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Guan A, Talingdan AS, Tanjasiri SP, Kanaya AM, Gomez SL. Lessons Learned from Immigrant Health Cohorts: A Review of the Evidence and Implications for Policy and Practice in Addressing Health Inequities among Asian Americans, Native Hawaiians, and Pacific Islanders. Annu Rev Public Health 2024; 45:401-424. [PMID: 38109517 DOI: 10.1146/annurev-publhealth-060922-040413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
The health of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) is uniquely impacted by structural and social determinants of health (SSDH) shaped by immigration policies and colonization practices, patterns of settlement, and racism. These SSDH also create vast heterogeneity in disease risks across the AANHPI population, with some ethnic groups having high disease burden, often masked with aggregated data. Longitudinal cohort studies are an invaluable tool to identify risk factors of disease, and epidemiologic cohort studies among AANHPI populations have led to seminal discoveries of disease risk factors. This review summarizes the limited but growing literature, with a focus on SSDH factors, from seven longitudinal cohort studies with substantial AANHPI samples. We also discuss key information gaps and recommendations for the next generation of AANHPI cohorts, including oversampling AANHPI ethnic groups; measuring and innovating on measurements of SSDH; emphasizing the involvement of scholars from diverse disciplines; and, most critically, engaging community members to ensure relevancy for public health, policy, and clinical impact.
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Affiliation(s)
- Alice Guan
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA;
| | - Ac S Talingdan
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA;
| | - Sora P Tanjasiri
- Department of Health, Society, and Behavior, and Chao Family Comprehensive Cancer Center, University of California, Irvine, California, USA
| | - Alka M Kanaya
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA;
- Department of Medicine, University of California, San Francisco, California, USA
| | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA;
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
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Zheng Y, Jiang P, Tu Y, Huang Y, Wang J, Gou S, Tian C, Yuan R. Incidence, risk factors, and a prognostic nomogram for distant metastasis in endometrial cancer: A SEER-based study. Int J Gynaecol Obstet 2024; 165:655-665. [PMID: 38010285 DOI: 10.1002/ijgo.15264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To evaluate the metastatic pattern, identify the risk factors, and establish a nomogram for predicting prognosis of endometrial cancer (EC) with distant metastasis. METHODS A retrospective cohort study of women diagnosed with EC was conducted according to the Surveillance, Epidemiology, and End Results (SEER) database during 2010-2017. Multivariate logistic analysis and Cox analysis were performed to identify the risk factors in promoting distant metastasis and predictors associated with overall survival (OS) in this particular subpopulation. A nomogram was then constructed and validated by the concordance index (C-index), the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. RESULTS A total of 2799 cases of distant metastasis in EC patients were identified, with an overall incidence rate of 3.74% from 2010 to 2017. Black race, unmarried status, non-endometrioid histologic types, and grade IV were significant risk factors for distant metastasis in EC patients. Meanwhile, race, histology, grade, metastasis status, surgery, lymphadenectomy, and chemotherapy were identified as independent prognostic factors for OS. A nomogram to predict 1-, 3-, and 5-year OS was established, and presented favorable accuracy and clinical applicability. Patients were further divided into high- and low-risk groups according to the model. CONCLUSION The nomogram was developed as a highly accurate, individualized tool to better predict the prognosis of EC patients with distant metastasis, which would help clinicians to identify high-risk patients, and adjust and tailor their treatment strategies.
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Affiliation(s)
- Yunfeng Zheng
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Tu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhen Huang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinyu Wang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shikai Gou
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenfan Tian
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Yuan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Hajat A, Andrea SB, Oddo VM, Winkler MR, Ahonen EQ. Ramifications of Precarious Employment for Health and Health Inequity: Emerging Trends from the Americas. Annu Rev Public Health 2024; 45:235-251. [PMID: 38012123 PMCID: PMC11128534 DOI: 10.1146/annurev-publhealth-071321-042437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Precarious employment (PE), which encompasses the power relations between workers and employers, is a well-established social determinant of health that has strong ramifications for health and health inequity. In this review, we discuss advances in the measurement of this multidimensional construct and provide recommendations for overcoming continued measurement challenges. We then evaluate recent evidence of the negative health impacts of PE, with a focus on the burgeoning studies from North America and South America. We also establish the role of PE in maintaining and perpetuating health inequities and review potential policy solutions to help alleviate its health burden. Last, we discuss future research directions with a call for a better understanding of the heterogeneity within PE and for research that focuses both on upstream drivers that shape PE and its impacts on health, as well as on the mechanisms by which PE causes poor health.
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Affiliation(s)
- Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA;
| | - Sarah B Andrea
- School of Public Health, Oregon Health and Sciences University-Portland State University, Portland, Oregon, USA
| | - Vanessa M Oddo
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Megan R Winkler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Q Ahonen
- Division of Occupational and Environmental Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Claussen AH, Holbrook JR, Hutchins HJ, Robinson LR, Bloomfield J, Meng L, Bitsko RH, O'Masta B, Cerles A, Maher B, Rush M, Kaminski JW. All in the Family? A Systematic Review and Meta-analysis of Parenting and Family Environment as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:249-271. [PMID: 35438451 PMCID: PMC9017071 DOI: 10.1007/s11121-022-01358-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.
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Affiliation(s)
- Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helena J Hutchins
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Atlanta, GA, USA
| | - Lara R Robinson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeanette Bloomfield
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lu Meng
- Covid-19 Response Health System and Worker Safety Task Force, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Pergolizzi J, LeQuang JAK, Wagner M, Varrassi G. Challenges in Palliative Care in Latin America: A Narrative Review. Cureus 2024; 16:e60698. [PMID: 38899235 PMCID: PMC11186623 DOI: 10.7759/cureus.60698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
In "graying" populations with extended lifespans and survivable forms of cancer, palliative services become increasingly important but may be difficult to introduce into public discourse, public policy, and healthcare systems. Latin America (LATAM) faces many challenges as it introduces and, in some cases, develops its palliative care programs; though the challenges faced here are in many ways universal ones, LATAM approaches may be unique and based on the region's specific culture, politics, and economics. This narrative review based on a literature search identified 10 main themes that can be interpreted as challenges and opportunities for palliative care in LATAM. These challenges are integrating palliation into healthcare systems; public policy and funding; therapeutic obstinacy; changing demographics; access to services; analgesia; the role of religion, spirituality, and folk medicine; social determinants of palliative care; low health literacy; and limited clinician training. Some of the LATAM nations have palliative programs and palliative care training in place while others are developing these systems. Integrating this care into existing healthcare and reimbursement systems has been a challenge. A notable challenge in LATAM is also access to care since palliative programs tend to cluster in metropolitan areas and create hardships for rural citizens to access them. The better-defined role of familial caregivers and telehealth may be important factors in the expansion of palliative care in LATAM and beyond.
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Affiliation(s)
- Joseph Pergolizzi
- Anesthesiology - Pain Medicine and Critical Care Medicine, NEMA Research, Inc., Naples, USA
| | | | - Morgan Wagner
- Entrepreneur Program, NEMA Research, Inc., Naples, USA
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McNamara C, Cook S, Brown LM, Palta M, Look KA, Westergaard RP, Burns ME. Prompt access to outpatient care post-incarceration among adults with a history of substance use: Predisposing, enabling, and need-based factors. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209277. [PMID: 38142041 PMCID: PMC11060918 DOI: 10.1016/j.josat.2023.209277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/30/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION As expanded Medicaid coverage reduces financial barriers to receiving health care among formerly incarcerated adults, more information is needed to understand the factors that predict prompt use of health care after release among insured adults with a history of substance use. This study's aim was to estimate the associations between characteristics suggested by the Andersen behavioral model of health service use and measures of health care use during the immediate reentry period and in the presence of Medicaid coverage. METHODS In this retrospective cohort study, we linked individual-level data from multiple Wisconsin agencies. The sample included individuals aged 18-64 released from a Wisconsin State Correctional Facility between April 2014 and June 2017 to a community in the state who enrolled in Medicaid within one month of release and had a history of substance use. We grouped predictors of outpatient care into variable domains within the Andersen model: predisposing- individual socio-demographic characteristics; enabling characteristics including area-level socio-economic resources, area-level health care supply, and characteristics of the incarceration and release; and need-based- pre-release health conditions. We used a model selection algorithm to select a subset of variable domains and estimated the association between the variables in these domains and two outcomes: any outpatient visit within 30 days of release from a state correctional facility, and receipt of medication for opioid use disorder within 30 days of release. RESULTS The size and sign of many of the estimated associations differed for our two outcomes. Race was associated with both outcomes, Black individuals being 12.1 p.p. (95 % CI, 8.7-15.4, P < .001) less likely than White individuals to have an outpatient visit within 30 days of release and 1.3 p.p. (95 % CI, 0.48-2.1, P = .002) less likely to receive MOUD within 30 days of release. Chronic pre-release health conditions were positively associated with the likelihood of post-release health care use. CONCLUSIONS Conditional on health insurance coverage, meaningful differences in post-incarceration outpatient care use still exist across adults leaving prison with a history of substance use. These findings can help guide the development of care transition interventions including the prioritization of subgroups that may warrant particular attention.
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Affiliation(s)
- Cici McNamara
- School of Economics, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Steven Cook
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA.
| | - Lars M Brown
- Division of Medicaid Services, Wisconsin Department of Health Services, Madison, WI, USA.
