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Lin SL. Immigrant and Racialized Populations' Cumulative Exposure to Discrimination and Associations with Long-Term Conditions During COVID-19: A Nationwide Large-Scale Study in Canada. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02074-1. [PMID: 39017775 DOI: 10.1007/s40615-024-02074-1] [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: 04/01/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND This cross-sectional study examines associations between the race-migration nexus, cumulative exposure to intersectional discrimination (2 years before and during the COVID-19 pandemic), and long-term conditions. METHODS A nationwide self-selected sample (n = 32,605) was obtained from a Statistics Canada's Crowdsourcing online survey from August 4 to 24, 2020. Binary and multinomial logistic regression models were used to examine disparities by the race-migration nexus in accumulative experiences of multiple situations- and identity-based discrimination and their relations with long-term conditions, after controlling for sociodemographic covariates. RESULTS During the pandemic, discrimination stemming from racialization - such as race/skin color (24.4% vs 20.1%) and ethnicity/culture (18.5% vs 16.5%) - and cyberspace (34.1% vs 29.8%) exaggerated relative to pre-pandemic period; compared to Canadian-born (CB) whites, the likelihood of experiencing multiple discrimination increased alongside the domains of discrimination being additively intersected (e.g., identity-based, all p's < 0.001) among CB racialized minorities (ORs 2.08 to 11.78), foreign-born (FB) racialized minorities (ORs 1.99 to 12.72), and Indigenous populations (ORs 1.62 to 8.17), except for FB whites (p > 0.01); dose-response relationships were found between cumulative exposure to multiple discrimination and odds of reporting long-term conditions (p's < 0.001), including seeing (ORs 1.63 to 2.99), hearing (ORs 1.83 to 4.45), physical (ORs 1.66 to 3.87), cognitive (ORs 1.81 to 3.79), and mental health-related impairments (ORs 1.82 to 3.41). CONCLUSIONS Despite a universal health system, Canadians who are CB/FB racialized and Indigenous populations, have a higher prevalence of cumulative exposure to different aspects of discrimination that are associated with multiple long-term conditions during the COVID-19 pandemic. Equity-driven solutions are needed to tackle upstream determinants of health inequalities through uprooting intersectional discrimination faced by racialized and immigrant communities.
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Affiliation(s)
- Shen Lamson Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
- Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom.
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Uwamahoro MC, Idowu J, Chowdhury N, Bele S, Popeski N, Boakye F, Odame-Ankrah C, King R, Rabi D, Turin TC. Defining the Black population in Canadian health research: a scoping review protocol. BMJ Open 2024; 14:e081296. [PMID: 38910001 DOI: 10.1136/bmjopen-2023-081296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION In the context of health research in Canada, various terms and labels have been employed to reference the Black population. This practice has had the unintended consequence of diminishing the comparability and efficiency of studies. Furthermore, using a broad term such as 'Black' may fail to encompass the diversity and intricacy of the ethnocultural backgrounds of people who are racialised as such. It may also obscure the subtleties of their experiences and health outcomes. This study aims to examine how health researchers have defined Black within the scope of their work and different labels used to identify the Black population in Canada. METHODS AND ANALYSIS We have developed and employed a comprehensive and sensitive search strategy to identify articles concerning the health and wellness of the Black population in Canada. Both peer-reviewed and grey literature will be searched. Original articles published in both English and French will be included. The screening process will consist of two stages: the title and abstract screening, followed by a thorough examination of full-text articles. Additionally, single citation tracking and manual search of reference lists will be conducted. Study characteristics and relevant information on the definition of the Black population will be extracted, followed by reflective thematic analysis and presentation of the key findings. ETHICS AND DISSEMINATION This review will not require ethical approval. We will disseminate the results through meetings with stakeholders. From the beginning, a knowledge translation approach was decided upon following consultation with citizen researchers and community champions. Our findings will also be disseminated through oral and poster presentations, peer-reviewed publications, and social media.
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Affiliation(s)
- Marie-Claire Uwamahoro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Idowu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nashit Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sumedh Bele
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naomi Popeski
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Regine King
- Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tanvir C Turin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mukhopadhyay B, Thambinathan V, Kinsella EA. Towards anti-racist futures: a scoping review exploring educational interventions that address systemic racism in post graduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10343-1. [PMID: 38874647 DOI: 10.1007/s10459-024-10343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
Since 2020, brought to the forefront by movements such as Black Lives Matter and Idle No More, it has been widely acknowledged that systemic racism contributes to racially differentiated health outcomes. Health professional educators have been called to address such disparities within healthcare, policy, and practice. To tackle structural racism within healthcare, one avenue that has emerged is the creation of medical education interventions within postgraduate residency medical programming. The objective of this scoping review is to examine the current literature on anti-racist educational interventions, that integrate a systemic or structural view of racism, within postgraduate medical education. Through the identification and analysis of 23 papers, this review identified three major components of interest across medical interventions, including (a) conceptualization, (b) pedagogical issues, and (c) outcomes & evaluation. There were overlapping points of discussion and analysis within each of these components. Conceptualization addressed how researchers conceptualized racism in different ways, the range of curricular content educators chose to challenge racism, and the absence of community's role in curricular development. Pedagogical issues addressed knowledge vs. skills-based teaching, and tensions between one-time workshops and integrative curriculum. Outcomes and evaluation highlighted self-reported Likert scales as dominant types of evaluation, self-evaluation in educational interventions, and misalignments between intervention outcomes and learning objectives. The findings are unique in their in-depth exploration of anti-racist medical interventions within postgraduate medical education programming, specifically in relation to efforts to address systemic and structural racism. The findings contribute a meaningful review of the current state of the field of medical education and generate new conversations about future possibilities for a broader anti-racist health professions curriculum.
