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Jurek L, Leaune E. Global Perspectives, Local Policies: The Complexities of Race and Ethnicity in Research. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)01882-3. [PMID: 39326514 DOI: 10.1016/j.jaac.2024.07.927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/23/2024] [Accepted: 07/30/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Lucie Jurek
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Centre Hospitalier le Vinatier, Lyon, France; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.
| | - Edouard Leaune
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Centre Hospitalier le Vinatier, Lyon, France; University College London, Division of Psychiatry, London, United Kingdom
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Heaton A. An incomplete picture: A scoping review of how scholars account for race and ethnicity in family homelessness research. JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 39233470 DOI: 10.1002/jcop.23148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/05/2024] [Accepted: 08/23/2024] [Indexed: 09/06/2024]
Abstract
Families of color in the United States experience homelessness at a disproportionately higher rate than White families; however, little is known about how scholars account for race and ethnicity in family homelessness research. This scoping review analyzes how researchers examine race and ethnicity in conceptual frameworks, methods, and analysis. Following PRISMA-ScR reporting standards, I searched PubMed, PsycINFO, Scopus, and ERIC for quantitative studies including a housing outcome for homeless service-involved families. I used Covidence to screen for inclusion and extract data, and QuADS to evaluate study quality. Fourteen studies met inclusion criteria. Researchers' articles lacked theory and the context of racism, lacked detail on how race and ethnicity were conceptualized and operationalized, and most (71%) did not disaggregate results. Without putting data within the context of systemic racism and disaggregating outcomes, research will produce incomplete knowledge on family homelessness, leading to ineffective interventions for families of color.
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Affiliation(s)
- Abigail Heaton
- School of Social Work, University of Iowa, Iowa City, Iowa, USA
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Freed GL, Bogan B, Nicholson A, Niedbala D, Woolford S. Error Rates in Race and Ethnicity Designation Across Large Pediatric Health Systems. JAMA Netw Open 2024; 7:e2431073. [PMID: 39226057 PMCID: PMC11372483 DOI: 10.1001/jamanetworkopen.2024.31073] [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: 09/04/2024] Open
Abstract
Importance Without knowledge of the degree of misattribution in racial and ethnic designations in data, studies run the risk of missing existing inequities and disparities and identifying others that do not exist. Further, accuracy of racial and ethnic designations is important to clinical care improvement efforts and health outcomes. Objective To determine the error rate of racial and ethnic attribution in the electronic medical records (EMRs) across the 3 largest pediatric health systems in Michigan. Design, Setting, and Participants This cross-sectional study collected race and ethnicity data from parents in outpatient clinics, emergency departments, and inpatient units at the 3 largest pediatric health systems in Michigan. A total of 1594 parents or guardians participated at health system A, 1537 at health system B, and 1202 at health system C from September 1, 2023, to January 31, 2024. Parent or guardian report of race and ethnicity for a child was used as the gold standard for comparison with the designation in the EMR. Exposure Race and ethnicity designations in the EMR. Options for race designation across the health systems ranged from 6 to 49; options for ethnicity, from 2 to 10. Main Outcomes and Measures Matching occurred in 3 stages. First, the exact racial and ethnic designations made by parents for their child were compared with what was found in the EMR. Second, for any child whose parent selected more than 1 racial category or for whom more than 1 appeared in the EMR, the designation of a minoritized racial group was used for matching purposes. Third, starting with the product of stage 2, racial designations were combined or collapsed into 6 (health systems A and C) or 5 (health system B) designations. Results A total of 4333 survey responses were included in the analysis. The greatest error rate across the health systems occurred with the exact match of parental report of racial designation with the EMR, which ranged from 41% to 78% across the health systems. Improvement in the matching rate for each health system occurred with consolidation of race options provided. Differences between the health systems narrowed at the final consolidation to varying from 79% to 88% matching. Ethnicity matching between the EMR and the parental report ranged from 65% to 95% across the health systems. Missing race or ethnicity data in the EMR was counted as a nonmatch. Rates of missing racial data varied across the health systems from 2% to 10%. The health system with the greatest number of options for race and ethnicity had the highest error rates. Conclusions and Relevance Although there will always be some misattribution of race and ethnicity in the EMR, the results of this cross-sectional study suggest that significant error in these data may undermine strategies to improve care. It is unclear whether those in an organization who determine the number of potential categories are the same persons who use those data to investigate potential disparities and inequities.
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Affiliation(s)
- Gary L Freed
- Michigan Child Health Equity Collaborative, Ann Arbor
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | - Brittany Bogan
- C. S. Mott Children's Hospital and Von Voigtlander Women's Hospital, Ann Arbor, Michigan
| | - Adam Nicholson
- Corewell Health Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | | | - Susan Woolford
- Michigan Child Health Equity Collaborative, Ann Arbor
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
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LoRe D, Groden CM, Schuh AR, Holmes C, Ostilla L, Vogel MM, Murray PD, Yamasato K, Tonismae T, Anani UE, Henner N, Famuyide M, Leuthner SR, Laventhal N, Andrews BL, Tucker Edmonds BM, Brennan KG, Feltman DM. Variability of Care Practices for Extremely Early Deliveries. Pediatrics 2024; 154:e2023065521. [PMID: 39129496 PMCID: PMC11350101 DOI: 10.1542/peds.2023-065521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVES Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries. METHODS Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age. RESULTS 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2-at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center. CONCLUSIONS Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center.
