1
|
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 PMCID: PMC11496381 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.
Collapse
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.
| |
Collapse
|
2
|
García AA, Huang YC, Zuñiga JA. Illness Perceptions Mediate the Impact of Depressive Symptoms on Quality of Life Among Latinos with Type 2 Diabetes. J Immigr Minor Health 2022; 24:1517-1525. [PMID: 35195797 DOI: 10.1007/s10903-022-01338-4] [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: 01/26/2022] [Indexed: 10/19/2022]
Abstract
Latinos' type 2 diabetes (T2DM) and concurrent depression significantly lower quality of life (QoL). Patients' beliefs about their diabetes, called illness perceptions (IP), may account for the impact of depression on QoL. Using secondary data, we explored predictive and mediation relationships among IP, depression, and QoL among Mexican American adults with T2DM using hierarchical multiple regression and mediation analyses. Participants (n = 75) were predominately middle-aged, female, most scoring low on depressive-symptoms, who believed that diabetes was a chronic disease with serious consequences, controllable by treatment and personal self-management. Participants with higher acculturation and weak perceptions about negative consequences of diabetes reported better QoL. Depressive symptoms' impact on QoL were mediated by overall IP and perceptions about diabetes consequences, in particular. By eliciting patients' perceptions about disease consequences and teaching realistic ways to avoid them, clinicians may alleviate the impact of depression on QoL.
Collapse
Affiliation(s)
- Alexandra A García
- School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, USA.
| | - Ya-Ching Huang
- St. David's School of Nursing, Texas State University, 1555 University Drive, Round Rock, TX, 78665, USA
| | - Julie A Zuñiga
- School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, USA
| |
Collapse
|
3
|
Lim E, Davis J, Siriwardhana C, Aggarwal L, Hixon A, Chen JJ. Racial/ethnic differences in health-related quality of life among Hawaii adult population. Health Qual Life Outcomes 2020; 18:380. [PMID: 33298089 PMCID: PMC7724821 DOI: 10.1186/s12955-020-01625-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
Background This study examined racial/ethnic differences in health-related quality of life (HRQOL) among adults and identified variables associated with HRQOL by race/ethnicity.
Methods This study was conducted under a cross-sectional design. We used the 2011–2016 Hawaii Behavioral Risk Factor Surveillance System data. HRQOL were assessed by four measures: self-rated general health, physically unhealthy days, mentally unhealthy days, and days with activity limitation. Distress was defined as fair/poor for general health and 14 days or more for each of the other three HRQOL measures. We conducted multivariable logistic regressions with variables guided by Anderson’s behavioral model on each distress measure by race/ethnicity. Results Among Hawaii adults, 30.4% were White, 20.9% Japanese, 16.8% Filipino, 14.6% Native Hawaiian and Pacific Islander (NHPI), 5.9% Chinese, 5.2% Hispanics, and 6.2% Other. We found significant racial/ethnic differences in the HRQOL measures. Compared to Whites, Filipinos, Japanese, NHPIs, and Hispanics showed higher distress rates in general health, while Filipinos and Japanese showed lower distress rates in the other HRQOL measures. Although no variables were consistently associated with all four HRQOL measures across all racial/ethnic groups, history of diabetes were significantly associated with general health across all racial/ethnic groups and history of depression was associated with at least three of the HRQOL measure across all racial/ethnic groups. Conclusions This study contributes to the literature on disparities in HRQOL and its association with other variables among diverse racial/ethnic subgroups. Knowing the common factors for HRQOL across different racial/ethnic groups and factors specific to different racial/ethnic groups will provide valuable information for identifying future public health priorities to improve quality of life and reduce health disparities.
Collapse
Affiliation(s)
- Eunjung Lim
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Medical Education Building, Suite 411, Honolulu, HI, 96813, USA.
| | - James Davis
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Medical Education Building, Suite 411, Honolulu, HI, 96813, USA
| | - Chathura Siriwardhana
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Medical Education Building, Suite 411, Honolulu, HI, 96813, USA
| | - Lovedhi Aggarwal
- Department of Family, Population & Preventive Medicine, Stony Brook University Medical Center, HSC L3, Rm 086, Stony Brook, NY, 11794-8036, USA.,Department of Family Medicine, John A. Burns School of Medicine, University of Hawaii, Family Medicine at the Physician Center at Mililani, 95-390 Kuahelani AVE, Mililani, HI, 96789, USA
| | - Allen Hixon
- Department of Family Medicine, John A. Burns School of Medicine, University of Hawaii, Family Medicine at the Physician Center at Mililani, 95-390 Kuahelani AVE, Mililani, HI, 96789, USA
| | - John J Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Medical Education Building, Suite 411, Honolulu, HI, 96813, USA
| |
Collapse
|