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Affiliation(s)
- Baijayanta Mukhopadhyay
- Office of Social Accountability and Community Engagement, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada.
| | - Vivetha Thambinathan
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
| | - Elizabeth Anne Kinsella
- Department of Equity, Ethics and Policy, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
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Penning MJ, Browning SD, Haq KS, Kidd B. Framing Later Life Vulnerability during the COVID-19 Pandemic: A Content Analysis of Newspaper Coverage in Canada and the United States. Can J Aging 2024:1-11. [PMID: 38679941 DOI: 10.1017/s0714980824000175] [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: 05/01/2024] Open
Abstract
This study explores vulnerability narratives used in relation to older adults and others during the COVID-19 pandemic. A mixed-method content analysis was conducted of 391 articles published in two major newspapers in Canada and the USA during the first wave of the pandemic. The findings indicated that during the early months of the pandemic, limited attention was directed towards its impact on older adults or other 'vulnerable' subpopulations in both countries. Where evident, intrinsic (individual-level) risk factors were most consistently used to frame the vulnerability of older adults. In contrast, vulnerability was more likely to be framed as structural with regard to other subpopulations (e.g., ethno-racial minorities). These narratives also differed somewhat in Canadian and US newspapers. The framing of older adults as intrinsically vulnerable reflects ageist stereotypes and promotes downstream policy interventions. Greater attention is needed to the role of structural factors in influencing pandemic-related outcomes among older adults.
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Affiliation(s)
- Margaret J Penning
- Department of Sociology, University of Victoria, Victoria, BCV8W 3P5, Canada
| | - Sean D Browning
- Department of Sociology, University of Victoria, Victoria, BCV8W 3P5, Canada
| | - Kazi Sabrina Haq
- Department of Sociology, University of Victoria, Victoria, BCV8W 3P5, Canada
| | - Bodhin Kidd
- Department of Sociology, University of Victoria, Victoria, BCV8W 3P5, Canada
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5
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Olstad DL, Nejatinamini S, Blanchet R, Moubarac JC, Polsky J, Vanderlee L, Livingstone KM, Hosseini Pozveh S. Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada. SSM Popul Health 2023; 24:101496. [PMID: 37701069 PMCID: PMC10493595 DOI: 10.1016/j.ssmph.2023.101496] [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: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023] Open
Abstract
Background The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015. Methods Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015. Results Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable. Conclusions Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Rosanne Blanchet
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, 7101 Avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Jean-Claude Moubarac
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, Montréal, Québec, H3T 1A8, Canada
| | - Jane Polsky
- Health Analysis Division, Statistics Canada, 150 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Lana Vanderlee
- École de Nutrition, Université Laval, Québec, Québec, G1V 0A6, Canada
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap St, Geelong, Victoria, 3220, Australia
| | - Seyed Hosseini Pozveh
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Jetha A, Shahidi FV. Racism: A Neglected Piece of the Work Disability Management Puzzle. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:415-417. [PMID: 37563527 DOI: 10.1007/s10926-023-10133-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Arif Jetha
- Institute for Work & Health, 400 University Avenue, Suite 1800, Toronto, ON, M5G 1S5, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Faraz Vahid Shahidi
- Institute for Work & Health, 400 University Avenue, Suite 1800, Toronto, ON, M5G 1S5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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7
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Le D, Almaw RD, Rinaldi D, Ivanochko NK, Harris S, Benjamin A, Maly MR. Barriers and strategies for recruiting participants who identify as racial minorities in musculoskeletal health research: a scoping review. Front Public Health 2023; 11:1211520. [PMID: 37601207 PMCID: PMC10433765 DOI: 10.3389/fpubh.2023.1211520] [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: 05/05/2023] [Accepted: 06/20/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Visible minorities are disproportionately affected by musculoskeletal disorders (MSD) and other diseases; yet are largely underrepresented in health research. The purpose of this scoping review was to identify barriers and strategies associated with increasing recruitment of visible minorities in MSD research. Methods Electronic databases (MEDLINE, EMBASE, CINAHL, and PsycInfo) were searched. Search strategies used terms related to the concepts of 'race/ethnicity', 'participation', 'research' and 'musculoskeletal'. All research designs were included. Two reviewers independently screened titles and abstracts, completed full-text reviews, and extracted data. Papers that did not focus on musculoskeletal research, include racial minorities, or focus on participation in research were excluded. Study characteristics (study location, design and methods; sample characteristics (size, age, sex and race); MSD of interest) as well as barriers and strategies to increasing participation of visible minorities in MSD research were extracted from each article and summarized in a table format. Results Of the 4,282 articles identified, 28 met inclusion criteria and were included. The majority were conducted in the United States (27 articles). Of the included studies, the groups of visible minorities represented were Black (25 articles), Hispanic (14 articles), Asian (6 articles), Indigenous (3 articles), Middle Eastern (1 article), and Multiracial (1 article). The most commonly cited barriers to research participation were mistrust, logistical barriers (e.g., transportation, inaccessible study location, financial constraints), and lack of awareness or understanding of research. Strategies for increasing diversity were ensuring benefit of participants, recruiting through sites serving the community of interest, and addressing logistical barriers. Conclusion Understanding the importance of diversity in MSD research, collaborating with communities of visible minorities, and addressing logistical barriers may be effective in reducing barriers to the participation of visible minorities in health research. This review presents strategies to aid researchers in increasing inclusion in MSD-related research.