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Affiliation(s)
- Danielle LoRe
- Department of Pediatrics, Columbia University, New York, New York
| | | | - Allison R. Schuh
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Chondraah Holmes
- Department of Pediatrics, Children’s Wisconsin, Milwaukee, Wisconsin
| | - Lorena Ostilla
- Department of Pediatrics, Lurie Children’s Hospital, Chicago, Illinois
| | - Maggie M. Vogel
- Department of Pediatrics, Advocate Christ Hospital, Oak Lawn, Illinois
| | - Peter D. Murray
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Kelly Yamasato
- Department of Obstetrics, Gynecology, and Women’s Health, University of Hawaii, Honolulu, Hawaii
| | | | - Uchenna E. Anani
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Natalia Henner
- Department of Pediatrics, Lurie Children’s Hospital, Chicago, Illinois
| | - Mobolaji Famuyide
- Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Naomi Laventhal
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Dalia M. Feltman
- Division of Neonatology, Department of Pediatrics, NorthShore University HealthSystem Evanston Hospital, Evanston, Illinois
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Saeedi A, von Sneidern M, Abend A, Taufique ZM, Eytan DF. Predictors of 30-day complications, readmission, and postoperative length of stay in children undergoing autologous rib grafting for microtia. J Plast Reconstr Aesthet Surg 2024; 98:73-81. [PMID: 39241679 DOI: 10.1016/j.bjps.2024.08.068] [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: 05/14/2024] [Revised: 08/07/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Predictors of outcomes in pediatric microtia surgery are not well understood within the current literature. A multi-institutional database study may reveal insights into these predictors. OBJECTIVES To explore the predictors of 30-day complications, 30-day readmission, and postoperative length of stay (PLOS) in pediatric microtia patients undergoing autologous rib grafting. METHODS The Pediatric National Surgical Quality Improvement Program was queried for details on patients with microtia (ICD-9/10 744.23/Q17.2) who underwent autologous rib grafting (CPT 21230) between 2012-2021. Demographics, comorbidities, inpatient status, 30-day complications, PLOS, and 30-day readmissions were analyzed. Statistical analyses were performed to compare the preoperative characteristics with postoperative outcomes. RESULTS Overall, 667 patients met the inclusion criteria. Sixty-three (9.4%) had at least one complication, and 19 (2.9%) were readmitted. Univariate analysis showed that inpatient status (p = 0.011) and race (p = 0.023) were associated with higher complication rates. Multivariate analysis revealed that outpatient status was associated with significantly lower odds of complications (OR: 0.49, 95% CI [0.27, 0.87], p = 0.018), and developmental delay was associated with higher odds of 30-day readmission (OR: 2.80, 95% CI [1.05, 7.17], p = 0.036). Longer operative time was associated with older age (13.9% increase per five-year age increase, p < 0.001) and inpatient status (35.3% increase, p < 0.001). PLOS was shorter for outpatients (45.45% shorter, p < 0.001) and cases performed by plastic surgeons (14.2% shorter, p < 0.001). CONCLUSION Microtia reconstruction using autologous cartilage is a relatively safe procedure with low complication and readmission rates. Significant predictors of postoperative outcomes include inpatient status, race, developmental delay, and age. These findings highlight the importance of considering these factors in surgical planning and patient counseling.
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Affiliation(s)
- Arman Saeedi
- University of Colorado Anschutz School of Medicine, USA
| | - Manuela von Sneidern
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA
| | - Audrey Abend
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA
| | - Zahrah M Taufique
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA
| | - Danielle F Eytan
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA.
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Chan K, Palis BE, Cotler JH, Janczewski LM, Weigel RJ, Bentrem DJ, Ko CY. Hospital Accreditation Status and Treatment Differences Among Black Patients With Colon Cancer. JAMA Netw Open 2024; 7:e2429563. [PMID: 39167405 PMCID: PMC11339660 DOI: 10.1001/jamanetworkopen.2024.29563] [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: 04/07/2024] [Accepted: 06/27/2024] [Indexed: 08/23/2024] Open
Abstract
Importance Hospital-level factors, such as hospital type or volume, have been demonstrated to play a role in treatment disparities for Black patients with cancer. However, data evaluating the association of hospital accreditation status with differences in treatment among Black patients with cancer are lacking. Objective To evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of guideline-concordant care and mortality among non-Hispanic Black patients with colon cancer. Design, Setting, and Participants This population-based cohort study used the National Program of Cancer Registries, which is a multicenter database with data from all 50 states and the District of Columbia, and covers 97% of the cancer population in the US. The participants included non-Hispanic Black patients aged 18 years or older diagnosed with colon cancer between January 1, 2018, and December 31, 2020. Race and ethnicity were abstracted from medical records as recorded by health care facilities and practitioners. The data were analyzed from December 7, 2023, to January 17, 2024. Exposure CoC hospital accreditation. Main Outcome and Measures Guideline-concordant care was defined as adequate lymphadenectomy during surgery for patients with stages I to III disease or chemotherapy administration for patients with stage III disease. Multivariable logistic regression models investigated associations with receipt of guideline-concordant care and Cox proportional hazards regression models assessed associations with 3-year cancer-specific mortality. Results Of 17 249 non-Hispanic Black patients with colon cancer (mean [SD] age, 64.8 [12.8] years; 8724 females [50.6%]), 12 756 (74.0%; mean [SD] age, 64.7 [12.8] years) were treated at a CoC-accredited hospital and 4493 (26.0%; mean [SD] age, 65.1 [12.5] years) at a non-CoC-accredited hospital. Patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals had higher odds of receiving guideline-concordant lymphadenectomy (adjusted odds ratio [AOR], 1.89; 95% CI, 1.69-2.11) and chemotherapy (AOR, 2.31; 95% CI, 1.97-2.72). Treatment at CoC-accredited hospitals was associated with lower cancer-specific mortality for patients with stages I to III disease who received surgery (adjusted hazard ratio [AHR], 0.87; 95% CI, 0.76-0.98) and for patients with stage III disease eligible for chemotherapy (AHR, 0.75; 95% CI, 0.59-0.96). Conclusions and Relevance In this cohort study of non-Hispanic Black patients with colon cancer, patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals were more likely to receive guideline-concordant care and have lower mortality risk. These findings suggest that increasing access to high-quality guideline-concordant care at CoC-accredited hospitals may reduce variations in cancer treatment and outcomes for underserved populations.