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
| | - Kevin A Look
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Marguerite E Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
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Islam JY, Hathaway CA, Hume E, Turner K, Hallanger-Johnson J, Tworoger SS, Camacho-Rivera M. Racial and Ethnic Inequities in Cancer Care Continuity During the COVID-19 Pandemic Among Those With SARS-CoV-2. JAMA Netw Open 2024; 7:e2412050. [PMID: 38767916 PMCID: PMC11107297 DOI: 10.1001/jamanetworkopen.2024.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 05/22/2024] Open
Abstract
Importance Racially and ethnically minoritized US adults were disproportionately impacted by the COVID-19 pandemic and experience poorer cancer outcomes, including inequities in cancer treatment delivery. Objective To evaluate racial and ethnic disparities in cancer treatment delays and discontinuations (TDDs) among patients with cancer and SARS-CoV-2 during different waves of the COVID-19 pandemic in the United States. Design, Setting, and Participants This cross-sectional study used data from the American Society of Clinical Oncology Survey on COVID-19 in Oncology Registry (data collected from April 2020 to September 2022), including patients with cancer also diagnosed with SARS-CoV-2 during their care at 69 US practices. Racial and ethnic differences were examined during 5 different waves of the COVID-19 pandemic in the United States based on case surge (before July 2020, July to November 2020, December 2020 to March 2021, April 2021 to February 2022, and March to September 2022). Exposures Race and ethnicity. Main Outcomes and Measures TDD was defined as any cancer treatment postponed more than 2 weeks or cancelled with no plans to reschedule. To evaluate TDD associations with race and ethnicity, adjusted prevalence ratios (aPRs) were estimated using multivariable Poisson regression, accounting for nonindependence of patients within clinics, adjusting for age, sex, body mass index, comorbidities, cancer type, cancer extent, and SARS-CoV-2 severity (severe defined as death, hospitalization, intensive care unit admission, or mechanical ventilation). Results A total of 4054 patients with cancer and SARS-CoV-2 were included (143 [3.5%] American Indian or Alaska Native, 176 [4.3%] Asian, 517 [12.8%] Black or African American, 469 [11.6%] Hispanic or Latinx, and 2747 [67.8%] White; 2403 [59.3%] female; 1419 [35.1%] aged 50-64 years; 1928 [47.7%] aged ≥65 years). The analysis focused on patients scheduled (at SARS-CoV-2 diagnosis) to receive drug-based therapy (3682 [90.8%]), radiation therapy (382 [9.4%]), surgery (218 [5.4%]), or transplant (30 [0.7%]), of whom 1853 (45.7%) experienced TDD. Throughout the pandemic, differences in racial and ethnic inequities based on case surge with overall TDD decreased over time. In multivariable analyses, non-Hispanic Black (third wave: aPR, 1.56; 95% CI, 1.31-1.85) and Hispanic or Latinx (third wave: aPR, 1.35; 95% CI, 1.13-1.62) patients with cancer were more likely to experience TDD compared with non-Hispanic White patients during the first year of the pandemic. By 2022, non-Hispanic Asian patients (aPR, 1.51; 95% CI, 1.08-2.12) were more likely to experience TDD compared with non-Hispanic White patients, and non-Hispanic American Indian or Alaska Native patients were less likely (aPR, 0.37; 95% CI, 0.16-0.89). Conclusions and Relevance In this cross-sectional study of patients with cancer and SARS-CoV-2, racial and ethnic inequities existed in TDD throughout the pandemic; however, the disproportionate burden among racially and ethnically minoritized patients with cancer varied across SARS-CoV-2 waves. These inequities may lead to downstream adverse impacts on cancer mortality among minoritized adults in the United States.
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Affiliation(s)
- Jessica Y. Islam
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Cassandra A. Hathaway
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Emma Hume
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Shelley S. Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Division of Oncological Sciences, School of Medicine, Oregon Health & Science University, Portland
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, New York, New York
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Galiatsatos P, Garibaldi B, Yao D, Xu Y, Perin J, Shahu A, Jackson JW, Piggott D, Falade-Nwulia O, Shubella J, Michtalik H, Belcher HME, Hansel NN, Golden S. Lack of racial and ethnic disparities in mortality in minority patients hospitalised with COVID-19 in a mid-Atlantic healthcare system. BMJ Open Respir Res 2024; 11:e002310. [PMID: 38692710 PMCID: PMC11086483 DOI: 10.1136/bmjresp-2024-002310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION In the USA, minoritised communities (racial and ethnic) have suffered disproportionately from COVID-19 compared with non-Hispanic white communities. In a large cohort of patients hospitalised for COVID-19 in a healthcare system spanning five adult hospitals, we analysed outcomes of patients based on race and ethnicity. METHODS This was a retrospective cohort analysis of patients 18 years or older admitted to five hospitals in the mid-Atlantic area between 4 March 2020 and 27 May 2022 with confirmed COVID-19. Participants were divided into four groups based on their race/ethnicity: non-Hispanic black, non-Hispanic white, Latinx and other. Propensity score weighted generalised linear models were used to assess the association between race/ethnicity and the primary outcome of in-hospital mortality. RESULTS Of the 9651 participants in the cohort, more than half were aged 18-64 years old (56%) and 51% of the cohort were females. Non-Hispanic white patients had higher mortality (p<0.001) and longer hospital length-of-stay (p<0.001) than Latinx and non-Hispanic black patients. DISCUSSION In this large multihospital cohort of patients admitted with COVID-19, non-Hispanic black and Hispanic patients did not have worse outcomes than white patients. Such findings likely reflect how the complex range of factors that resulted in a life-threatening and disproportionate impact of incidence on certain vulnerable populations by COVID-19 in the community was offset through admission at well-resourced hospitals and healthcare systems. However, there continues to remain a need for efforts to address the significant pre-existing race and ethnicity inequities highlighted by the COVID-19 pandemic to be better prepared for future public health emergencies.
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Affiliation(s)
| | | | - Dapeng Yao
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Yanxun Xu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jamie Perin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andi Shahu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - John W Jackson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Liu J, Niederdeppe J. Effects of communicating health disparities using social comparison framing: A comprehensive review. Soc Sci Med 2024; 348:116808. [PMID: 38537451 DOI: 10.1016/j.socscimed.2024.116808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024]
Abstract
Communicating health disparities in mass and social media has typically taken the form of comparing disease risks and outcomes between two or more social groups, a strategy known as social comparison framing. This comprehensive review examined the design and results of 17 studies from 15 peer-reviewed journal articles about the effects of social comparison framing of health disparities. Most studies focus on race-based disparities across a variety of health topics. For individual-level outcomes, social comparison tends to reduce perceived disease risks for the lower disease prevalence group while prompting negative emotions and yielding inconsistent impact on health behavioral intentions among members of the higher prevalence group. For societal-level outcomes, social comparison often has either null or polarizing effects on support for policies to address these disparities that vary by racial identity/attitudes of the respondents. Studies also find that racial comparisons trigger lower levels of support for policy remedies relative to economic, educational, or geographic comparisons. We conclude that social comparison framing of health disparities, in the absence of broader discussion of the social and structural causes of these disparities, is more likely to incur negative consequences. We propose several possible strategies to communicate health disparity information more effectively.
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Affiliation(s)
- Jiawei Liu
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, USA.
| | - Jeff Niederdeppe
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, USA; Department of Communication, Cornell University, Ithaca, NY, USA
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Caston NE, Williams CP, Levitan EB, Griffin R, Azuero A, Wheeler SB, Rocque GB. Why location matters: associations between county-level characteristics and availability of National Cancer Oncology Research Program and National Cancer Institute sites. JNCI Cancer Spectr 2024; 8:pkae038. [PMID: 38745369 PMCID: PMC11163183 DOI: 10.1093/jncics/pkae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/30/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The majority of patients with cancer seek care at community oncology sites; however, most clinical trials are available at National Cancer Institute (NCI)-designated sites. Although the NCI National Cancer Oncology Research Program (NCORP) was designed to address this problem, little is known about the county-level characteristics of NCORP site locations. METHODS This cross-sectional analysis determined the association between availability of NCORP or NCI sites and county-level characteristic theme percentile scores from the Center for Disease Control and Prevention's Social Vulnerability Index themes. Health Resources and Services Administration's Area Health Resource Files were used to determine contiguous counties. We estimated risk ratios and 95% confidence intervals (CIs) using modified Poisson regression models to evaluate the association between county-level characteristics and site availability within singular and singular and contiguous counties. RESULTS Of 3141 included counties, 14% had an NCORP, 2% had an NCI, and 1% had both sites. Among singular counties, for a standard deviation increase in the racial and ethnic theme score, there was a 22% higher likelihood of NCORP site availability (95% CI = 1.10 to 1.36); for a standard deviation increase in the socioeconomic status theme score, there was a 24% lower likelihood of NCORP site availability (95% CI = 0.67 to 0.87). Associations were of smaller magnitude when including contiguous counties. NCI sites were located in more vulnerable counties. CONCLUSIONS NCORP sites were more often in racially diverse counties and less often in socioeconomically vulnerable counties. Research is needed to understand how clinical trial representation will increase if NCORP sites strategically increase their locations in more vulnerable counties.
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Affiliation(s)
- Nicole E Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Courtney P Williams
- Division of Preventive Medicine, University of Alabama at Birmingham Department of Medicine, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Brandt C, Vo JB, Gierach GL, Cheng I, Torres VN, Lawrence WR, McCullough LE, Veiga LHS, Berrington de González A, Ramin C. Second primary cancer risks according to race and ethnicity among U.S. breast cancer survivors. Int J Cancer 2024. [PMID: 38685564 DOI: 10.1002/ijc.34971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Abstract
Breast cancer survivors have an increased risk of developing second primary cancers, yet risks by race and ethnicity have not been comprehensively described. We evaluated second primary cancer risks among 717,335 women diagnosed with first primary breast cancer (aged 20-84 years and survived ≥1-year) in the SEER registries using standardized incidence ratios (SIRs; observed/expected). SIRs were estimated by race and ethnicity compared with the racial- and ethnic-matched general population, and further stratified by clinical characteristics of the index breast cancer. Poisson regression was used to test for heterogeneity by race and ethnicity. SIRs for second primary cancer differed by race and ethnicity with the highest risks observed among non-Hispanic/Latina Asian American, Native Hawaiian, or other Pacific Islander (AANHPI), non-Hispanic/Latina Black (Black), and Hispanic/Latina (Latina) survivors and attenuated risk among non-Hispanic/Latina White (White) survivors (SIRAANHPI = 1.49, 95% CI = 1.44-1.54; SIRBlack = 1.41, 95% CI = 1.37-1.45; SIRLatina = 1.45, 95% CI = 1.41-1.49; SIRWhite = 1.09, 95% CI = 1.08-1.10; p-heterogeneity<.001). SIRs were particularly elevated among AANHPI, Black, and Latina survivors diagnosed with an index breast cancer before age 50 (SIRs range = 1.88-2.19) or with estrogen receptor-negative tumors (SIRs range = 1.60-1.94). Heterogeneity by race and ethnicity was observed for 16/27 site-specific second cancers (all p-heterogeneity's < .05) with markedly elevated risks among AANHPI, Black, and Latina survivors for acute myeloid and acute non-lymphocytic leukemia (SIRs range = 2.68-3.15) and cancers of the contralateral breast (SIRs range = 2.60-3.01) and salivary gland (SIRs range = 2.03-3.96). We observed striking racial and ethnic differences in second cancer risk among breast cancer survivors. Additional research is needed to inform targeted approaches for early detection strategies and treatment to reduce these racial and ethnic disparities.
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Affiliation(s)
- Carolyn Brandt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, California, USA
| | - Vanessa N Torres
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Cody Ramin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Li Y, Menon G, Long JJ, Chen Y, Metoyer GT, Wu W, Crews DC, Purnell TS, Thorpe RJ, Hill CV, Szanton SL, Segev DL, McAdams-DeMarco MA. Neighborhood Racial and Ethnic Segregation and the Risk of Dementia in Older Adults Living with Kidney Failure. J Am Soc Nephrol 2024:00001751-990000000-00300. [PMID: 38671538 DOI: 10.1681/asn.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
Key Points
Regardless of race and ethnicity, older adults with kidney failure residing in or receiving care at dialysis facilities located in high-segregation neighborhoods were at a 1.63-fold and 1.53-fold higher risk of dementia diagnosis, respectively.Older adults with kidney failure residing in minority-predominant high-segregation neighborhoods had a 2.19-fold higher risk of dementia diagnosis compared with White individuals in White-predominant neighborhoods.
Background
Dementia disproportionately affects older minoritized adults with kidney failure. To better understand the mechanism of this disparity, we studied the role of racial and ethnic segregation (segregation hereafter), i.e., a form of structural racism recently identified as a mechanism in numerous other health disparities.