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Affiliation(s)
- Denise Le
- Department of Biology, University of Waterloo, Waterloo, ON, Canada
| | - Rachel D. Almaw
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Daniel Rinaldi
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Natasha K. Ivanochko
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheereen Harris
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Ashley Benjamin
- Department of Chemistry, University of Waterloo, Waterloo, ON, Canada
| | - Monica R. Maly
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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8
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Cruz-Kan K, Dufault B, Fesehaye L, Kornelsen J, Hrymak C, Zubert S, Ratana P, Leeies M. Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators. CAN J EMERG MED 2023; 25:617-626. [PMID: 37389771 DOI: 10.1007/s43678-023-00533-y] [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: 09/26/2022] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients. METHODS We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens. RESULTS A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism. CONCLUSIONS Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.
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Affiliation(s)
- Kanisha Cruz-Kan
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lula Fesehaye
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Jodi Kornelsen
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Shelly Zubert
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Paul Ratana
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada.
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Cénat JM, Dromer É, Darius WP, Dalexis RD, Furyk SE, Poisson H, Mansoub Bekarkhanechi F, Shah M, Diao DG, Gedeon AP, Lebel S, Labelle PR. Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review. Cancer 2023; 129:335-355. [PMID: 36436148 DOI: 10.1002/cncr.34551] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Canada, two of five individuals will be diagnosed with cancer in their lifetime and one in four will die from this disease. Given the disparities observed in health research among Black individuals, we conducted a scoping review to analyze the state of cancer research in Canadian Black communities regarding prevalence, incidence, screening, mortality, and related factors to observe advances and identify gaps and disparities. METHODS A comprehensive search strategy was developed and executed in December 2021 across 10 databases (e.g., Embase). Of 3451 studies generated by the search, 19 were retained for extraction and included in this study. RESULTS Studies were focused on a variety of cancer types among Black individuals including anal, breast, cervical, colorectal, gastric, lung, and prostate cancers. They included data on incidence, stage of cancer at diagnosis, type of care received, diagnostic interval length, and screening. A few studies also demonstrated racial disparities among Black individuals. This research reveals disparities in screening, incidence, and quality of care among Black individuals in Canada. CONCLUSIONS Given the gaps observed in cancer studies among Black individuals, federal and provincial governments and universities should consider creating special funds to generate research on this important health issue. PLAIN LANGUAGE SUMMARY Important gaps were observed on research on cancer among Black communities in Canada. Studies included in the scoping review highlights disparities in screening, incidence, and quality of care among Black individuals in Canada.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada.,University of Ottawa Research Chair on Black Health, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Élisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Hannah Poisson
- Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Muhammad Shah
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Guangyu Diao
- Faculty of Arts and Science, McGill University, Montreal, Quebec, Canada
| | | | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Foster N, Kapiriri L, Grignon M, McKenzie K. "But…I survived": A phenomenological study of the health and wellbeing of aging Black women in the Greater Toronto Area, Canada. J Women Aging 2023; 35:22-37. [PMID: 35635795 DOI: 10.1080/08952841.2022.2079925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Studies that assess the association between race and health have focused intently on the cumulative impact of continuous exposure to racism over an extended period. While these studies have contributed significantly to the general understanding of the life experiences and health status of racialized people, few studies have explicitly bridged the experiences of aging with gender and the wide structural barriers and social factors that have shaped the lives of racialized older women. This study aimed to investigate the origins of health inequities to highlight factors that intersect to affect the health and wellbeing of older Black women across their life course. Descriptive phenomenology was used to describe older Black women's health and wellbeing, and factors that impact their health across their life course. Criteria-based sampling was used to recruit study participants (n = 27). To be eligible women needed to be 55 years or older, speak English, self-identify as a Black female, and live in the Greater Toronto Area. Data analysis was guided by phenomenology. Themes identified demonstrated that participants' health and wellbeing were influenced by gender bias, racism, abuse, and retirement later in life. Participants reported having poor mental health during childhood and adulthood due to anxiety and depression. Other chronic illnesses reported included hypertension, diabetes, and cancer. Qualitative methods provided details regarding events and exposures that illuminate pathways through which health inequities emerge across the life course.