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Affiliation(s)
- Kelley Chan
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Bryan E. Palis
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | | | - Lauren M. Janczewski
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald J. Weigel
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, Carver College of Medicine, The University of Iowa, Iowa City
| | - David J. Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Clifford Y. Ko
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Pettit NR, Lane KA, Gibbs L, Musey P, Li X, Vest JR. Concordance Between Electronic Health Record-Recorded Race and Ethnicity and Patient Report in Emergency Department Patients. Ann Emerg Med 2024; 84:111-117. [PMID: 38691067 DOI: 10.1016/j.annemergmed.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/27/2024] [Accepted: 03/22/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE We assessed the concordance of patient-reported race and ethnicity for emergency department (ED) patients compared with what was recorded in the electronic health record. METHODS We conducted a single-center, prospective, observational study of 744 ED patients (English- and/or Spanish-speaking), asking them to describe their race and ethnicity. We compared the distributions of ethnicity and race between patient-reported and electronic health record data using McNemar's test. We calculated percent agreement and Cohen's kappa, with 95% confidence intervals (CI), for the concordance of patient-reported race and ethnicity with electronic health record data. RESULTS Of 744 ED patients, 731 participants who completed the survey reported their ethnicity, resulting in 98.2% of electronic health records obtained ethnicities matched self-reported data (kappa = 0.95; 95% CI: 0.92 to 0.98). For those who self-reported as Hispanic, only 92.3% agreement was observed between the self-reported and electronic health record values. For all patients who had race recorded, 85.4% agreement was observed (kappa = 0.75; 95% CI 0.71 to 0.79). High rates of agreement were observed for Black or African American patients (98.7%) and White patients (96.6%), with low rates for those who identified as "More than one race" (22.9%) or "Other" race (1.8%). In the subset of Hispanic patients, low rates of agreement (25.0%) were observed for race (kappa = 0.10; 95% CI 0.01 to 0.19). CONCLUSIONS Documentation discordance regarding race and ethnicity exists between electronic health records and self-reported data for our ED patients, particularly for ethnically Hispanic and Latino/a patients. Future efforts should focus on ensuring that demographic information in the electronic health record is accurately collected.
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Affiliation(s)
- Nicholas R Pettit
- Department of Emergency Medicine (Pettit, Gibbs, Musey), Indiana University School of Medicine, Indianapolis, IN.
| | - Kathleen A Lane
- Department of Biostatistics and Health Data Science (Lane, Li), Indiana University School of Medicine, Indianapolis, IN
| | - Leslie Gibbs
- Department of Emergency Medicine (Pettit, Gibbs, Musey), Indiana University School of Medicine, Indianapolis, IN
| | - Paul Musey
- Department of Emergency Medicine (Pettit, Gibbs, Musey), Indiana University School of Medicine, Indianapolis, IN
| | - Xiaochun Li
- Department of Biostatistics and Health Data Science (Lane, Li), Indiana University School of Medicine, Indianapolis, IN; Department of Health Policy and Management (Li, Vest), Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Joshua R Vest
- Department of Health Policy and Management (Li, Vest), Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
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Groden CM, Raed M, Helft P, Allen JD. End of life care in a level IV outborn neonatal intensive care unit. J Perinatol 2024; 44:1022-1028. [PMID: 38480788 DOI: 10.1038/s41372-024-01930-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Describe care surrounding the end of life (EOL) in the neonatal intensive care unit (NICU). STUDY DESIGN Retrospective chart review of 208 infants who died in a level IV referral-only NICU over 5 years. RESULTS A goals of care (GOC) conversation was documented before the day of death for 63% of infants. 73% died following withdrawal of life-sustaining treatment (WD); 13% died in a code. The median age at death was 17.5 days. 72% were held by a parent at EOL. 94% of families desired formal memory-making. We identified associations with mode of death and parental holding at death, including: WD was associated with palliative care consultation, early GOC conversations, and increased unit-specific length of stay. Holding was associated with chaplain visits, memory-making, and increased home-to-hospital distance. CONCLUSION We present a detailed description of EOL care in an outborn NICU, including novel data on parental holding and memory-making.
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Affiliation(s)
| | - Mona Raed
- Division of Palliative Care, Community Health Network, Indianapolis, IN, USA
| | - Paul Helft
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jayme D Allen
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Lupi M, Tsokani S, Howell AM, Ahmed M, Brogden D, Tekkis P, Kontovounisios C, Mills S. Anogenital HPV-Related Cancers in Women: Investigating Trends and Sociodemographic Risk Factors. Cancers (Basel) 2024; 16:2177. [PMID: 38927883 PMCID: PMC11202297 DOI: 10.3390/cancers16122177] [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: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
The incidences of anogenital HPV-related cancers in women are on the rise; this is especially true for anal cancer. Medical societies are now beginning to recommend anal cancer screening in certain high-risk populations, including high-risk women with a history of genital dysplasia. The aim of this study is to investigate national anogenital HPV cancer trends as well as the role of demographics, deprivation, and ethnicity on anogenital cancer incidence in England, in an attempt to better understand this cohort of women which is increasingly affected by anogenital HPV-related disease. Demographic data from the Clinical Outcomes and Services Dataset (COSD) were extracted for all patients diagnosed with anal, cervical, vulval and vaginal cancer in England between 2014 and 2020. Outcomes included age, ethnicity, deprivation status and staging. An age over 55 years, non-white ethnicity and high deprivation are significant risk factors for late cancer staging, as per logistic regression. In 2019, the incidences of anal and vulval cancer in white women aged 55-74 years surpassed that of cervical cancer. More needs to be done to educate women on HPV-related disease and their lifetime risk of these conditions.