Methods
We identified 901,065 older adults (aged ≥55 years) with kidney failure from 2003 to 2019 using the United States Renal Data System. We quantified dementia risk across tertiles of residential neighborhood segregation score using cause-specific hazard models, adjusting for individual- and neighborhood-level factors. We included an interaction term to quantify the differential effect of segregation on dementia diagnosis by race and ethnicity.
Results
We identified 79,851 older adults with kidney failure diagnosed with dementia between 2003 and 2019 (median follow-up: 2.2 years). Compared with those in low-segregation neighborhoods, older adults with kidney failure in high-segregation neighborhoods had a 1.63-fold (95% confidence interval [CI], 1.60 to 1.66) higher risk of dementia diagnosis, an association that differed by race and ethnicity (Asian: adjusted hazard ratio [aHR] = 1.26, 95% CI, 1.15 to 1.38; Black: aHR = 1.66, 95% CI, 1.61 to 1.71; Hispanic: aHR = 2.05, 95% CI, 1.93 to 2.18; White: aHR = 1.59, 95% CI, 1.55 to 1.64; P
interaction < 0.001). Notably, older Asian (aHR = 1.76; 95% CI, 1.64 to 1.89), Black (aHR = 2.65; 95% CI, 2.54 to 2.77), Hispanic (aHR = 2.15; 95% CI, 2.04 to 2.26), and White (aHR = 2.20; 95% CI, 2.09 to 2.31) adults with kidney failure residing in minority-predominant high-segregation neighborhoods had a higher risk of dementia diagnosis compared with older White adults with kidney failure in White-predominant high-segregation neighborhoods. Moreover, older adults with kidney failure receiving care at dialysis facilities located in high-segregation neighborhoods also experienced a higher risk of dementia diagnosis (aHR = 1.53; 95% CI, 1.50 to 1.56); this association differed by race and ethnicity (P
interaction < 0.001).
Conclusions
Residing in or receiving care at dialysis facilities located in high-segregation neighborhoods was associated with a higher risk of dementia diagnosis among older individuals with kidney failure, particularly minoritized individuals.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Jane J Long
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Yusi Chen
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Garyn T Metoyer
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Wenbo Wu
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Deidra C Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanjala S Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roland J Thorpe
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carl V Hill
- Diversity, Equity, and Inclusion Officer, Alzheimer's Association, Chicago, Illinois
| | - Sarah L Szanton
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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63
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Arrington LA, Kramer B, Ogunwole SM, Harris TL, Dankwa L, Knight S, Creanga AA, Bower KM. Interrupting false narratives: applying a racial equity lens to healthcare quality data. BMJ Qual Saf 2024; 33:340-344. [PMID: 38216312 DOI: 10.1136/bmjqs-2023-016612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024]
Affiliation(s)
| | - Briana Kramer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Lois Dankwa
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Andreea A Creanga
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly M Bower
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Jewett PI, Taliaferro LA, Borowsky IW, Mathiason MA, Areba EM. Structural adverse childhood experiences associated with suicidal ideation, suicide attempts, and repetitive nonsuicidal self-injury among racially and ethnically minoritized youth. Suicide Life Threat Behav 2024. [PMID: 38651757 DOI: 10.1111/sltb.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots. METHODS Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety. RESULTS Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures. CONCLUSION Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.
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Affiliation(s)
- Patricia I Jewett
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lindsay A Taliaferro
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Eunice M Areba
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
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Arizpe A, Ochoa-Dominguez CY, Navarro S, Kim SE, Queen K, Pickering TA, Farias AJ. Racial/Ethnic Disparities: Discrimination's Impact on Health-Related Quality of Life-An All of Us Cancer Survivors' Cross-sectional Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02006-z. [PMID: 38653897 DOI: 10.1007/s40615-024-02006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Discrimination is associated with worse mental and physical health outcomes. However, the associations among cancer survivors are limited. OBJECTIVE We examined whether discrimination is associated with HRQoL and whether adjusting for it reduces racial/ethnic disparities in HRQoL among cancer survivors. METHODS Cross-sectional data from adult cancer survivors who completed surveys on discrimination in the medical settings (DMS), everyday perceived discrimination (PD), and HRQoL in the "All of Us" Program from 2018 to 2022 were assessed. We created a binary indicator for fair-to-poor vs. good-to-excellent physical health and mental health. PD and DMS scores were a continuous measure with higher scores reflecting more discrimination. Multivariable logistic regression models tested whether DMS and PD are associated with HRQoL and whether they differently affect the association between race/ethnicity and HRQoL. RESULTS The sample (N = 16,664) of cancer survivors was predominantly White (86%) and female (59%), with a median age of 69. Every 5-unit increase in DMS and PD scores was associated with greater odds of fair-to-poor physical health (DMS: OR [95%CI] = 1.66 [1.55, 1.77], PD: 1.33 [1.27, 1.40]) and mental health (DMS: 1.57 [1.47, 1.69], PD: 1.33 [1.27, 1.39]). After adjusting for DMS or PD, Black and Hispanic survivors had a decreased likelihood of fair-to-poor physical health and mental health (decrease estimate range: - 6 to - 30%) compared to White survivors. This effect was greater for Black survivors when adjusting for PD, as the odds of fair-to-poor mental health compared to White survivors were no longer statistically significant (1.78 [1.32, 2.34] vs 1.22 [0.90, 1.64]). CONCLUSION Experiences of discrimination are associated with lower HRQoL and reducing it may mitigate racial/ethnic disparities in HRQoL.
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Affiliation(s)
- Angel Arizpe
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | | | - Stephanie Navarro
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Sue E Kim
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Katelyn Queen
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Trevor A Pickering
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Albert J Farias
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
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Symanski E, Whitworth KW, Mendez-Figueroa H, Aagaard KM, Moussa I, Alvarez J, Chardon Fabian A, Kannan K, Walker CL, Coarfa C, Suter MA, Salihu HM. The Maternal and Infant Environmental Health Riskscape study of perinatal disparities in greater Houston: rationale, study design and participant profiles. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1304717. [PMID: 38712340 PMCID: PMC11070492 DOI: 10.3389/frph.2024.1304717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/01/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction The Maternal and Infant Environmental Health Riskscape (MIEHR) Center was established to address the interplay among chemical and non-chemical stressors in the biological, physical, social, and built environments that disproportionately impact perinatal health among Black pregnant people in a large and diverse urban area with documented disparities in the U.S. Methods The MIEHR cohort is recruiting non-Hispanic Black and non-Hispanic white pregnant people who deliver their infants at major obstetric hospitals in Houston, Texas. At enrollment, all participants are asked to provide urine samples for chemical [metals, cotinine, and polycyclic aromatic hydrocarbons (PAHs)] analyses and blood samples. A subset of the cohort is asked to provide oral and vaginal swabs, and fecal samples. Questionnaire and electronic health record data gather information about residential address history during pregnancy, pregnancy history and prenatal care, sociodemographic and lifestyle factors, experiences of discrimination and stress, and sources of social support. Using information on where a participant lived during their pregnancy, features of their neighborhood environment are characterized. We provide summaries of key individual- and neighborhood-level features of the entire cohort, as well as for Black and white participants separately. Results Between April 2021 and February 2023, 1,244 pregnant people were recruited. Nearly all participants provided urine samples and slightly less than half provided blood samples. PAH exposure patterns as assessed on 47% of participants thus far showed varying levels depending on metabolite as compared to previous studies. Additionally, analyses suggest differences between Black and white pregnant people in experiences of discrimination, stress, and levels of social support, as well as in neighborhood characteristics. Discussion Our findings to date highlight racial differences in experiences of discrimination, stress, and levels of support, as well as neighborhood characteristics. Recruitment of the cohort is ongoing and additional neighborhood metrics are being constructed. Biospecimens will be analyzed for metals and PAH metabolites (urine samples), miRNAs (plasma samples) and the microbiome (oral swabs). Once enrollment ends, formal assessments are planned to elucidate individual- and neighborhood-level features in the environmental riskscape that contribute to Black-White disparities in perinatal health.
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Affiliation(s)
- Elaine Symanski
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Kristina W. Whitworth
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Hector Mendez-Figueroa
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Kjersti M. Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - Iman Moussa
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Juan Alvarez
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Adrien Chardon Fabian
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | | | - Cheryl L. Walker
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX, United States
| | - Cristian Coarfa
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX, United States
| | - Melissa A. Suter
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - Hamisu M. Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
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Orakwue K, Hing AK, Chantarat T, Hersch D, Okah E, Allen M, Patten CA, Enders FT, Hardeman R, Phelan SM. The C2DREAM framework: Investigating the structural mechanisms undergirding racial health inequities. J Clin Transl Sci 2024; 8:e80. [PMID: 38745879 PMCID: PMC11091923 DOI: 10.1017/cts.2024.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/07/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Racism shapes the distribution of the social determinants of health (SDoH) along racial lines. Racism determines the environments in which people live, the quality of housing, and access to healthcare. Extensive research shows racism in its various forms negatively impacts health status, yet few studies and interventions seriously interrogate the role of racism in impacting health. The C2DREAM framework illuminates how exposure to racism, in multiple forms, connects to cardiovascular disease, hypertension, and obesity. The goal of the C2DREAM framework is to guide researchers to critically think about and measure the role of racism across its many levels of influence to better elucidate the ways it contributes to persistent health inequities. The conceptual framework highlights the interconnectedness between forms of racism, SDoH, and the lifecourse to provide a greater context to individual health outcomes. Utilizing this framework and critically contending with the effects of racism in its multiple and cumulative forms will lead to better research and interventions.
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Affiliation(s)
- Kene Orakwue
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
- Center for Antiracism Research for Health Equity, Minneapolis, MN, USA
| | - Anna K. Hing
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
- Center for Antiracism Research for Health Equity, Minneapolis, MN, USA
| | - Tongtan Chantarat
- Center for Antiracism Research for Health Equity, Minneapolis, MN, USA
| | - Derek Hersch
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ebiere Okah
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michele Allen
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
- University of Minnesota Clinical Translational Science Institute, Minneapolis, MN, USA
| | - Christi A. Patten
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Felicity T. Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
- Center for Antiracism Research for Health Equity, Minneapolis, MN, USA
| | - Sean M. Phelan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery & Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
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Berk J, Frank HE, Drainoni ML. Locked in and left out: the "prison penalty" for implementation of evidence-based interventions. Implement Sci Commun 2024; 5:36. [PMID: 38594784 PMCID: PMC11005118 DOI: 10.1186/s43058-024-00573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND While the broader medical community grapples with the widely accepted notion that it takes an average of 17 years for research evidence to be incorporated into clinical practice, the implementation of evidence-based interventions in carceral settings (i.e., jails and prisons) faces longer delays, exacerbating health disparities. MAIN BODY The "prison implementation penalty" describes the significant delay in and limited adoption of evidence-based healthcare practices in carceral settings. We explore the complex challenges of implementing evidence-based interventions in jails and prisons, environments where healthcare often plays a secondary role under security and discipline. We use specific frameworks to highlight the unique barriers within these settings and propose potential implementation strategies. These challenges have broad implications for health equity due to the disproportionate impact on the marginalized groups affected by mass incarceration. Implementation science has potential to mitigate these disparities. CONCLUSION Bridging the gap between healthcare evidence and practice in carceral settings offers a public health opportunity. Implementation science offers a unique role in improving healthcare standards and reducing health inequities in this environment.