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Affiliation(s)
- Nicoda Foster
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
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11
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Morin SN, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D. Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Osteoporos Int 2022; 33:2637-2648. [PMID: 36044061 DOI: 10.1007/s00198-022-06539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
UNLABELLED Most of the published epidemiology on osteoporosis is derived from White populations; still many countries have increasing ethno-culturally diverse populations, leading to gaps in the development of population-specific effective fracture prevention strategies. We describe differences in prevalent fracture and bone mineral density patterns in Canadians of different racial/ethnic backgrounds. INTRODUCTION We described prevalent fracture and bone mineral density (BMD) patterns in Canadians by their racial/ethnic backgrounds. METHODS For this cross-sectional analysis, we used the Canadian Longitudinal Study on Aging baseline data (2011-2015) of 22,091 randomly selected participants of Black, East Asian, South or Southeast Asian (SSEA) and White race/ethnic backgrounds, aged 45-85 years with available information on the presence or absence of self-reported prevalent low trauma fractures and femoral neck BMD (FNBMD) measurement. Logistic and linear regression models examined associations of race/ethnic background with fracture and FNBMD, respectively. Covariates included sex, age, height, body mass index (BMI), grip strength and physical performance score. RESULTS We identified 11,166 women and 10,925 men. Self-reported race/ethnic backgrounds were: 139 Black, 205 East Asian, 269 SSEA and 21,478 White. White participants were older (mean 62.5 years) than the other groups (60.5 years) and had a higher BMI (28.0 kg/m2) than both Asian groups, but lower than the Black group. The population-weighted prevalence of falls was 10.0%, and that of low trauma fracture was 12.0% ranging from 3.3% (Black) to 12.3% (White), with Black and SSEA Canadians having lower adjusted odds ratios (aOR) of low trauma fractures than White Canadians (Black, aOR = 0.3 [95% confidence interval: 0.1-0.7]; SSEA, aOR = 0.5 [0.3-0.8]). The mean (SD) FNBMD varied between groups: Black, 0.907 g/cm2 (0.154); East Asian, 0.748 g/cm2 (0.119); SSEA, 0.769 g/cm2 (0.134); and White, 0.773 g/cm2 (0.128). Adjusted linear regressions suggested that Black and both Asian groups had higher FNBMD compared to White. CONCLUSION Our results support the importance of characterizing bone health predictors in Canadians of different race/ethnic backgrounds to tailor the development of population-specific fracture prevention strategies.
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Affiliation(s)
- Suzanne N Morin
- McGill University, Montreal, Quebec, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | | | | | - Elham Rahme
- McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | | | - David Goltzman
- McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
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12
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Bakhtiari E. Diminished Returns in Europe: Socioeconomic Status and Ethno-Racial Health Disparities Across 30 Countries in the European Social Survey. J Racial Ethn Health Disparities 2022; 9:2412-2426. [PMID: 35094375 DOI: 10.1007/s40615-021-01178-2] [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: 08/13/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022]
Abstract
Ethnic and racial minorities in many countries experience worse relative health outcomes and earlier mortality compared to national averages or outcomes of the majority population. Although socioeconomic status often contributes to a portion of ethno-racial health disparities, there are many unanswered questions about the relationship between socioeconomic status and ethno-racial health disparities across contexts. Recent scholarship in the USA has found support for a "diminished returns" effect in which the socioeconomic health gradient is systematically smaller for marginalized groups, yet it is unclear whether this pattern exists in other national contexts. This study tests the interaction between socioeconomic status and ethno-racial minority status in 30 countries across six waves of the European Social Survey. The results include evidence of the diminished returns pattern, particularly for populations with origins in Sub-Saharan Africa and the Middle East. Multilevel mixed-effects models find variation across countries in the interaction between socioeconomic status and ethno-racial minority status. The findings suggest racism and socioeconomic status interact to affect health and health disparities in multiple contexts and highlight the importance of cross-national comparison to further understand variation across countries.
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Affiliation(s)
- Elyas Bakhtiari
- Department of Sociology, William & Mary, 100 Ukrop Way, Williamsburg, VA, 23185, USA.