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Affiliation(s)
- Micol Lupi
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2AZ, UK; (D.B.); (P.T.); (C.K.); (S.M.)
- Department of Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK;
| | - Sofia Tsokani
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
- Cochrane Methods Support Unit, Evidence Production and Methods Department, Cochrane, London W1G 0AN, UK
| | - Ann-Marie Howell
- Department of Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK;
| | - Mosab Ahmed
- Department of Anesthesiology, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Danielle Brogden
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2AZ, UK; (D.B.); (P.T.); (C.K.); (S.M.)
| | - Paris Tekkis
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2AZ, UK; (D.B.); (P.T.); (C.K.); (S.M.)
- Department of Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK;
- Department of Colorectal Surgery and Cancer, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2AZ, UK; (D.B.); (P.T.); (C.K.); (S.M.)
- Department of Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK;
- Department of Colorectal Surgery and Cancer, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- Evangelismos General Hospital, Ipsilantou 45-47, 106 76 Athens, Greece
| | - Sarah Mills
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2AZ, UK; (D.B.); (P.T.); (C.K.); (S.M.)
- Department of Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK;
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Sojka PC, Maron MM, Dunsiger SI, Belgrave C, Hunt JI, Brannan EH, Wolff JC. Evaluation of Reliability Between Race and Ethnicity Data Obtained from Self-report Versus Electronic Health Record. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02041-w. [PMID: 38839729 DOI: 10.1007/s40615-024-02041-w] [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: 02/06/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Disparities based on perceived race and ethnicity exist in all fields of medicine. Accurate data collection is crucial to addressing these disparities, yet few studies have evaluated the validity of data gathered. This study compares self-reported race and ethnicity data, considered the gold standard, with data documented in the electronic health record (EHR), to assess the validity of that data. METHODS Data from self-reported questionnaires was collected from adolescents admitted to a psychiatric inpatient unit from February 2019 to July 2022. Demographic questionnaires were self-administered as part of a larger battery completed during the admission process. Data was compared to demographic information collected from the hospital's EHR for the same patients and time. RESULTS In a sample of 1191 patients (ages 11-18, 61.9% female, 89% response rate), substantial agreement was observed for Hispanic ethnicity (κ = 0.64), while agreement for specific racial groups ranged from slight to substantial (κ = 0.10-0.63). In addition, it was noted that there was discrepancy between multiracial identification, with 17.1% of patients identifying as more than one race in self-reported data compared to 3.1% in EHR data. CONCLUSIONS The findings from this data set highlight the need for caution when using EHR data to draw conclusions about health disparities. It also suggests that the method of data collection meaningfully influences the responses patients provide. Addressing these challenges is essential for advancing equitable healthcare and mitigating disparities among patients.
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Affiliation(s)
- Phillip C Sojka
- Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | | | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Christa Belgrave
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Bradley Hospital, East Providence, RI, USA
| | - Jeffrey I Hunt
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Bradley Hospital, East Providence, RI, USA
| | - Elizabeth H Brannan
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Bradley Hospital, East Providence, RI, USA
| | - Jennifer C Wolff
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Bradley Hospital, East Providence, RI, USA
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11
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Goyal M, Alpern ER, Webb M, Brousseau DC, Chamberlain JM, Zorc JJ, Frey T, Wiersma A, Barney BJ, Drendel AL. Agreement of electronic health record-documented race and ethnicity with parental report. Acad Emerg Med 2024; 31:613-616. [PMID: 38049203 PMCID: PMC11147953 DOI: 10.1111/acem.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Monika Goyal
- Pediatrics & Emergency Medicine, Children’s National Hospital, The George Washington University, Washington, DC
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Webb
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - James M. Chamberlain
- Pediatrics & Emergency Medicine, Children’s National Hospital, The George Washington University, Washington, DC
| | - Joseph J. Zorc
- The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Theresa Frey
- Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH
| | - Alexandria Wiersma
- Pediatrics, University of Colorado, Children’s Hospital Colorado, Denver, CO
| | | | - Amy L. Drendel
- Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI
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12
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Farcas AM, Crowe RP, Kennel J, Little N, Haamid A, Camacho MA, Pleasant T, Owusu-Ansah S, Joiner AP, Tripp R, Kimbrell J, Grover JM, Ashford S, Burton B, Uribe J, Innes JC, Page DI, Taigman M, Dorsett M. Achieving Equity in EMS Care and Patient Outcomes Through Quality Management Systems: A Position Statement. PREHOSP EMERG CARE 2024; 28:871-881. [PMID: 38727731 DOI: 10.1080/10903127.2024.2352582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/16/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
Improving health and safety in our communities requires deliberate focus and commitment to equity. Inequities are differences in access, treatment, and outcomes between individuals and across populations that are systemic, avoidable, and unjust. Within health care in general, and Emergency Medical Services (EMS) in particular, there are demonstrated inequities in the quality of care provided to patients based on a number of characteristics linked to discrimination, exclusion, or bias. Given the critical role that EMS plays within the health care system, it is imperative that EMS systems reduce inequities by delivering evidence-based, high-quality care for the communities and patients we serve. To achieve equity in EMS care delivery and patient outcomes, the National Association of EMS Physicians recommends that EMS systems and agencies:make health equity a strategic priority and commit to improving equity at all levels.assess and monitor clinical and safety quality measures through the lens of inequities as an integrated part of the quality management process.ensure that data elements are structured to enable equity analysis at every level and routinely evaluate data for limitations hindering equity analysis and improvement.involve patients and community stakeholders in determining data ownership and stewardship to ensure its ongoing evolution and fitness for use for measuring care inequities.address biases as they translate into the quality of care and standards of respect for patients.pursue equity through a framework rooted in the principles of improvement science.