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Affiliation(s)
- Justin Berk
- Departments of Medicine and Pediatrics, Alpert Medical School at Brown University, 245 Chapman St;, RI, Providence, 02906, USA.
| | - Hannah E Frank
- Department of Psychiatry and Human Behavior, Brown Research On Implementation and Dissemination to Guide Evidence Use (BRIDGE) Program, Division of Biology and Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Mari-Lynn Drainoni
- Department of Medicine, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Ave, Room 2014, MA, Boston, 02118, USA
- Department of Health Law Policy & Management, Boston University School of Public Health, 801 Massachusetts Ave, Room 2014, MA, Boston, 02118, USA
- Department of Medicine, Evans Center for Implementation and Improvement Sciences, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Ave, Room 2014, MA, Boston, 02118, USA
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69
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Ganguly AP, Oren H, Jack HE, Abe R. Equity M&M - Adaptation of the Morbidity and Mortality Conference to Analyze and Confront Structural Inequity in Internal Medicine. J Gen Intern Med 2024; 39:867-872. [PMID: 37904072 PMCID: PMC11043282 DOI: 10.1007/s11606-023-08487-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND At morbidity and mortality (M&M) conferences, medical teams review cases for medical education and system improvement. Adverse outcomes are often driven by social inequity, but processes to analyze such outcomes are lacking. AIM Adapt quality improvement and patient safety (QIPS) tools in the M&M format to systematically analyze adverse patient outcomes rooted in social and structural determinants of health (SSDH). SETTING One-hour conferences conducted in health systems in Seattle, WA, and Dallas, TX. PARTICIPANTS Equity M&M conferences were held 11 times, each with approximately 45 participants comprised of internal medicine trainees, faculty, and non-medical staff. PROGRAM DESCRIPTION Conferences included a case narrative and counternarrative highlighting SSDH, an equity-framed root cause analysis, and potential interventions. PROGRAM EVALUATION Conferences were received well across both institutions. Following conferences, most respondents reported increased identification of opportunities for action towards equity (88.5%) and confidence in discussing equity issues with colleagues (92.3%). DISCUSSION Equity M&M conferences are a structured tool for deconstructing and confronting structural inequity that leads to adverse patient outcomes. Evaluations demonstrate educational impact on participants. Anecdotal examples suggest institutional impact. Other health systems could adopt this model for similar advocacy and system improvement.
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Affiliation(s)
- Anisha P Ganguly
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, USA.
- Division of General Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Hannah Oren
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ryan Abe
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Rollin FG, Sonu S, Ahmad S, Beriwal S. Reflective Errors: A Call for a More Careful Use of Race in Research. Ophthalmic Epidemiol 2024; 31:188-189. [PMID: 37288807 DOI: 10.1080/09286586.2023.2222824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/14/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Francois G Rollin
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stan Sonu
- Department of Pediatrics and Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samera Ahmad
- Resident Physician, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Surabhi Beriwal
- Medical Student, Emory University School of Medicine, Atlanta, Georgia, USA
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Hazlehurst MF, Hajat A, Szpiro AA, Tandon PS, Kaufman JD, Loftus CT, Bush NR, LeWinn KZ, Hare ME, Sathyanarayana S, Karr CJ. Individual and Neighborhood Level Predictors of Children's Exposure to Residential Greenspace. J Urban Health 2024; 101:349-363. [PMID: 38485845 PMCID: PMC11052952 DOI: 10.1007/s11524-024-00829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 04/28/2024]
Abstract
Inequities in urban greenspace have been identified, though patterns by race and socioeconomic status vary across US settings. We estimated the magnitude of the relationship between a broad mixture of neighborhood-level factors and residential greenspace using weighted quantile sum (WQS) regression, and compared predictive models of greenspace using only neighborhood-level, only individual-level, or multi-level predictors. Greenspace measures included the Normalized Difference Vegetation Index (NDVI), tree canopy, and proximity of the nearest park, for residential locations in Shelby County, Tennessee of children in the CANDLE cohort. Neighborhood measures include socioeconomic and education resources, as well as racial composition and racial residential segregation. In this sample of 1012 mother-child dyads, neighborhood factors were associated with higher NDVI and tree canopy (0.021 unit higher NDVI [95% CI: 0.014, 0.028] per quintile increase in WQS index); homeownership rate, proximity of and enrollment at early childhood education centers, and racial composition, were highly weighted in the WQS index. In models constrained in the opposite direction (0.028 unit lower NDVI [95% CI: - 0.036, - 0.020]), high school graduation rate and teacher experience were highly weighted. In prediction models, adding individual-level predictors to the suite of neighborhood characteristics did not meaningfully improve prediction accuracy for greenspace measures. Our findings highlight disparities in greenspace for families by neighborhood socioeconomic and early education factors, and by race, suggesting several neighborhood indicators for consideration both as potential confounders in studies of greenspace and pediatric health as well as in the development of policies and programs to improve equity in greenspace access.
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Affiliation(s)
- Marnie F Hazlehurst
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA.
| | - Anjum Hajat
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Pooja S Tandon
- Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Nicole R Bush
- Department of Pediatrics, School of Medicine, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sheela Sathyanarayana
- Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Catherine J Karr
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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Rattani A, Mian Z, Farahani S, Ridge M, Uzamere T, Bajwa M. A systematic review of barriers to pursuing careers in medicine among Black premedical students. J Natl Med Assoc 2024; 116:95-118. [PMID: 38267334 DOI: 10.1016/j.jnma.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 01/26/2024]
Abstract
Among the various etiologies of the exclusion of Black male physicians from the healthcare workforce, it is critical to identify and examine the barriers in their trajectory. Given that most medical school matriculants graduate and pursue residency training, medical school admission has been identified as the primary impediment to a career in medicine. Thus, this work aims to identify barriers in the journey of primarily Black, and secondarily underrepresented minority, premedical students. A systematic review of the medical literature was conducted for articles pertaining to the undergraduate/premedical period, Black experiences, and the medical school application process. The search yielded 5336 results, and 13 articles were included. Most papers corroborated common barriers, such as financial/socioeconomic burdens, lack of access to preparatory materials and academic enrichment programs, lack of exposure to the medical field, poor mentorship/advising experiences, systemic and interpersonal racism, and limited support systems. Common facilitators of interest and interventions included increasing academic enrichment programs, improving mentorship and career guidance quality and availability, and improving access to and availability of resources as well as exposure opportunities. No article explicitly discussed addressing racism. There is a dearth of studies exploring the premedical stage-the penultimate point of entry into medicine. Though interest in becoming a physician may be present, multiple and disparate impediments restrict Black men's participation in medicine. Addressing the barriers Black and underrepresented minority premedical students face requires an awareness of how multiple systems work together to discriminate and restrict access to careers in medicine beyond the traditional pipeline understanding.
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Affiliation(s)
- Abbas Rattani
- Department of Radiation Oncology, Tufts Medical Center, 800 Washington St., Boston, MA 02111, United States of America.
| | - Zoha Mian
- University of Louisville School of Medicine, A Building, Suite 110, 500 S. Preston Street, Louisville, KY 40204, United States of America
| | | | - Margaret Ridge
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, OH, 45229, United States of America
| | - Theodore Uzamere
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Suite W6104, Houston, TX, 77030, United States of America
| | - Moazzum Bajwa
- Department of Family Medicine at the University of California Riverside, 900 University Avenue Riverside, CA, 92521, United States of America
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Li Y, Menon G, Kim B, Bae S, Quint EE, Clark-Cutaia MN, Wu W, Thompson VL, Crews DC, Purnell TS, Thorpe RJ, Szanton SL, Segev DL, McAdams DeMarco MA. Neighborhood Segregation and Access to Live Donor Kidney Transplantation. JAMA Intern Med 2024; 184:402-413. [PMID: 38372985 PMCID: PMC10877505 DOI: 10.1001/jamainternmed.2023.8184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/10/2023] [Indexed: 02/20/2024]
Abstract
Importance Identifying the mechanisms of structural racism, such as racial and ethnic segregation, is a crucial first step in addressing the persistent disparities in access to live donor kidney transplantation (LDKT). Objective To assess whether segregation at the candidate's residential neighborhood and transplant center neighborhood is associated with access to LDKT. Design, Setting, and Participants In this cohort study spanning January 1995 to December 2021, participants included non-Hispanic Black or White adult candidates for first-time LDKT reported in the US national transplant registry. The median (IQR) follow-up time for each participant was 1.9 (0.6-3.0) years. Main Outcome and Measures Segregation, measured using the Theil H method to calculate segregation tertiles in zip code tabulation areas based on the American Community Survey 5-year estimates, reflects the heterogeneity in neighborhood racial and ethnic composition. To quantify the likelihood of LDKT by neighborhood segregation, cause-specific hazard models were adjusted for individual-level and neighborhood-level factors and included an interaction between segregation tertiles and race. Results Among 162 587 candidates for kidney transplant, the mean (SD) age was 51.6 (13.2) years, 65 141 (40.1%) were female, 80 023 (49.2%) were Black, and 82 564 (50.8%) were White. Among Black candidates, living in a high-segregation neighborhood was associated with 10% (adjusted hazard ratio [AHR], 0.90 [95% CI, 0.84-0.97]) lower access to LDKT relative to residence in low-segregation neighborhoods; no such association was observed among White candidates (P for interaction = .01). Both Black candidates (AHR, 0.94 [95% CI, 0.89-1.00]) and White candidates (AHR, 0.92 [95% CI, 0.88-0.97]) listed at transplant centers in high-segregation neighborhoods had lower access to LDKT relative to their counterparts listed at centers in low-segregation neighborhoods (P for interaction = .64). Within high-segregation transplant center neighborhoods, candidates listed at predominantly minority neighborhoods had 17% lower access to LDKT relative to candidates listed at predominantly White neighborhoods (AHR, 0.83 [95% CI, 0.75-0.92]). Black candidates residing in or listed at transplant centers in predominantly minority neighborhoods had significantly lower likelihood of LDKT relative to White candidates residing in or listed at transplant centers located in predominantly White neighborhoods (65% and 64%, respectively). Conclusions Segregated residential and transplant center neighborhoods likely serve as a mechanism of structural racism, contributing to persistent racial disparities in access to LDKT. To promote equitable access, studies should assess targeted interventions (eg, community outreach clinics) to improve support for potential candidates and donors and ultimately mitigate the effects of segregation.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Sunjae Bae
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Maya N Clark-Cutaia
- New York University Rory Meyers College of Nursing, New York, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Wenbo Wu
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Valerie L Thompson
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanjala S Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Roland J Thorpe
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Mara A McAdams DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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Guglielminotti J, LEE A, LANDAU R, SAMARI G, LI G. Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People. Obstet Gynecol 2024; 143:571-581. [PMID: 38301254 PMCID: PMC10957331 DOI: 10.1097/aog.0000000000005519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To assess the association between structural racism and labor neuraxial analgesia use. METHODS This cross-sectional study analyzed 2017 U.S. natality data for non-Hispanic Black and White birthing people. The exposure was a multidimensional structural racism index measured in the county of the delivery hospital. It was calculated as the mean of three Black-White inequity ratios (ratios for lower education, unemployment, and incarceration in jails) and categorized into terciles, with the third tercile corresponding to high structural racism. The outcome was the labor neuraxial analgesia rate. Adjusted odds ratios and 95% CIs of neuraxial analgesia associated with terciles of the index were estimated with multivariate logistic regression models. Black and White people were compared with the use of an interaction term between race and ethnicity and the racism index. RESULTS Of the 1,740,716 birth certificates analyzed, 396,303 (22.8%) were for Black people. The labor neuraxial analgesia rate was 77.2% for Black people in the first tercile of the racism index, 74.7% in the second tercile, and 72.4% in the third tercile. For White people, the rates were 80.4%, 78.2%, and 78.2%, respectively. For Black people, compared with the first tercile of the racism index, the second tercile was associated with 18.4% (95% CI, 16.9-19.9%) decreased adjusted odds of receiving neuraxial analgesia and the third tercile with 28.3% (95% CI, 26.9-29.6%) decreased adjusted odds. For White people, the decreases were 13.4% (95% CI, 12.5-14.4%) in the second tercile and 15.6% (95% CI, 14.7-16.5%) in the third tercile. A significant difference in the odds of neuraxial analgesia was observed between Black and White people for the second and third terciles. CONCLUSION A multidimensional index of structural racism is associated with significantly reduced odds of receiving labor neuraxial analgesia among Black people and, to a lesser extent, White people.