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13
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Unmet Need in People with Psoriasis and Skin of Color in Canada and the United States. Dermatol Ther (Heidelb) 2022; 12:2401-2413. [PMID: 36131193 PMCID: PMC9588130 DOI: 10.1007/s13555-022-00811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
The experience of dermatological conditions such as psoriasis is different for people with skin of color (SoC) than for white individuals. The objective of this literature review was to understand challenges and unmet needs associated with access to care, diagnosis, and treatment of psoriasis among people with SoC in Canada and the United States. The review focused on studies published in the last 5 years. After screening 919 unique records, 26 studies were included. Importantly, lack of culturally competent care was identified as a key unmet need for psoriasis among people with SoC. In addition, cost of care and cultural views of psoriasis may influence decisions to seek care among people with SoC. Baseline patient characteristics in psoriasis studies and the prevalence/incidence of psoriasis vary across racial/ethnic groups, which may reflect differences in the rate and/or timing of diagnosis. The presentation of psoriasis differs across racial/ethnic groups, which may contribute to challenges in proper and timely diagnosis. Compared with white patients with psoriasis, individuals with SoC may be less familiar with and have different rates of treatment with biologic therapies for psoriasis, are more likely to be hospitalized for psoriasis, and their access to physicians may differ. Further, people with SoC are underrepresented in clinical trials of psoriasis therapies. Overall, the results of this literature review suggest that people with psoriasis and SoC face unique challenges in their disease experience. It is essential that clinicians and other stakeholders recognize and address these disparities to ensure equitable care. Skin conditions such as psoriasis are experienced differently by people with skin of color (SoC) compared with white individuals. Although it is known that psoriasis can vary in how it appears between these groups, other factors that affect care for patients with SoC are not well understood. For this review, we focused on challenges associated with accessing healthcare, receiving a diagnosis, and receiving treatment for psoriasis among people with SoC. A search of the academic literature identified several such challenges for people with SoC in Canada and the United States. A major challenge for people with psoriasis and SoC is having access to care that is compatible with their cultural values and practices. The cost of healthcare and cultural views of psoriasis may influence whether individuals with SoC decide to seek care. People with SoC are more likely to be hospitalized for psoriasis, and their access to physicians may differ compared with white individuals. In addition, differences in how psoriasis appears across racial/ethnic groups may hinder diagnosis. Psoriasis treatments that patients with SoC receive may differ from those that white individuals receive, and people with SoC may be less likely to be properly represented in clinical trials evaluating psoriasis therapies. Taken together, the findings of our review indicate that people with psoriasis and SoC face unique challenges in how they receive medical care for their condition. It is essential that clinicians and other stakeholders in the healthcare system recognize these challenges and work to address them.
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14
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Zajacova A, Siddiqi A. A comparison of health and socioeconomic gradients in health between the United States and Canada. Soc Sci Med 2022; 306:115099. [PMID: 35779499 PMCID: PMC9383268 DOI: 10.1016/j.socscimed.2022.115099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
Data from the early 2000s indicated worse overall health and larger socioeconomic (SES) health inequalities in the U.S. than in Canada. Yet, sociopolitical contexts, health levels, and SES-health inequalities have changed in both countries during the intervening two decades. Drawing on new data, we update the comparison of health levels and SES-health gradients between the two countries. Analyses, focused on self-rated health, are based on two complementary sets of data sources: Resilience and Recovery (RR) data, a harmonized U.S.-Canada survey of social conditions collected in 2020 (N = 3743); and a pair of leading nationally representative health data sources from each country: the National Health Interview Surveys (NHIS, N = 104,027) and the Canadian Community Health Survey (CCHS, N = 97,605), both collected in 2017-2018. Health levels and disparities, net of demographic and socioeconomic covariates, were estimated using modified Poisson models for relative comparisons; descriptives and predicted levels of fair/poor health show the comparisons from absolute perspective. Both data sources show that U.S. adults continue to have significantly worse health than Canadians; the disadvantage may be due to SES differences between the two populations. However, the two data sources yield conflicting findings on SES-health inequalities: the RR data indicate no difference between the two countries in socioeconomic health gradients, while the NHIS/CCHS data show a significantly steeper gradient in the U.S. than in Canada for both education and income. Canadian adults continue to report better health than their U.S. peers, but it is unclear whether health inequalities remain smaller as well. We discuss potential reasons for the conflicting findings and call for a large new cross-national data collection, which will enable scholars and policymakers to better understand health and wellbeing in the U.S. and Canadian contexts.
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Affiliation(s)
- Anna Zajacova
- 5330 Social Science Centre, University of Western Ontario, London, ON, N6A 5C2, Canada.
| | - Arjumand Siddiqi
- University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada
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15
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Fisher S, Bennett C, Hennessy D, Finès P, Jessri M, Bader Eddeen A, Frank J, Robertson T, Taljaard M, Rosella LC, Sanmartin C, Jha P, Leyland A, Manuel DG. Comparison of mortality hazard ratios associated with health behaviours in Canada and the United States: a population-based linked health survey study. BMC Public Health 2022; 22:478. [PMID: 35272641 PMCID: PMC8915535 DOI: 10.1186/s12889-022-12849-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications. METHODS The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history. RESULTS A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a 'healthy profile' was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada. CONCLUSION Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development.
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Affiliation(s)
- Stacey Fisher
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa and Toronto, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Carol Bennett
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa and Toronto, Ontario, Canada
| | | | | | - Mahsa Jessri
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa and Toronto, Ontario, Canada.,Statistics Canada, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa and Toronto, Ontario, Canada
| | - John Frank
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Tony Robertson
- Centre for Public Health and Population Health Research, Faculty of Health Sciences & Sport, University of Stirling, Stirling, Scotland
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Laura C Rosella
- ICES, Ottawa and Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Prabhat Jha
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,ICES, Ottawa and Toronto, Ontario, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. .,Statistics Canada, Ottawa, Ontario, Canada. .,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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16
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Urrutia D, Manetti E, Williamson M, Lequy E. Overview of Canada's Answer to the COVID-19 Pandemic's First Wave (January-April 2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137131. [PMID: 34281075 PMCID: PMC8297373 DOI: 10.3390/ijerph18137131] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 01/09/2023]
Abstract
Canada is a federal state of almost 38 million inhabitants distributed over ten provinces and three territories, each with their own power regarding health. This case study describes the health infrastructures’ situation before the COVID-19 outbreak and their adaptations to face the expected cases, the available epidemiologic data for the beginning of the first wave (January–April 2020), and the public health and economic measures taken to control the pandemic both at the federal level and breaking down by province and territory. Canadian health infrastructures offered on average 12.9 intensive care units beds per 100,000 (occupancy rate ~90% before the outbreak), unevenly distributed across provinces and territories. Canada implemented public health measures, such as social distancing, when hospitalization and death rates due to the pandemic were still lower than in other countries; each province and territory adapted and implemented specific measures. Cumulated cases and deaths substantially increased from mid-March 2020, reaching 65 cases and 2 deaths per 100,000 on April 12, with strong differences across provinces and territories. Canada has been affected by the COVID-19 pandemic’s first wave with a generally slower dynamic than in the USA or in the European Union at the same period. This suggests that implementation of public health measures when health indicators were still low may have been efficient in Canada; yet the long-term care sector faced many challenges in some provinces, which drove a large part of the pandemic indicators.