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Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Jamie Kennel
- Oregon Health & Science University and Oregon Institute of Technology, Portland, Oregon
| | | | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Mario Andres Camacho
- Department of Emergency Medicine, Denver Health Medical Center, School of Medicine, University of Colorado, Denver, Colorado
| | | | - Sylvia Owusu-Ansah
- Division of Pediatric Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anjni P Joiner
- Department of Emergency Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joshua Kimbrell
- Department of Pre-Hospital Care, Jamaica Hospital Medical Center, Jamaica, New York
| | - Joseph M Grover
- UNC Department of Emergency Medicine, Chapel Hill, North Carolina
| | | | - Brooke Burton
- Unified Fire Authority in Salt Lake County, Salt Lake City, Utah
| | - Jeffrey Uribe
- Department of Emergency Medicine, Medstar Health, Columbia, Maryland
| | - Johanna C Innes
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - David I Page
- Center for Prehospital Care, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Maia Dorsett
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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13
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Steventon L, Nicum S, Man K, Chaichana U, Wei L, Chambers P. A systematic review of ethnic minority participation in randomised controlled trials of systemic therapies for gynecological cancers. Gynecol Oncol 2024; 184:178-189. [PMID: 38330832 DOI: 10.1016/j.ygyno.2024.01.052] [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: 10/26/2023] [Revised: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Randomised controlled trials (RCTs) must include ethnic minority patients to produce generalisable findings and ensure health equity as cancer incidence rises globally. This systematic review examines participation of ethnic minorities in RCTs of licensed systemic anti-cancer therapies (SACT) for gynecological cancers, defining the research population and distribution of research sites to identify disparities in participation on the global scale. METHODS A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Phase II and III RCTs of licensed therapies for gynecological cancers published 01/11/2012-01/11/2022 that reported patient race/ethnicity were included. Extracted data included race/ethnicity and research site location. RCT populations were aggregated and participation of groups compared. Global distribution of research sites was described. RESULTS 26 RCTs met inclusion criteria of 351 publications included in full-text screening, representing 17,041 patients. 79.8% were "Caucasian", 9.1% "East Asian", 3.7% "Black/African American" and 6.1% "Other, Unknown, Not Reported". "Caucasian" patients participated at higher rates than all other groups. Of 5,478 research sites, 80.1% were located in North America, 13.0% in Europe, 3.4% in East Asia, 1.3% in the Middle East, 1.3% in South America and 0.8% in Australasia. CONCLUSIONS Ethnic minorities formed smaller proportions of RCT cohorts compared to the general population. The majority of sites were located in North America and Europe, with few in other regions, limiting enrollment of South Asian, South-East Asian and African patients in particular. Efforts to recruit more ethnic minority patients should be made in North America and Europe. More sites in underserved regions would promote equitable access to RCTs and ensure findings are generalisable to diverse groups. This review assessed the global population enrolled in contemporary RCTs for novel therapies now routinely given for gynecological cancers, adding novel understanding of the global distribution of research sites.
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Affiliation(s)
- Luke Steventon
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom; University College London Hospitals NHS Foundation Trust, Medical Oncology Department, 250 Euston Road, London NW1 2PG, United Kingdom
| | - Shibani Nicum
- University College London Hospitals NHS Foundation Trust, Medical Oncology Department, 250 Euston Road, London NW1 2PG, United Kingdom; UCL Cancer Institute, Department of Oncology, 72 Huntley Street, London WC1 6DD, United Kingdom
| | - Kenneth Man
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom
| | - Ubonphan Chaichana
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom
| | - Li Wei
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom
| | - Pinkie Chambers
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom; University College London Hospitals NHS Foundation Trust, Medical Oncology Department, 250 Euston Road, London NW1 2PG, United Kingdom.
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14
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Mayer SL, Brajcich MR, Juste L, Hsu JY, Yehya N. Racial and Ethnic Disparity in Approach for Pediatric Intensive Care Unit Research Participation. JAMA Netw Open 2024; 7:e2411375. [PMID: 38748423 PMCID: PMC11096993 DOI: 10.1001/jamanetworkopen.2024.11375] [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: 01/06/2024] [Accepted: 03/13/2024] [Indexed: 05/18/2024] Open
Abstract
Importance While disparities in consent rates for research have been reported in multiple adult and pediatric settings, limited data informing enrollment in pediatric intensive care unit (PICU) research are available. Acute care settings such as the PICU present unique challenges for study enrollment, given the highly stressful and emotional environment for caregivers and the time-sensitive nature of the studies. Objective To determine whether race and ethnicity, language, religion, and Social Deprivation Index (SDI) were associated with disparate approach and consent rates in PICU research. Design, Setting, and Participants This retrospective cohort study was performed at the Children's Hospital of Philadelphia PICU between July 1, 2011, and December 31, 2021. Participants included patients eligible for studies requiring prospective consent. Data were analyzed from February 2 to July 26, 2022. Exposure Exposures included race and ethnicity (Black, Hispanic, White, and other), language (Arabic, English, Spanish, and other), religion (Christian, Jewish, Muslim, none, and other), and SDI (composite of multiple socioeconomic indicators). Main Outcomes and Measures Multivariable regressions separately tested associations between the 4 exposures (race and ethnicity, language, religion, and SDI) and 3 outcomes (rates of approach among eligible patients, consent among eligible patients, and consent among those approached). The degree to which reduced rates of approach mediated the association between lower consent in Black children was also assessed. Results Of 3154 children included in the study (median age, 6 [IQR, 1.9-12.5] years; 1691 [53.6%] male), rates of approach and consent were lower for Black and Hispanic families and those of other races, speakers of Arabic and other languages, Muslim families, and those with worse SDI. Among children approached for research, lower consent odds persisted for those of Black race (unadjusted odds ratio [OR], 0.73 [95% CI, 0.55-0.97]; adjusted OR, 0.68 [95% CI, 0.49-0.93]) relative to White race. Mediation analysis revealed that 51.0% (95% CI, 11.8%-90.2%) of the reduced odds of consent for Black individuals was mediated by lower probability of approach. Conclusions and Relevance In this cohort study of consent rates for PICU research, multiple sociodemographic factors were associated with lower rates of consent, partly attributable to disparate rates of approach. These findings suggest opportunities for reducing disparities in PICU research participation.