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Affiliation(s)
- Jean Guglielminotti
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
| | - Allison LEE
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
| | - Ruth LANDAU
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
| | - Goleen SAMARI
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, 1845 North Soto Street, Los Angeles, CA 90033, USA
| | - Guohua LI
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
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Adekunle TB, Ringel JV, Williams MS, Faherty LJ. Continuity of Trust: Health Systems' Role in Advancing Health Equity Beyond the COVID-19 Pandemic. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:323-329. [PMID: 37400357 PMCID: PMC10333557 DOI: 10.1177/2752535x231185221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Given COVID-19's disproportionate impact on populations that identify as Black, Indigenous, and People of Color (BIPOC) in the United States, researchers and advocates have recommended that health systems and institutions deepen their engagement with community-based organizations (CBOs) with longstanding relationships with these communities. However, even as CBOs leverage their earned trust to promote COVID-19 vaccination, health systems and institutions must also address underlying causes of health inequities more broadly. In this commentary, we discuss key lessons learned about trust from our participation in the U.S. Equity-First Vaccination Initiative, an effort funded by The Rockefeller Foundation to promote COVID-19 vaccination equity. The first lesson is that trust cannot be "surged" to meet the needs of the moment until it is no longer deemed important; rather, it must predate and outlast the crisis. Second, to generate long-term change, health systems cannot simply rely on CBOs to bridge the trust gap; instead, they must directly address the root causes of this gap among BIPOC populations.
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Affiliation(s)
| | | | | | - Laura J. Faherty
- RAND Corporation, Boston, MA, USA
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
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76
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Blebu B, Jackson A, Reina A, Dossett EC, Saleeby E. Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness. Health Aff (Millwood) 2024; 43:532-539. [PMID: 38560805 DOI: 10.1377/hlthaff.2023.01456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30 percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.
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Affiliation(s)
- Bridgette Blebu
- Bridgette Blebu , Harbor-UCLA Medical Center, Torrance, California
| | - Ashaki Jackson
- Ashaki Jackson, Los Angeles County Department of Health Services, Torrance, California
| | - Astrid Reina
- Astrid Reina, University of California Los Angeles, Los Angeles, California
| | - Emily C Dossett
- Emily C. Dossett, University of Southern California, Los Angeles, California
| | - Erin Saleeby
- Erin Saleeby, Los Angeles County Department of Health Services
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77
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Ashad-Bishop KC, Balogun OD, Chidebe RCW, Cook LM, Towers C. Black voices in cancer research and oncology. Nat Rev Cancer 2024; 24:235-239. [PMID: 38374427 DOI: 10.1038/s41568-023-00662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/21/2024]
Affiliation(s)
| | - Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA.
| | - Runcie C W Chidebe
- Project PINK BLUE - Health & Psychological Trust Centre, Abuja, Nigeria.
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.
| | - Leah M Cook
- University of Nebraska Medical Center and Fred & Pamela Buffett Cancer Center, Omaha, NE, USA.
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Goel N, Hernandez AE, Mazul A. Neighborhood Disadvantage and Breast Cancer-Specific Survival in the US. JAMA Netw Open 2024; 7:e247336. [PMID: 38635268 DOI: 10.1001/jamanetworkopen.2024.7336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Importance Despite improvements in breast cancer screening, treatment, and survival, disparate breast cancer-specific survival outcomes persist, particularly in disadvantaged neighborhoods. Most of these disparities are attributed to disparities in individual, tumor, and treatment characteristics. However, a critical knowledge gap exists as to whether disparities in breast cancer-specific survival remain after accounting for individual, tumor, and treatment characteristics. Objective To evaluate if neighborhood disadvantage is associated with shorter breast cancer-specific survival after controlling for individual, tumor, and treatment characteristics in a national population. Design, Setting, and Participants This national retrospective cohort study included patients with breast cancer diagnosed from 2013 to 2018 from the Surveillance, Epidemiology, and End Results 17 Census tract-level socioeconomic status and rurality database of the National Cancer Institute. Data analysis was performed from September 2022 to December 2023. Exposures Neighborhood disadvantage measured by Yost index quintiles. Main Outcomes and Measures Breast cancer-specific survival was evaluated using a competing risks cause-specific hazard model controlling for age, race, ethnicity, rurality, stage, subtype, insurance, and receipt of treatment. Results A total of 350 824 patients with breast cancer were included; 41 519 (11.8%) were Hispanic, 39 631 (11.3%) were non-Hispanic Black, and 234 698 (66.9%) were non-Hispanic White. A total of 87 635 patients (25.0%) lived in the most advantaged neighborhoods (group 5) and 52 439 (14.9%) lived in the most disadvantaged neighborhoods (group 1). A larger number of non-Hispanic White patients (66 529 patients [76.2%]) lived in advantaged neighborhoods, while disadvantaged neighborhoods had the highest proportion of non-Hispanic Black (16 141 patients [30.9%]) and Hispanic patients (10 168 patients [19.5%]). Breast cancer-specific survival analysis found the most disadvantaged neighborhoods (group 1) had the highest risk of mortality (hazard ratio, 1.43; 95% CI, 1.36-1.50; P < .001) compared with the most advantaged neighborhoods. Conclusions and Relevance In this national cohort study of patients with breast cancer, neighborhood disadvantage was independently associated with shorter breast cancer-specific survival even after controlling for individual-level factors, tumor characteristics, and treatment. This suggests potential unaccounted-for mechanisms, including both nonbiologic factors and biologic factors.
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Affiliation(s)
- Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Alexandra E Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Angela Mazul
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Washington University School of Medicine, St Louis, Missouri
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Okah E, Jetty A, Jabbarpour Y, Sloane P. Duration of Residence and Hypertension in Black Foreign-Born Residents: NHIS, 2004-2017. J Racial Ethn Health Disparities 2024; 11:591-597. [PMID: 36853405 DOI: 10.1007/s40615-023-01543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Black Americans have the highest prevalence of hypertension in the USA. Black immigrants, who, by definition, have time-limited exposure to the USA, may provide insight into the relationship between exposure to the US environment, Black race, and hypertension. METHODS This is a cross-sectional analysis of pooled National Health Interview Survey (2004-2017) data of foreign-born White European and Black adults (N = 11,516). Multivariable robust Poisson regressions assessed the relationship between self-reported hypertension and duration of the residency (< 5, 5-9, 10-14, ≥ 15 years) among Black, Black African, Black Caribbean, and White European foreign-born residents. RESULTS In multivariable analyses-controlling for age, sex, education, poverty-to-income ratio, insurance status, recent encounter with a clinician, and BMI-Black foreign-born residents (PR = 1.40, 95% CI = 1.03, 1.90) and Black Africans (10-14 years.: PR = 1.70, 95% CI = 1.13, 2.56; ≥ 15 years.: PR = 1.56, 95% CI = 1.04, 2.34) with a duration of residency of at least 15 and 10 years, respectively, had a greater prevalence of hypertension than those with duration less than 5 years. A nonsignificant positive association between a duration of residency of at least 15 years (compared to less than 5 years) and self-reported hypertension was observed for White Europeans (PR 1.49, 95% CI = 0.88, 2.51) and Black Caribbeans (PR = 1.09, 95% CI = 0.69, 1.72). CONCLUSION Duration of residency is particularly associated with hypertension among Black Africans after migration to the USA. This discrepancy may be explained by differences in primary care utilization and awareness of hypertension diagnoses among recent African immigrants, along with greater stress associated with living in the USA.
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Affiliation(s)
- Ebiere Okah
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Minneapolis, MN, 55414, USA.
| | - Anuradha Jetty
- The Robert Graham Center, 1133 Connecticut Avenue NW, Washington, DC, 20036, USA
| | - Yalda Jabbarpour
- The Robert Graham Center, 1133 Connecticut Avenue NW, Washington, DC, 20036, USA
| | - Philip Sloane
- Department of Family Medicine, University of North Carolina School of Medicine, 590 Manning Dr, Chapel Hill, NC, 27514, USA
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Rokicki S, McConnell M. Racial and Socioeconomic Disparities in Preconception Health Risk Factors and Access to Care. J Womens Health (Larchmt) 2024. [PMID: 38563909 DOI: 10.1089/jwh.2023.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: Black birthing people have significantly higher risks of maternal mortality and morbidity compared with White people. Preconception chronic conditions increase the risk of adverse pregnancy outcomes, yet little is known about disparities in preconception health. This study applies an intersectional framework to examine the simultaneous contributions of racial marginalization and economic deprivation in determining disparities in preconception risk factors and access to care. Methods: Using data from the Pregnancy Risk Assessment Monitoring System, 2016-2020 (N = 123,697), we evaluated disparities by race and income in self-reported preconception hypertension, diabetes, obesity, depression, and smoking, as well as preconception insurance coverage and utilization of health care. We estimated linear regression models and calculated predicted probabilities. Results: Black respondents experienced higher probabilities of preconception obesity and high blood pressure at every income level compared with White respondents. Higher income did not attenuate the probability of obesity for Black respondents (linear trend p = 0.21), as it did for White respondents (p < 0.001). Conversely, while White respondents with low income were at higher risk of preconception depression and smoking than their Black counterparts, higher income was strongly associated with reduced risk, with significantly steeper reductions for White compared with Black respondents (difference in trends p < 0.001 for both risk factors). White respondents had higher probabilities of utilizing preconception care across all income levels, despite similar probabilities of insurance coverage. Conclusions: Higher income does not protect against the risk of preconception obesity and other preconception risk factors for Black birthing people as it does for White birthing people. Results point to the need to consider multiple forms of intersecting structural factors in policy and intervention research to improve preconception and maternal health.
