five years to better understand areas of ethnic inequality within perinatal care.

Design: This study employed a focused ethnography, recruiting a purposive sample through posters, professional organisations, and social media platforms. Efforts to ensure maximum phenomenon variation included diverse ethnic and geographical representation. Semi-structured interviews using the digital platform, Zoom, explored experiences of accessing and receiving care, with a focus on challenges and perceptions related to ethnicity, race or skin pigmentation. Interview schedules underwent stakeholder validation and pilot testing. NVivo software facilitated qualitative analysis, employing an inductive approach with rigorous coding and thematic analysis.

Results: Ethnic minority parental experiences (n = 24) revealed significant systemic challenges within the healthcare system. Three major themes were observed: Parent's voices not being heard, Systemic factors and Discrimination. Participants expressed feelings of marginalisation and inadequate communication with healthcare providers. Instances where concerns were dismissed or belittled, coupled with issues related to consent, highlighted pervasive systemic shortcomings. Structural barriers such as difficulties in scheduling appointments and perceived organisational neglect further compounded these challenges. Discriminatory attitudes and racial stereotypes also influenced the quality of care received, contributing to disparities in health outcomes and maternal wellbeing. Participants noted feelings of social isolation, exacerbated by pandemic-related restrictions and a lack of tailored support networks.

Conclusion: These findings underscore the urgent need for systemic reforms aimed at ensuring culturally safe and anti-racist practice, addressing communication barriers, and reducing discriminatory practices to enhance healthcare experiences and outcomes for ethnic minority parents. This includes training all healthcare staff around cultural safety.

Background: The HIV epidemic and COVID-19 are disproportionately impacting Black communities. For Black women living with HIV (BWLWH), 2020 COVID-19 mandates (e.g. stay-at-home orders) may have had implications for HIV medication adherence, engagement in care, and mental health.

Method: In April 2020 during COVID-19 spikes in the US, thirty Black women living with HIV in Miami, FL participated in qualitative semi-structured interviews that asked about COVID-related concerns, HIV medication adherence, engagement in care, and mental health. Interviews were audio recorded, transcribed, and coded using thematic content analysis.

Results: Qualitative analyses highlighted themes around concerns (e.g. whether HIV placed them at increased risk for COVID-19, feeling confined and restricted); mental health (e.g. feeling anxious, depressed); medication adherence (adhering to HIV medication despite COVID-19); engagement in care (e.g. providers canceling appointments, being persistent in contacting providers); adaptive coping (e.g. cleaning/chores, watching series/videos, seeking/receiving social support, praying/watching virtual church services, limiting news consumption, social distancing and wearing masks); minimal use of unhelpful coping strategies (e.g. substance use, eating more unhealthy food); losses/deaths; and the need for financial, food, mental health, and community level (e.g. testing sites) resources. Additionally, survey responses to quantitative measures indicated that a significant portion of women (between 20% and 47%) had difficulties such as getting food, paying bills, getting hand sanitizer and cleaning supplies, communicating with loved ones, reduced wages/work hours, and transportation barriers.

Conclusion: Our findings indicate that in the context of COVID-19 stay-at-home orders BWLWH were moderately impacted, shared concerns and mental health symptoms, and voiced the shortfalls of medical providers. Further, BWLWH exhibited resilience with regard to medication adherence and the use of adaptive coping strategies while echoing the need for additional resources and structural interventions.