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Affiliation(s)
- Sarah L. Mayer
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Michelle R. Brajcich
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Lionola Juste
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Jesse Y. Hsu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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15
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Madbouly A, Bolon YT. Race, ethnicity, ancestry, and aspects that impact HLA data and matching for transplant. Front Genet 2024; 15:1375352. [PMID: 38560292 PMCID: PMC10978785 DOI: 10.3389/fgene.2024.1375352] [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: 01/23/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Race, ethnicity, and ancestry are terms that are often misinterpreted and/or used interchangeably. There is lack of consensus in the scientific literature on the definition of these terms and insufficient guidelines on the proper classification, collection, and application of this data in the scientific community. However, defining groups for human populations is crucial for multiple healthcare applications and clinical research. Some examples impacted by population classification include HLA matching for stem-cell or solid organ transplant, identifying disease associations and/or adverse drug reactions, defining social determinants of health, understanding diverse representation in research studies, and identifying potential biases. This article describes aspects of race, ethnicity and ancestry information that impact the stem-cell or solid organ transplantation field with particular focus on HLA data collected from donors and recipients by donor registries or transplant centers.
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Affiliation(s)
- Abeer Madbouly
- Center for International Blood and Marrow Transplant Research (CIBMTR), Minneapolis, MN, United States
| | - Yung-Tsi Bolon
- Center for International Blood and Marrow Transplant Research (CIBMTR), Minneapolis, MN, United States
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16
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Paetznick C, Okoro O. The Intersection between Pharmacogenomics and Health Equity: A Case Example. PHARMACY 2023; 11:186. [PMID: 38133461 PMCID: PMC10747429 DOI: 10.3390/pharmacy11060186] [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: 09/01/2023] [Revised: 10/25/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Pharmacogenomics (PGx) and the study of precision medicine has substantial power to either uplift health equity efforts or further widen the gap of our already existing health disparities. In either occurrence, the medication experience plays an integral role within this intersection on an individual and population level. Examples of this intertwined web are highlighted through a case discussion. With these perspectives in mind, several recommendations for the research and clinical communities are highlighted to promote equitable healthcare with PGx integrated.
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Affiliation(s)
| | - Olihe Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN 55812, USA
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17
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Zapf MAC, Fabbri DV, Andrews J, Li G, Freundlich RE, Al-Droubi S, Wanderer JP. Development of a machine learning model to predict intraoperative transfusion and guide type and screen ordering. J Clin Anesth 2023; 91:111272. [PMID: 37774648 PMCID: PMC10623374 DOI: 10.1016/j.jclinane.2023.111272] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
STUDY OBJECTIVE To develop an algorithm to predict intraoperative Red Blood Cell (RBC) transfusion from preoperative variables contained in the electronic medical record of our institution, with the goal of guiding type and screen ordering. DESIGN Machine Learning model development on retrospective single-center hospital data. SETTING Preoperative period and operating room. PATIENTS The study included patients ≥18 years old who underwent surgery during 2019-2022 and excluded those who refused transfusion, underwent emergency surgery, or surgery for organ donation after cardiac or brain death. INTERVENTION Prediction of intraoperative transfusion vs. no intraoperative transfusion. MEASUREMENTS The outcome variable was intraoperative transfusion of RBCs. Predictive variables were surgery, surgeon, anesthesiologist, age, sex, body mass index, race or ethnicity, preoperative hemoglobin (g/dL), partial thromboplastin time (s), platelet count x 109 per liter, and prothrombin time. We compared the performances of seven machine learning algorithms. After training and optimization on the 2019-2021 dataset, model thresholds were set to the current institutional performance level of sensitivity (93%). To qualify for comparison, models had to maintain clinically relevant sensitivity (>90%) when predicting on 2022 data; overall accuracy was the comparative metric. MAIN RESULTS Out of 100,813 cases that met study criteria from 2019 to 2021, intraoperative transfusion occurred in 5488 (5.4%) of cases. The LightGBM model was the highest performing algorithm in external temporal validity experiments, with overall accuracy of (76.1%) [95% confidence interval (CI), 75.6-76.5], while maintaining clinically relevant sensitivity of (91.2%) [95% CI, 89.8-92.5]. If type and screens were ordered based upon the LightGBM model, the predicted type and screen to transfusion ratio would improve from 8.4 to 5.1. CONCLUSIONS Machine learning approaches are feasible in predicting intraoperative transfusion from preoperative variables and may improve preoperative type and screen ordering practices when incorporated into the electronic health record.