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Affiliation(s)
- Slawa Rokicki
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret McConnell
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Aikins M, Willems Y, Mitchell C, Goosby B, Raffington L. Linked emergence of racial disparities in mental health and epigenetic biological aging across childhood and adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.26.586786. [PMID: 38586008 PMCID: PMC10996608 DOI: 10.1101/2024.03.26.586786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Marginalization due to structural racism may confer an increased risk for aging-related diseases - in part - via effects on people's mental health. Here we leverage a prospective birth cohort study to examine whether the emergence of racial disparities in mental health and DNA-methylation measures of biological aging (i.e., DunedinPACE, GrimAge Acceleration, PhenoAge Acceleration) are linked across childhood and adolescence. We further consider to what extent racial disparities are statistically accounted for by perinatal and postnatal factors in preregistered analyses of N=4,898 participants from the Future of Families & Child Wellbeing Study, of which N=2,039 had repeated saliva DNA methylation at ages 9 and 15 years. We find that racially marginalized children had higher levels of externalizing and internalizing behaviors and diverging longitudinal internalizing slopes. Black compared to White identifying children, children living in more racially segregated neighborhoods, and racially marginalized children more affected by colorism tended to have higher age-9 levels of biological aging and more biological age acceleration over adolescence. Notably, longitudinal increases in internalizing and externalizing behavior were correlated with longitudinal increases in biological aging. While racial and ethnic disparities in mental health were largely statistically accounted for by socioeconomic variables, racial differences in biological aging were often still visible beyond covariate controls. Our findings indicate that racial disparities in mental health and biological aging are linked and emerge early in life. Programs promoting racial health equity must address the psychological and physical impacts of structural racism in children. Comprehensive measures of racism are lacking in current population cohorts.
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Affiliation(s)
- Muna Aikins
- Max Planck Research Group Biosocial – Biology, Social Disparities, and Development; Max Planck Institute for Human Development; Berlin, Germany
| | - Yayouk Willems
- Max Planck Research Group Biosocial – Biology, Social Disparities, and Development; Max Planck Institute for Human Development; Berlin, Germany
| | - Colter Mitchell
- Survey Research Center of the Institute for Social Research; University of Michigan, Ann Arbor, MI, USA
- Population Studies Center of the Institute for Social Research; University of Michigan, Ann Arbor, MI, USA
| | - Bridget Goosby
- Population Research Center; University of Texas at Austin, Austin, TX, USA
| | - Laurel Raffington
- Max Planck Research Group Biosocial – Biology, Social Disparities, and Development; Max Planck Institute for Human Development; Berlin, Germany
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82
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Henry CM, Oseran AS, Zheng Z, Dong H, Wadhera RK. Cardiovascular hospitalizations and mortality among adults aged 25-64 years in the USA. Eur Heart J 2024; 45:1017-1026. [PMID: 37952173 PMCID: PMC10972685 DOI: 10.1093/eurheartj/ehad772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND AIMS Declines in cardiovascular mortality have stagnated in the USA since 2011. There is growing concern that these patterns reflect worsening cardiovascular health in younger adults. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality has changed in this population. Changes in cardiovascular hospitalizations and mortality among adults aged 25-64 years were evaluated, overall and by community-level income. METHODS Using the National Inpatient Sample, age-standardized annual hospitalization and in-hospital mortality rates for acute myocardial infarction (AMI), heart failure, and ischaemic stroke were determined among adults aged 25-64 years. Quasi-Poisson and quasi-binominal regression models were fitted to compare outcomes between individuals residing in low- and higher-income communities. RESULTS Between 2008 and 2019, age-standardized hospitalization rates for AMI increased among younger adults from 155.0 (95% confidence interval: 154.6, 155.4) per 100 000 to 160.7 (160.3, 161.1) per 100 000 (absolute change +5.7 [5.0, 6.3], P < .001). Heart failure hospitalizations also increased (165.3 [164.8, 165.7] to 225.3 [224.8, 225.8], absolute change +60.0 (59.3, 60.6), P < .001), as ischaemic stroke hospitalizations (76.3 [76.1, 76.7] to 108.1 [107.8, 108.5], absolute change +31.7 (31.2, 32.2), P < .001). Across all conditions, hospitalizations rates were significantly higher among younger adults residing in low-income compared with higher-income communities, and disparities did not narrow between groups. In-hospital mortality decreased for all conditions over the study period. CONCLUSIONS There was an alarming increase in cardiovascular hospitalizations among younger adults in the USA from 2008 to 2019, and disparities between those residing in low- and higher-income communities did not narrow.
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Affiliation(s)
- Chantal M Henry
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Meharry Medical College, Nashville,
TN, USA
| | - Andrew S Oseran
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Huaying Dong
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
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83
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Perino MT, Sylvester CM, Rogers CE, Luby JL, Barch DM. Neighborhood Resource Deprivation as a Predictor of Bullying Perpetration and Resource-Driven Conduct Symptoms. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00137-0. [PMID: 38522614 DOI: 10.1016/j.jaac.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/11/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Resource deprivation is linked to systemic factors that disproportionately impact historically marginalized communities, and theoretical work suggests that resource deprivation may increase risk for bullying behaviors. Bullying perpetration is an intransigent social problem and an early risk factor that perpetuates the school-to-prison pipeline. This study explored how resource deprivation (family- and neighborhood-level metrics) was associated with early childhood bullying behaviors and clinician-rated symptoms of psychopathology, while accounting for other known risk factors (early life stressors, traumatic events, parental arrest, domestic violence). METHOD Participants (306 children, mean age = 4.45 years) were enrolled in a longitudinal study (Preschool Depression Study) where demographics, clinician-rated assessments of psychopathology, and parent reports of social functioning were collected. Measures of bullying behaviors (bullying perpetration, generalized aggression, and victimization) were constructed. A cross-sectional approach was employed, and analyses examined the interrelations between race, bullying-related behaviors, resource deprivation, and psychopathology, while accounting for confounding variables, at the baseline assessment time point. RESULTS The bullying measure showed acceptable model fit (comparative fit index = 0.956, Tucker-Lewis index = 0.945, root mean square error of approximation = 0.061, standardized root mean residual = 0.052, normed χ2 ratio = 2). Neighborhood resource deprivation was more strongly associated with bullying perpetration (r = 0.324, p < .001) than generalized aggression (r = 0.236, Williams t303 = 2.11, p = .036) and remained significant when controlling for other known risk factors (parental arrests, domestic violence, stressors, traumas) and demographic factors. Bullying perpetration was linked with racial category, but the relation was fully mediated by neighborhood resource deprivation. Linear regression including bullying behaviors and symptoms of clinical psychopathology suggested that resource deprivation specifically led to increases in bullying perpetration (t = 2.831, p = .005) and clinician-rated symptoms of conduct disorder (t = 2.827, p = .005), which were attributable to increased rates of resource-driven conduct symptoms (bullies, lies to obtain goods, stolen without confrontation). CONCLUSION Resource deprivation is strongly and specifically associated with increases in bullying perpetration. Children growing up in impoverished neighborhoods show significant increases in resource-driven conduct behaviors, yet interventions often target individual-level factors. These results highlight the need to target social inequity to reduce bullying perpetration and suggest that interventions targeting neighborhoods should be tested to reduce bullying in early childhood. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper received support from a program designed to increase minority representation in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
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Affiliation(s)
- Michael T Perino
- Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| | - Chad M Sylvester
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Cynthia E Rogers
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine in St. Louis, St. Louis, Missouri; Washington University in St. Louis, St. Louis, Missouri
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84
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Creary MS, Peoples W, Fleming PJ. Health Equity Requires Working Toward Antiracist Local Public Health Departments. Public Health Rep 2024:333549241237382. [PMID: 38519864 DOI: 10.1177/00333549241237382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Affiliation(s)
- Melissa S Creary
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Whitney Peoples
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Paul J Fleming
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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85
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Rockhold MN, Gimbel BA, Richardson AA, Kautz-Turnbull C, Speybroeck EL, de Water E, Myers J, Hargrove E, May M, Abdi SS, Petrenko CLM. Racial and ethnic disparities in psychological care for individuals with FASD: a dis/ability studies and critical race theory perspective toward improving prevention, assessment/diagnosis, and intervention. Front Public Health 2024; 12:1355802. [PMID: 38544727 PMCID: PMC10965703 DOI: 10.3389/fpubh.2024.1355802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 05/14/2024] Open
Abstract
Fetal alcohol spectrum disorders (FASD) are among the most common neurodevelopmental disorders and substantially impact public health. FASD can affect people of all races and ethnicities; however, there are important racial and ethnic disparities in alcohol-exposed pregnancy prevention, assessment and diagnosis of FASD, and interventions to support individuals with FASD and their families. In this article we use the Dis/Ability Studies and Critical Race Theory (Dis/Crit) framework to structure the exploration of disparities and possible solutions within these three areas (prevention, diagnosis, intervention). Dis/Crit provides a guide to understanding the intersection of dis/ability and race, while framing both as social constructs. Following the Dis/Crit framework, the systemic, historical, and contemporary racism and ableism present in psychological care is further discussed. We aim to elucidate these racial and ethnic disparities within the fields of psychology and neuropsychology through the Dis/Crit framework and provide potential points of action to reduce these disparities.
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Affiliation(s)
| | - Blake A. Gimbel
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | | | | | - Emily L. Speybroeck
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | - Julianne Myers
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Emily Hargrove
- International Adult Leadership Collaborative of FASD Changemakers
| | - Maggie May
- International Adult Leadership Collaborative of FASD Changemakers
| | - Samia S. Abdi
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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86
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Vereen RJ, Wolf MF. Physician Workforce Diversity Is Still Necessary and Achievable if It Is Intentionally Prioritized. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01953-x. [PMID: 38466513 DOI: 10.1007/s40615-024-01953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024]
Abstract
The 2023 Supreme Court Decision from Students for Fair Admissions v. Harvard and Students for Fair Admissions v. University of North Carolina threatens the current progress in achieving diversity within undergraduate and graduate medical education. This is necessary to achieve a diverse healthcare workforce, which is a key to healing historical healthcare trauma, eliminating health disparities, and providing equitable healthcare access for all communities. Although the Supreme Court decision seems obstructionist, viable opportunities exist to enhance recruitment further and solidify diversity efforts in undergraduate and graduate medical education to achieve these goals.