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Affiliation(s)
- Deborah Urrutia
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland; (D.U.); (M.W.)
| | - Elisa Manetti
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland; (D.U.); (M.W.)
- Correspondence: ; Tel.: +41-78-342-08-72
| | - Megan Williamson
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland; (D.U.); (M.W.)
| | - Emeline Lequy
- Centre de Recherche du Centre Hospitalier de L’université de Montréal, Montréal, QC H2X 0A9, Canada;
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17
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Access to health care among racialised immigrants to Canada in later life: a theoretical and empirical synthesis. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x20001841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.
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18
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Mahabir DF, O’Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Experiences of everyday racism in Toronto's health care system: a concept mapping study. Int J Equity Health 2021; 20:74. [PMID: 33691682 PMCID: PMC7943708 DOI: 10.1186/s12939-021-01410-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/14/2021] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.
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Affiliation(s)
- Deb Finn Mahabir
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada
| | - Aisha Lofters
- Women’s College Hospital, 76 Grenville St., Toronto, M5S 1B2 Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5 Canada
| | - Christina Salmon
- Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1T8 Canada
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7 Canada
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19
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Lacey KK, Briggs AQ, Park J, Jackson JS. Social and economic influences on disparities in the health of racial and ethnic group Canadian immigrants. Canadian Journal of Public Health 2021; 112:482-492. [PMID: 33417191 DOI: 10.17269/s41997-020-00446-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine social, economic, and migratory influences on the health of racial and ethnic minority groups in Canada, with a special focus on Caribbean immigrants. METHODS Combined annual cycles (2011-2016) of the Canadian Community Health Survey (CCHS) data totaling over 300,000 adult Canadian residents were aggregated. Descriptive statistics and multivariable logistic regression models were used to examine the prevalence and associated factors of (1) cardiovascular disease diagnosed by a healthcare professional, and (2) self-rated general health among racial and ethnic groups. RESULTS Caribbeans in general, Black and other non-White Canadians had significantly higher odds (adjusted for age/sex) of reporting any cardiovascular disease compared with White Canadians. Only non-Caribbean Blacks had higher odds of self-rated fair or poor general health compared with White Canadians. Multivariate logistic regression models revealed that after controlling for social and demographic factors, immigration status and years since migration, Caribbean non-Blacks and Black Caribbeans were at higher odds of having a doctor-reported cardiovascular health condition compared with White Canadians. Caribbean non-Blacks also had higher odds of fair or poor self-rated health than White Canadians. CONCLUSION The results of this study highlight the need for additional investigations of other potential influences on physical health statuses, especially among migrants and those of African ancestry who might be more prone to adverse health outcomes.
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Affiliation(s)
- Krim K Lacey
- University of Michigan-Dearborn, Dearborn, MI, USA.
| | - Anthony Q Briggs
- Grossman School of Medicine, Department of Population Health, New York University, New York, NY, USA
| | - Jungwee Park
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - James S Jackson
- Department of Psychology and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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20
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Waldner D, Harrison R, Johnstone J, Saxinger L, Webster D, Sligl W. COVID-19 epidemiology in Canada from January to December 2020: the pre-vaccine era. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This paper summarizes COVID-19 disease epidemiology in Canada in the pre-vaccine era—from January through to December 2020. Canadian case numbers, risk factors, disease presentations (including severe and critical disease), and outcomes are described. Differences between provinces and territories in geography, population size and density, health demographics, and pandemic impact are highlighted. Key concepts in public health response and mitigation are reviewed, including masking, physical distancing, hand washing, and the promotion of outdoor interactions. Adequate investment in public health infrastructure is stressed, and regional differences in screening and testing strategies are highlighted. The spread of COVID-19 in Canadian workplaces, long-term care homes, and schools is described and lessons learned emphasized. The impact of COVID-19 on vulnerable populations in Canada—including Indigenous Peoples, ethnic minorities and newcomers, people who use drugs, people who are homeless, people who are incarcerated, and people with disabilities—is described. Sex and gender disparities are also highlighted. Author recommendations include strategies to reduce transmission (such as test–trace–isolate), the establishment of nationally standardized definitions and public reporting, the protection of high risk and vulnerable populations, and the development of a national strategy on vaccine allocation.