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Affiliation(s)
- Matthew A C Zapf
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Daniel V Fabbri
- Department of Biomedical Informatics and Department of Computer Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Andrews
- Department of Pathology, Microbiology and Immunology and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gen Li
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert E Freundlich
- Department of Anesthesiology and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samer Al-Droubi
- HealthIT Department, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan P Wanderer
- Department of Anesthesiology and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Brems JH, Balasubramanian A, Psoter KJ, Shah P, Bush EL, Merlo CA, McCormack MC. Race-Specific Interpretation of Spirometry: Impact on the Lung Allocation Score. Ann Am Thorac Soc 2023; 20:1408-1415. [PMID: 37315331 PMCID: PMC10559135 DOI: 10.1513/annalsats.202212-1004oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
Rationale: Interpretation of spirometry using race-specific reference equations may contribute to health disparities via underestimation of the degree of lung function impairment in Black patients. The use of race-specific equations may differentially affect patients with severe respiratory disease via the use of percentage predicted forced vital capacity (FVCpp) when included in the lung allocation score (LAS), the primary determinant of priority for lung transplantation. Objectives: To determine the impact of a race-specific versus a race-neutral approach to spirometry interpretation on the LAS among adults listed for lung transplantation in the United States. Methods: We developed a cohort from the United Network for Organ Sharing database including all White and Black adults listed for lung transplantation between January 7, 2009, and February 18, 2015. The LAS at listing was calculated for each patient under race-specific and race-neutral approaches, using the FVCpp generated from the Global Lung Function Initiative equation corresponding to each patient's race (race-specific) or from the Global Lung Function Initiative "other" (race-neutral) equation. Differences in LAS between approaches were compared by race, with positive values indicating a higher LAS under the race-neutral approach. Results: In this cohort of 8,982 patients, 90.3% were White and 9.7% were Black. The mean FVCpp was 4.4% higher versus 3.8% lower among White versus Black patients (P < 0.001) under a race-neutral compared with a race-specific approach. Compared with White patients, Black patients had a higher mean LAS under both a race-specific (41.9 vs. 43.9; P < 0.001) and a race-neutral (41.3 vs. 44.3; P < 0.001) approach. However, the mean difference in LAS under a race-neutral approach was -0.6 versus +0.6 for White versus Black patients (P < 0.001). Differences in LAS under a race-neutral approach were most pronounced for those in group B (pulmonary vascular disease) (-0.71 vs. +0.70; P < 0.001) and group D (restrictive lung disease) (-0.78 vs. +0.68; P < 0.001). Conclusions: A race-specific approach to spirometry interpretation has potential to adversely affect the care of Black patients with advanced respiratory disease. Compared with a race-neutral approach, a race-specific approach resulted in lower LASs for Black patients and higher LASs for White patients, which may have contributed to racially biased allocation of lung transplantation. The future use of race-specific equations must be carefully considered.
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Affiliation(s)
- J. Henry Brems
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Kevin J. Psoter
- Division of General Pediatrics, Department of Pediatrics, and
| | - Pali Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Errol L. Bush
- Division of Thoracic Surgery, Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Christian A. Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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19
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Lewis AE, Weiskopf N, Abrams ZB, Foraker R, Lai AM, Payne PRO, Gupta A. Electronic health record data quality assessment and tools: a systematic review. J Am Med Inform Assoc 2023; 30:1730-1740. [PMID: 37390812 PMCID: PMC10531113 DOI: 10.1093/jamia/ocad120] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE We extended a 2013 literature review on electronic health record (EHR) data quality assessment approaches and tools to determine recent improvements or changes in EHR data quality assessment methodologies. MATERIALS AND METHODS We completed a systematic review of PubMed articles from 2013 to April 2023 that discussed the quality assessment of EHR data. We screened and reviewed papers for the dimensions and methods defined in the original 2013 manuscript. We categorized papers as data quality outcomes of interest, tools, or opinion pieces. We abstracted and defined additional themes and methods though an iterative review process. RESULTS We included 103 papers in the review, of which 73 were data quality outcomes of interest papers, 22 were tools, and 8 were opinion pieces. The most common dimension of data quality assessed was completeness, followed by correctness, concordance, plausibility, and currency. We abstracted conformance and bias as 2 additional dimensions of data quality and structural agreement as an additional methodology. DISCUSSION There has been an increase in EHR data quality assessment publications since the original 2013 review. Consistent dimensions of EHR data quality continue to be assessed across applications. Despite consistent patterns of assessment, there still does not exist a standard approach for assessing EHR data quality. CONCLUSION Guidelines are needed for EHR data quality assessment to improve the efficiency, transparency, comparability, and interoperability of data quality assessment. These guidelines must be both scalable and flexible. Automation could be helpful in generalizing this process.
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Affiliation(s)
- Abigail E Lewis
- Division of Computational and Data Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nicole Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Zachary B Abrams
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randi Foraker
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Albert M Lai
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Aditi Gupta
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
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20
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Williams P. Retaining Race in Chronic Kidney Disease Diagnosis and Treatment. Cureus 2023; 15:e45054. [PMID: 37701164 PMCID: PMC10495104 DOI: 10.7759/cureus.45054] [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: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
The best overall measure of kidney function is glomerular filtration rate (GFR) as commonly estimated from serum creatinine concentrations (eGFRcr) using formulas that correct for the higher average creatinine concentrations in Blacks. After two decades of use, these formulas have come under scrutiny for estimating GFR differently in Blacks and non-Blacks. Discussions of whether to include race (Black vs. non-Black) in the calculation of eGFRcr fail to acknowledge that the original race-based eGFRcr provided the same CKD treatment recommendations for Blacks and non-Blacks based on directly (exogenously) measured GFR. Nevertheless, the National Kidney Foundation and the American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease removed race in CKD treatment guidelines and pushed for the immediate adoption of a race-free eGFRcr formula by physicians and clinical laboratories. This formula is projected to negate CKD in 5.51 million White and other non-Black adults and reclassify CKD to less severe stages in another 4.59 million non-Blacks, in order to expand treatment eligibility to 434,000 Blacks not previously diagnosed and to 584,000 Blacks previously diagnosed with less severe CKD. This review examines: 1) the validity of the arguments for removing the original race correction, and 2) the performance of the proposed replacement formula. Excluding race in the derivation of eGFRcr changed the statistical bias from +3.7 to -3.6 ml/min/1.73m2 in Blacks and from +0.5 to +3.9 in non-Blacks, i.e., promoting CKD diagnosis in Blacks at the cost of restricting diagnosis in non-Blacks. By doing so, the revised eGFRcr greatly exaggerates the purported racial disparity in CKD burden. Claims that the revised formulas identify heretofore undiagnosed CKD in Blacks are not supported when studies that used kidney failure replacement therapy and mortality are interpreted as proxies for baseline CKD. Alternatively, a race-stratified eGFRcr (i.e., separate equations for Blacks and non-Blacks) would provide the least biased eGFRcr for both Blacks and non-Blacks and the best medical treatment for all patients.