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Affiliation(s)
- Rasheda J Vereen
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University, Carl R. Darnall Army Medical Center, Fort Cavazos, TX, USA.
| | - Mattie F Wolf
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, GA, USA
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87
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Satcher LA, Erving CL, Pitt RN. Are There Regional Differences in Mental Health among Black Americans? An Exploration of Explanatory Mechanisms. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01969-3. [PMID: 38468118 DOI: 10.1007/s40615-024-01969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/13/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
Using data from the National Survey of American Life (NSAL) (2001-2003), we examine regional differences in past-year anxiety disorder and past-year major depressive episodes among a geographically diverse sample of Black Americans (N = 3,672). We find that Black Americans residing in the South experience a mental health advantage over Black Americans living in other parts of the country, experiencing lower rates of both anxiety disorder and past-year major depression. We also examine the extent to which stress exposure, religious involvement, and neighborhood contexts help explain any regional differences. We find that stress exposure helps to explain much of the differences observed across regions, while religious involvement and neighborhood contexts help explain observed regional differences to a lesser extent. These findings highlight the importance of considering regional contexts in understanding intra-racial differences in mental health.
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Affiliation(s)
- Lacee A Satcher
- Boston College, 140 Commonwealth Avenue, McGuinn Hall 420, 02467, Chestnut Hill, MA, USA.
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88
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Linde S, Egede LE. Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes. HEALTH ECONOMICS REVIEW 2024; 14:18. [PMID: 38446368 PMCID: PMC10916057 DOI: 10.1186/s13561-024-00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Chargemaster prices are the list prices that providers and health systems assign to each of their medical services in the US. These charges are often several factors of magnitude higher than those extended to individuals with either private or public insurance, however, these list prices are billed in full to uninsured patients, putting them at increased risk of catastrophic health expenditures (CHE). The objective of this study was to examine the risk of CHE across insurance status, diabetes diagnosis and to examine disparity gaps across race/ethnicity. METHODS We perform a retrospective observational study on a nationally representative cohort of adult patients from the Medical Expenditure Panel Survey for the years 2002-2017. Using logistic regression models we estimate the risk of CHE across insurance status, diabetes diagnosis and explore disparity gaps across race/ethnicity. RESULTS Our fully adjusted results show that the relative odds of having CHE if uninsured is 5.9 (p < 0.01) compared to if insured, and 1.1 (p < 0.01) for patients with a diabetes diagnosis (compared to those without one). We note significant interactions between insurance status and diabetes diagnosis, with uninsured patients with a diabetes diagnosis being 9.5 times (p < 0.01) more likely to experience CHE than insured patients without a diabetes diagnosis. In terms of racial/ethnic disparities, we find that among the uninsured, non-Hispanic blacks are 13% (p < 0.05), and Hispanics 14.2% (p < 0.05), more likely to experience CHE than non-Hispanic whites. Among uninsured patients with diabetes, we further find that Hispanic patients are 39.3% (p < 0.05) more likely to have CHE than non-Hispanic white patients. CONCLUSIONS Our findings indicate that uninsured patients with diabetes are at significantly elevated risks for CHE. These risks are further found to be disproportionately higher among uninsured racial/ethnic minorities, suggesting that CHE may present a channel through which structural economic and health disparities are perpetuated.
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Affiliation(s)
- Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, 212 Adriance Lab Rd, College Station, Texas, TX, 77843, USA.
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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89
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Hansen EE, Chiem JL, Low DK, Rampersad SE, Martin LD. Enhancing Outcomes in Clinical Practice: Lessons Learned in the Quality Improvement Trenches. Anesth Analg 2024:00000539-990000000-00776. [PMID: 38446706 DOI: 10.1213/ane.0000000000006713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Elizabeth E Hansen
- From the Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Jennifer L Chiem
- From the Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Daniel K Low
- From the Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Sally E Rampersad
- From the Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Lynn D Martin
- From the Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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90
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Futterman J, Bi C, Crow B, Kureshi S, Okah E. Medical educators' perception of race in clinical practice. BMC MEDICAL EDUCATION 2024; 24:230. [PMID: 38439004 PMCID: PMC10913645 DOI: 10.1186/s12909-024-05232-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND While several medical societies endorse race as a social construct, it is still often used as a biological trait in medical education. How medical educators employ race while teaching is likely impacted by their beliefs as to what race represents and its relevance in clinical care. Understanding these beliefs is necessary to guide medical education curriculum reform. METHODS This was a qualitative survey study, conducted in June 2020, of Georgetown University Medical Center faculty. As part of the survey, faculty were asked to rate, on a 5-point Likert scale, the extent to which they perceived race as a biological trait and its importance in clinical care. Self-identified clinical or preclinical faculty (N = 147) who believed that race had any importance were asked to provide an example illustrating its significance. Free-text responses were coded using content analysis with an inductive approach and contextualized by faculty's perspectives on the biological significance of race. RESULTS There were 130 (88%) responses categorized into two major themes: race is important for [1] screening, diagnosing, and treating diseases and [2] contextualizing patients' experiences and health behaviors. Compared to faculty who perceived race as biological, those who viewed race as strictly social were more likely to report using race to understand or acknowledge patients' exposure to racism. However, even among these faculty, explanations that suggested biological differences between racial groups were prevalent. CONCLUSIONS Medical educators use race primarily to understand diseases and frequently described biological differences between racial groups. Efforts to reframe race as sociopolitical may require education that examines race through a global lens, accounting for the genetic and cultural variability that occurs within racial groups; greater awareness of the association between structural racism and health inequities; movement away from identity-based risk stratification; and incorporation of tools that appraise race-based medical literature.
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Affiliation(s)
| | | | - Brendan Crow
- Mountain Area Health Education Center, Asheville, NC, USA
| | - Sarah Kureshi
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ebiere Okah
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
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Binda DD, Kraus A, Gariépy-Assal L, Tang B, Wade CG, Olveczky DD, Molina RL. Anti-racism curricula in undergraduate medical education: A scoping review. MEDICAL TEACHER 2024:1-11. [PMID: 38431914 DOI: 10.1080/0142159x.2024.2322136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Medical educators have increasingly focused on the systemic effects of racism on health inequities in the United States (U.S.) and globally. There is a call for educators to teach students how to actively promote an anti-racist culture in healthcare. This scoping review assesses the existing undergraduate medical education (UME) literature of anti-racism curricula, implementation, and assessment. METHODS The Ovid, Embase, ERIC, Web of Science, and MedEdPORTAL databases were queried on 7 April 2023. Keywords included anti-racism, medical education, and assessment. Inclusion criteria consisted of any UME anti-racism publication. Non-English articles with no UME anti-racism curriculum were excluded. Two independent reviewers screened the abstracts, followed by full-text appraisal. Data was extracted using a predetermined framework based on Kirkpatrick's educational outcomes model, Miller's pyramid for assessing clinical competence, and Sotto-Santiago's theoretical framework for anti-racism curricula. Study characteristics and anti-racism curriculum components (instructional design, assessment, outcomes) were collected and synthesized. RESULTS In total, 1064 articles were screened. Of these, 20 met the inclusion criteria, with 90% (n = 18) published in the past five years. Learners ranged from first-year to fourth-year medical students. Study designs included pre- and post-test evaluations (n = 10; 50%), post-test evaluations only (n = 7; 35%), and qualitative assessments (n = 3; 15%). Educational interventions included lectures (n = 10, 50%), multimedia (n = 6, 30%), small-group case discussions (n = 15, 75%), large-group discussions (n = 5, 25%), and reflections (n = 5, 25%). Evaluation tools for these curricula included surveys (n = 18; 90%), focus groups (n = 4; 20%), and direct observations (n = 1; 5%). CONCLUSIONS Our scoping review highlights the growing attention to anti-racism in UME curricula. We identified a gap in published assessments of behavior change in applying knowledge and skills to anti-racist action in UME training. We also provide considerations for developing UME anti-racism curricula. These include explicitly naming and defining anti-racism as well as incorporating longitudinal learning opportunities and assessments.
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Affiliation(s)
- Dhanesh D Binda
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alexandria Kraus
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Laurence Gariépy-Assal
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Université de Montreal, Montréal, QC, Canada
| | - Brandon Tang
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Carrie G Wade
- Countway Library of Medicine, Harvard Medical School, Boston, MA, USA
| | - Daniele D Olveczky
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Division of Global and Community Health, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Dillon FR, Ertl MM, Eklund AC, Westbrook J, Balek G, Algarin A, Martin J, Sánchez FJ, Ebersole R. Sexual Identity Development and Social Ecological Facilitators and Barriers of PrEP Uptake and Adherence Among Latinx Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1197-1211. [PMID: 38212437 DOI: 10.1007/s10508-023-02776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
Latinx gay, bisexual, and other men who have sex with men (LMSM) report lower pre-exposure prophylaxis (PrEP) use than their white, non-Latinx counterparts. We hypothesize that this disparity is partially attributable to social ecological factors that can be addressed via prevention interventions. In this retrospective study, we first examined data from 253 LMSM to determine whether theorized associations existed between acquisition of a PrEP prescription (uptake) in relation to several social ecological factors based on a conceptual framework of determinants of access to and uptake of PrEP for LMSM. We also explored relations between frequency of PrEP use (adherence) and social ecological factors with a subsample of 33 LMSM who had initiated PrEP 12 months prior to assessment. In this study, individual-level factors from this framework included age and socioeconomic status. Perceived access to medical care represented both individual- and community-level determinants of PrEP uptake and adherence. Interpersonal-level factors were social support and relationship status. Structural/cultural-level factors were sexual identity development status, the masculinity norm of heterosexual self-presentation, traditional Latinx masculine gender role beliefs of machismo and caballerismo, racial identity, and immigration status. Results indicated that older men and those who endorsed the synthesis/integration status of sexual identity development were more likely to acquire a PrEP prescription during their lifetime in comparison to peers. PrEP adherence was linked with being older, reporting higher socioeconomic status, reporting more appraisal social support, self-identifying as white-Latinx, being U.S.-born, and endorsing less sexual identity uncertainty and more heterosexual self-presentation. Results specify modifiable factors that may inform tailored, community-based prevention efforts to increase PrEP use and decrease existing HIV/AIDS disparities among LMSM.
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Affiliation(s)
- Frank R Dillon
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA.
| | - Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Austin C Eklund
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Jaelen Westbrook
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA
| | - Gabrielle Balek
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Angel Algarin
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA
| | - Jessica Martin
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Francisco J Sánchez
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA
| | - Ryan Ebersole
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
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93
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Cozier YC, Arkema EV. Epidemiology of Sarcoidosis. Clin Chest Med 2024; 45:1-13. [PMID: 38245359 DOI: 10.1016/j.ccm.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a systemic, granulomatous disease with variable presentation earning it the term "the great mimicker." The current epidemiology confirms that the disease occurs worldwide, affecting both sexes, and all races, ethnicities, and ages. To date, no causal exposure or agent has been identified. The organ systems most frequently affected by sarcoidosis are also those with greatest exposure to the natural world suggesting environmental and lifestyle contributions to the disease. These include particulate matter, microorganisms, nicotine, and obesity. In this article, we review the epidemiology of sarcoidosis and discuss these non-genetic risk factors in the hope of providing important insight into sarcoidosis and stimulating future research.