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Affiliation(s)
| | | | | | | | | | - Wendy Sligl
- University of Alberta, Edmonton, AB T6G 2B7, Canada
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21
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Amoud R, Grindrod K, Cooke M, Alsabbagh MW. The Impact of Prescription Medication Cost Coverage on Oral Medication Use for Hypertension and Type 2 Diabetes Mellitus. Healthc Policy 2020; 16:82-100. [PMID: 33337316 PMCID: PMC7710965 DOI: 10.12927/hcpol.2020.26351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND No previous study, to the best of our knowledge, has examined both the time trend and impact of not having insurance or prescription medication cost coverage (PMCC) on the usage of type 2 diabetes and hypertension oral medications in Ontario and New Brunswick, Canada. METHODS We used data from the Canadian Community Health Survey (CCHS) from 2007 to 2014 to examine the time trend and impact of PMCC. A multivariable-adjusted logistic regression model was fitted. RESULTS The pseudo-cohort included 23,215 individuals representing a population of approximately 8.7 million people. Overall, 20.0% of respondents reported absence of PMCC. This proportion increased slightly from 19.6% (95% confidence interval [CI] 95% CI [17.5, 22.5]) to 20.7% (95% CI [16.9, 23.1]). Adjusted odds ratios (OR) showed that uninsured individuals were 23% less likely to use their medications (OR = 0.77, 95% CI [0.657, 0.911]). CONCLUSION There was a slight decline in PMCC over time and this decline was associated with reduced use of medications for type 2 diabetes and hypertension.
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Affiliation(s)
- Razan Amoud
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
| | - Kelly Grindrod
- Associate Professor, School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
| | - Martin Cooke
- Associate Professor, School of Public Health and Health Systems, Faculty of Applied Health Sciences, Department of Sociology and Legal Studies, Faculty of Arts, University of Waterloo, Waterloo, ON
| | - Mhd Wasem Alsabbagh
- Assistant Professor, School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
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22
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Plessas A, McCormack J, Kafantaris I. The Potential Role of Applied Behavior Analysis in the Cultural Environment of Māori Mental Health. Behav Anal Pract 2019; 12:854-868. [PMID: 31976298 PMCID: PMC6834803 DOI: 10.1007/s40617-019-00359-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Significant mental health disparity exists in Aotearoa New Zealand between Māori and the non-Māori majority. Although much has been written about mental health and the cultural competence of health professionals, cultural context has not been specifically considered within the behavioral paradigm, and it was placed in the center of practice in multicultural societies by the behavioral community only recently. In this article, we discuss some of the problems encountered by Māori in the mental health system and the role of behavior analysts in addressing the divide in service provision. Dialogue with other disciplines that investigate the importance of indigenous cultural values is necessary. We conclude with some suggestions about strategies that may be implemented across services by behavior analysts in order to improve mental health outcomes for Māori.
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Affiliation(s)
- Anna Plessas
- Monorodi Association, 247 Pan. Tsaldari, Kallithea, Athens, Greece
| | - Jessica McCormack
- School of Psychology, University of Auckland, Science Centre, 23 Symonds Street, Auckland, New Zealand
| | - Ignatios Kafantaris
- iCAMHS, Lakes District Health Board, Children’s Hub and Library, Rotorua, New Zealand
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23
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Growing sense of social status threat and concomitant deaths of despair among whites. SSM Popul Health 2019; 9:100449. [PMID: 31993479 PMCID: PMC6978487 DOI: 10.1016/j.ssmph.2019.100449] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/17/2019] [Accepted: 07/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background A startling population health phenomenon has been unfolding since the turn of the 21st century. Whites in the United States, who customarily have the most favorable mortality profile of all racial groups, have experienced rising mortality rates, without a commensurate rise in other racial groups. The two leading hypotheses to date are that either contemporaneous economic conditions or longer-term (post-1970s) economic transformations have led to declining economic and social prospects of low-educated whites, culminating in “deaths of despair.” We re-examine these hypotheses and investigate a third hypothesis: mortality increases are attributable to (false) perceptions of whites that they are losing social status. Methods Using administrative and survey data, we examined trends and correlations between race-, age- and, education-specific mortality and a range of economic and social indicators. We also conducted a county-level fixed effects model to determine whether changes in the Republican share of voters during presidential elections, as a marker of growing perceptions of social status threat, was associated with changes in working-age white mortality from 2000 to 2016, adjusting for demographic and economic covariates. Findings Rising white mortality is not restricted to the lowest education bracket and is occurring deeper into the educational distribution. Neither short-term nor long-term economic factors can themselves account for rising white mortality, because parallel trends (and more adverse levels) of these factors were being experienced by blacks, whose mortality rates are not rising. Instead, perceptions – misperceptions – of whites that their social status is being threatened by their declining economic circumstances seems best able to reconcile the observed population health patterns. Conclusion Rising white mortality in the United States is not explained by traditional social and economic population health indicators, but instead by a perceived decline in relative group status on the part of whites – despite no actual loss in relative group position. Rising U.S. white mortality is wide-sweeping, spanning all education levels. Economic conditions of whites are declining in absolute, but not relative terms. Declining absolute economic conditions of whites do not explain their rising mortality. Rising white Mortality is better explained by perceived loss of relative status.