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Affiliation(s)
- Paul Williams
- Life Sciences, Lawrence Berkeley National Laboratory, Berkeley, USA
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21
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Khusid E, Lui B, Tangel VE, Jiang SY, Oxford C, Abramovitz SE, Weinstein ER, White RS. Patient- and Hospital- Level Disparities in Severe Maternal Morbidity: a Retrospective Multistate Analysis, 2015-2020. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01763-7. [PMID: 37610646 DOI: 10.1007/s40615-023-01763-7] [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: 06/02/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
The rate of severe maternal morbidity (SMM) in the United States (US) rose roughly 9% among all insured racial/ethnic groups between 2018 and 2020, disproportionately affecting racial and ethnic minority populations. Limited research on hospital-level factors and SMM found that even after adjusting for patient-level factors, women of all races delivering in high Black-serving delivery units had higher odds of SMM. Our retrospective cohort study augments the current understanding of multi-level racial/ethnic disparities in SMM by analyzing patient- and hospital- level factors using multistate data from 2015 to 2020. Because rises in SMM have been driven in part by an increase in blood transfusions, multivariable logistic regression models were employed to estimate the impact of patient- and hospital-level factors on the adjusted odds of experiencing any SMM, with and without blood transfusions, as well as blood transfusions alone. Our cohort consisted of 3,497,233 deliveries: 56,885 (1.63%) with any SMM, 16,070 (0.46%) with SMM excluding blood transfusion, and 45,468 (1.30%) with blood transfusions alone. We found that Black race, Hispanic ethnicity, and delivering at Black-serving delivery-units, both independently and interactively, increase the odds of any SMM with or without blood transfusions. Our findings illustrate the persistence of structural- and individual- level racial and ethnic disparities in maternal outcomes over time and emphasize the need for multi-level public policies to address racial/ethnic disparities in maternal healthcare.
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Affiliation(s)
- Elizabeth Khusid
- Weill Cornell Medical College, Weill Cornell Medicine, NY, New York, USA
| | - Briana Lui
- Weill Cornell Medical College, Weill Cornell Medicine, NY, New York, USA
| | - Virginia E Tangel
- Department of Anesthesiology, New York Presbyterian/Weill Cornell Hospital, 525 East 68th Street, M324, New York, NY, 10065, USA
| | - Silis Y Jiang
- Department of Anesthesiology, New York Presbyterian/Weill Cornell Hospital, 525 East 68th Street, M324, New York, NY, 10065, USA
| | - Corrina Oxford
- Department of Maternal and Fetal Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Sharon E Abramovitz
- Department of Anesthesiology, New York Presbyterian/Weill Cornell Hospital, 525 East 68th Street, M324, New York, NY, 10065, USA
| | - Eliana R Weinstein
- Department of Anesthesiology, New York Presbyterian/Weill Cornell Hospital, 525 East 68th Street, M324, New York, NY, 10065, USA
| | - Robert S White
- Department of Anesthesiology, New York Presbyterian/Weill Cornell Hospital, 525 East 68th Street, M324, New York, NY, 10065, USA.
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Rawat S, Mathe P, Unnithan VB, Kumar P, Abhishek K, Praveen N, Guleria K. Poor Representation of Developing Countries in Editorial Boards of Leading Obstetrics and Gynaecology Journals. Asian Bioeth Rev 2023; 15:241-258. [PMID: 37399006 PMCID: PMC9902818 DOI: 10.1007/s41649-023-00241-w] [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: 12/06/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Evidence suggests a limited contribution to the total research output in leading obstetrics and gynaecology journals by researchers from the developing world. Editorial bias, quality of scientific research produced and language barriers have been attributed as possible causes for this phenomenon. The aim of this study was to understand the prevalence of editorial board members based out of low and lower-middle income countries in leading journals in the field of obstetrics and gynaecology. The top 21 journals in the field of obstetrics and gynaecology were selected based on their impact factor, SCImago ranking and literature search. The composition of the editorial boards of these journals was studied based on World Bank Income Criteria to understand the representation status of researchers from low and lower-middle income countries. A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals. The majority of these editors belong to high-income countries (n = 1148; 87.3%). Low (n = 6; 0.45%) and lower-middle income (n = 55; 4.18%) countries make up for a very minuscule proportion of editorial board members. Only a meagre 9 out of 21 journals have editorial board members from these countries (42.85%). Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in research from these countries has grave consequences for a large proportion of the global population and multidisciplinary collaborative efforts must be taken to rapidly change this statistic with immediate effect.
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Affiliation(s)
- Seema Rawat
- Department of Obstetrics and Gynecology, University College of Medical Sciences, New Delhi, India
| | - Priyanka Mathe
- Department of Obstetrics and Gynecology, University College of Medical Sciences, New Delhi, India
| | | | - Pratyush Kumar
- Dr. Baba Saheb Ambedkar Medical College, New Delhi, India
| | - Kumar Abhishek
- Dr. Baba Saheb Ambedkar Medical College, New Delhi, India
| | - Nazia Praveen
- Department of Obstetrics and Gynecology, University College of Medical Sciences, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynecology, University College of Medical Sciences, New Delhi, India
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