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Affiliation(s)
- Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 3-East, Boston, MA 02118-2526, USA.
| | - Elizabeth V Arkema
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, T2, Stockholm 17176, Sweden
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Desai MU, Guy K, Brown M, Thompson D, Manning B, Johnson S, Davidson L, Bellamy C. "That Was a State of Depression by Itself Dealing with Society": Atmospheric racism, mental health, and the Black and African American faith community. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:104-117. [PMID: 37006193 PMCID: PMC10545810 DOI: 10.1002/ajcp.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 06/19/2023]
Abstract
Despite increased societal focus on structural racism, and its negative impact on health, empirical research within mental health remains limited relative to the magnitude of the problem. The current study-situated within a community-engaged project with members of a predominantly Black and African American church in the northeastern US-collaboratively examined depressive experience, recovery, and the role of racism and racialized structures. This co-designed study featured individual interviews (N = 11), a focus group (N = 14), and stakeholder engagement. A form of qualitative, phenomenological analysis that situates psychological phenomena within their social structural contexts was utilized. Though a main focal point of the study was depressive and significantly distressing experience, participant narratives directed us more towards a world that was structured to deplete and deprive-from basic neighborhood conditions, to police brutality, to workplace discrimination, to pervasive racist stereotypes, to differential treatment by health and social services. Racism was thus considered as atmospheric, in the sense of permeating life itself-with social, affective, embodied, and temporal dimensions, alongside practical (e.g., livelihood, vocation, and care) and spatial (e.g., neighborhood, community, and work) ones. The major thematic subsections-world, body, time, community, and space-reflect this fundamental saturation of racism within lived reality. There are two, interrelated senses of structural racism implicated here: the structures of the world and their impact on the structural dimensions of life. This study on the atmospheric nature of racism provides a community-centered complement to existing literature on structural racism and health that often proceed from higher, more population level scales. This combined literature suggests placing ever-renewed emphasis on addressing the causes and conditions that make this kind of distorted world possible in the first place.
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Affiliation(s)
- Miraj U Desai
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly Guy
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mychal Brown
- Beulah Heights First Pentecostal Church, New Haven, Connecticut, USA
| | - Denisha Thompson
- Beulah Heights First Pentecostal Church, New Haven, Connecticut, USA
| | - Bobby Manning
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Spencer Johnson
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chyrell Bellamy
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
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95
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Rojas-Saunero LP, Glymour MM, Mayeda ER. Selection Bias in Health Research: Quantifying, Eliminating, or Exacerbating Health Disparities? CURR EPIDEMIOL REP 2024; 11:63-72. [PMID: 38912229 PMCID: PMC11192540 DOI: 10.1007/s40471-023-00325-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/25/2024]
Abstract
Purpose of review To summarize recent literature on selection bias in disparities research addressing either descriptive or causal questions, with examples from dementia research. Recent findings Defining a clear estimand, including the target population, is essential to assess whether generalizability bias or collider-stratification bias are threats to inferences. Selection bias in disparities research can result from sampling strategies, differential inclusion pipelines, loss to follow-up, and competing events. If competing events occur, several potentially relevant estimands can be estimated under different assumptions, with different interpretations. The apparent magnitude of a disparity can differ substantially based on the chosen estimand. Both randomized and observational studies may misrepresent health disparities or heterogeneity in treatment effects if they are not based on a known sampling scheme. Conclusion Researchers have recently made substantial progress in conceptualization and methods related to selection bias. This progress will improve the relevance of both descriptive and causal health disparities research.
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Affiliation(s)
- L. Paloma Rojas-Saunero
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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97
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Thyden NH, Slaughter-Acey J, Widome R, Warren JR, Osypuk TL. Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs). JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:285-294. [PMID: 38151718 PMCID: PMC11068335 DOI: 10.1097/phh.0000000000001849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To assess sudden unexpected infant death (SUID) investigations for structural inequities by race/ethnicity and geography. METHODS The SUID Case Registry compiles data on death investigations. We analyzed cases from 2015 to 2018 (N = 3847) to examine likelihood of an incomplete death investigation, defined as missing autopsy, missing scene investigation, or missing detailed information about where and how the body was found. We also analyzed which specific components of death investigations led to the greatest number of incomplete investigations. RESULTS Twenty-four percent of SUIDs had incomplete death investigations. Death scenes in rural places had 1.51 times the odds of incomplete death investigations (95% confidence interval [CI], 1.19-1.92) compared with urban areas. Scene investigations led by law enforcement were more likely to result in incomplete death investigations (odds ratio [OR] = 1.49; 95% CI, 1.18-1.88) than those led by medical examiners. American Indian/Alaska Native SUIDs were more likely than other racial groups to have an incomplete investigation (OR = 1.49; 95% CI, 0.92-2.42), more likely to occur in rural places ( P = .055), and more likely to be investigated by law enforcement ( P < .001). If doll reenactments had been performed, 358 additional cases would have had complete investigations, and if SUID investigation forms had been performed, 243 additional cases would have had complete investigations. American Indian/Alaska Native SUIDs were also more likely to be missing specific components of death investigations. CONCLUSION To produce equitable public health surveillance data used in prevention efforts, it is crucial to improve SUID investigations, especially in rural areas and among American Indian/Alaska Native babies.
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Affiliation(s)
- Naomi Harada Thyden
- University of Minnesota, Minnesota Population Center, Minneapolis, Minnesota (Drs Thyden, Warren, and Osypuk); Division of Epidemiology & Community Health (Drs Thyden, Widome, and Osypuk) and Department of Sociology (Dr Warren), University of Minnesota, Minneapolis, Minnesota; University of Illinois Chicago, Community Health Sciences, Chicago, Illinois (Dr Thyden); and University of North Carolina at Chapel Hill, Gillings School of Public Health, Department of Epidemiology, Chapel Hill, North Carolina (Dr Slaughter-Acey)
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98
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Bell K, White S, Diaz A, Bahria P, Sima F, Al-Delaimy WK, dosReis S, Hassan O, Drabarek D, Nisha M, Baptiste-Roberts K, Gwiazdon K, Raynes-Greenow C, Taylor Wilson R, Gaudino JA, da Silveira Moreira R, Jennings B, Gulliver P. Can evidence drive health equity in the COVID-19 pandemic and beyond? J Public Health Policy 2024; 45:137-151. [PMID: 38216689 PMCID: PMC10920204 DOI: 10.1057/s41271-023-00452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.
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Affiliation(s)
- Katy Bell
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia.
- International Network for Epidemiology in Policy, Sydney, NSW, Australia.
| | - Sam White
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Abbey Diaz
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- First Nations Cancer and Wellbeing Research Team, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Priya Bahria
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- European Medicines Agency, Amsterdam, The Netherlands
| | - Fiona Sima
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Institute for Health Research, University of Bedfordshire, Luton, England, UK
| | - Wael K Al-Delaimy
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Susan dosReis
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- University of Maryland School of Pharmacy, Pharmaceutical Health Services Research, Baltimore, MD, USA
| | - Omar Hassan
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Dorothy Drabarek
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Monjura Nisha
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Kesha Baptiste-Roberts
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Katy Gwiazdon
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Environmental Ethics and Law, Vienna, VA, USA
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Robin Taylor Wilson
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Department of Epidemiology & Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | - James A Gaudino
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- School of Public Health, Oregon Health & Sciences University and Portland State University, Portland, OR, USA
| | - Rafael da Silveira Moreira
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Area of Social Medicine, Faculty of Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Bruce Jennings
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Pauline Gulliver
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Section of Social and Community Health, University of Auckland, Auckland, New Zealand
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Daw JR, MacCallum-Bridges CL, Kozhimannil KB, Admon LK. Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes. JAMA HEALTH FORUM 2024; 5:e240004. [PMID: 38457131 PMCID: PMC10924249 DOI: 10.1001/jamahealthforum.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/31/2023] [Indexed: 03/09/2024] Open
Abstract
Importance Pursuant to the Families First Coronavirus Response Act (FFCRA), continuous Medicaid eligibility during the COVID-19 public health emergency (PHE) created a de facto national extension of pregnancy Medicaid eligibility beyond 60 days postpartum. Objective To evaluate the association of continuous Medicaid eligibility with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. Design, Setting, and Participants This cohort study using a generalized difference-in-differences design included 21 states with continuous prepolicy (2017-2019) and postpolicy (2020-2021) participation in the Pregnancy Risk Assessment Monitoring System (PRAMS). Exposures State-level change in Medicaid income eligibility after 60 days postpartum associated with the FFCRA measured as a percent of the federal poverty level (FPL; ie, the difference in 2020 income eligibility thresholds for pregnant people and low-income adults/parents). Main Outcomes and Measures Health insurance, postpartum visit attendance, contraceptive use (any effective method; long-acting reversible contraceptives), any breastfeeding and depressive symptoms at the time of the PRAMS survey (mean [SD], 4 [1.3] months postpartum). Results The sample included 47 716 PRAMS respondents (64.4% aged <30 years; 18.9% Hispanic, 26.2% non-Hispanic Black, 36.3% non-Hispanic White, and 18.6% other race or ethnicity) with a Medicaid-paid birth. Based on adjusted estimates, a 100% FPL increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point (pp) increase in reported postpartum Medicaid enrollment, no change in commercial coverage, and a 6.6 pp decline in uninsurance. This represents a 40% reduction in postpartum uninsurance after a Medicaid-paid birth compared with the prepolicy baseline of 16.7%. In subgroup analyses by race and ethnicity, uninsurance reductions were observed only among White and Black non-Hispanic individuals; Hispanic individuals had no change. No policy-associated changes were observed in other outcomes. Conclusions and Relevance In this cohort study, continuous Medicaid eligibility during the COVID-19 PHE was associated with significantly reduced postpartum uninsurance for people with Medicaid-paid births, but was not associated with postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms at approximately 4 months postpartum. These findings, though limited to the context of the COVID-19 PHE, may offer preliminary insight regarding the potential impact of post-pandemic postpartum Medicaid eligibility extensions. Collection of longer-term and more comprehensive follow-up data on postpartum health care and health will be critical to evaluating the effect of ongoing postpartum policy interventions.
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Affiliation(s)
- Jamie R. Daw
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York
| | | | - Katy B. Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Lindsay K. Admon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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100
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Mays EJ, Diggs S, Vesoulis ZA, Warner B. The Effects of Health Disparities on Neonatal Outcomes. Crit Care Nurs Clin North Am 2024; 36:11-22. [PMID: 38296368 DOI: 10.1016/j.cnc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The history of racism in the United States was established with slavery, and the carry-over effect continues to impact health care through structural and institutional racism. Racial segregation and redlining have impacted access to quality health care, thereby impacting prematurity and infant mortality rates. Health disparities also impact neonatal morbidities such as intraventricular hemorrhage and necrotizing enterocolitis and the family care experience including the establishment of breastfeeding and health care provider interactions.
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Affiliation(s)
- Erin J Mays
- St. Louis Children's Hospital NICU, 1 Childrens Place, St Louis, MO 63110, USA.
| | - Stephanie Diggs
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Barbara Warner
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
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