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24
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Del Pino S, Sánchez-Montoya SB, Guzmán JM, Mújica OJ, Gómez-Salgado J, Ruiz-Frutos C. Health Inequalities amongst People of African Descent in the Americas, 2005-2017: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3302. [PMID: 31500391 PMCID: PMC6765792 DOI: 10.3390/ijerph16183302] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 12/01/2022]
Abstract
Ethnic inequalities are often associated with social determinants of health. This study seeks to identify the latest scientific evidence on inequalities in the health of people of African descent in the Americas. For this, a systematic review of the literature on health and people of African descent in the Americas was carried out in the LILACS, PubMed, MEDLINE, and IBECS databases. Institutional and academic repositories were also consulted. Evidence was obtained on the presence and persistence of health inequalities in the population of African descent in the Americas from the identification of five types of quantitative and qualitative evidence: (1) ethnic/racial concept and variables; (2) relations with other social determinants; (3) health risks; (4) barriers and inequalities in health services; and, (5) morbi-mortality from chronic diseases. Studies with qualitative methods revealed invisibility, stereotypes, and rejection or exclusion as main factors of inequality. This review evidenced the existence of health inequalities, its interconnection with other adverse social determinants and risk factors, and its generation and perpetuation by discrimination, marginalization, and social disadvantage. These conditions make people of African descent a priority population group for action on equity, as demanded by the 2030 Agenda for Sustainable Development.
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Affiliation(s)
- Sandra Del Pino
- Cultural Diversity, Office of Equity, Gender and Cultural Diversity, Pan American Health Organization, PAHO/WHO, Washington, DC 20037, USA.
| | | | - José Milton Guzmán
- Health and Cultural Diversity, El Chaco Region, Pan American Health Organization, PAHO/WHO, Asuncion 595-21, Paraguay.
| | - Oscar J Mújica
- Social Epidemiology and Health Equity, Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC 20037, USA.
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain.
- Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain.
- Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
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Akee R, Jones MR, Porter SR. Race Matters: Income Shares, Income Inequality, and Income Mobility for All U.S. Races. Demography 2019; 56:999-1021. [DOI: 10.1007/s13524-019-00773-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Using unique linked data, we examine income inequality and mobility across racial and ethnic groups in the United States. Our data encompass the universe of income tax filers in the United States for the period 2000–2014, matched with individual-level race and ethnicity information from multiple censuses and American Community Survey data. We document both income inequality and mobility trends over the period. We find significant stratification in terms of average incomes by racial/ethnic group and distinct differences in within-group income inequality. The groups with the highest incomes—whites and Asians—also have the highest levels of within-group inequality and the lowest levels of within-group mobility. The reverse is true for the lowest-income groups: blacks, American Indians, and Hispanics have lower within-group inequality and immobility. On the other hand, low-income groups are also highly immobile in terms of overall, rather than within-group, mobility. These same groups also have a higher probability of experiencing downward mobility compared with whites and Asians. We also find that within-group income inequality increased for all groups between 2000 and 2014, and the increase was especially large for whites. The picture that emerges from our analysis is of a rigid income structure, with mainly whites and Asians positioned at the top and blacks, American Indians, and Hispanics confined to the bottom.
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Affiliation(s)
- Randall Akee
- Economic Studies, Brookings Institution, 1775 Massachusetts Avenue NW, Washington, DC 20036, USA
- Department of Public Policy, UCLA, 3250 Public Affairs Building, Los Angeles, CA 90095-1656, USA
- National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138, USA
| | - Maggie R. Jones
- U.S. Census Bureau, Center for Economic Studies, 4600 Silver Hill Road, Suitland, MD 20746, USA
| | - Sonya R. Porter
- U.S. Census Bureau, Center for Economic Studies, 4600 Silver Hill Road, Suitland, MD 20746, USA
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Escobar KM, Murariu D, Munro S, Gorey KM. Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis. J Public Health Res 2019; 8:1479. [PMID: 30997359 PMCID: PMC6444377 DOI: 10.4081/jphr.2019.1479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/22/2019] [Indexed: 01/19/2023] Open
Abstract
This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians' chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states. Canada's single payer system ought to be maintained and strengthened, but not through privatization.
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Affiliation(s)
| | | | - Sharon Munro
- Leddy Library, University of Windsor, ON, Canada
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Veenstra G. Black, White, Black and White: mixed race and health in Canada. ETHNICITY & HEALTH 2019; 24:113-124. [PMID: 28393550 DOI: 10.1080/13557858.2017.1315374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/18/2017] [Indexed: 06/07/2023]
Abstract
Objectives: To document inequalities in hypertension, self-rated health, and self-rated mental health between Canadian adults who identify as Black, White, or Black and White and determine whether differences in educational attainment and household income explain them. Design: The dataset was comprised of ten cycles (2001-2013) of the Canadian Community Health Survey. The health inequalities were examined by way of binary logistic regression modeling of hypertension and multinomial logistic regression modeling of self-rated health and self-rated mental health. Educational attainment and household income were investigated as potentially mediating factors using nested models and the Karlson-Holm-Breen decomposition technique. Results: Black respondents were significantly more likely than White respondents to report hypertension, a disparity that was partly attributable to differences in income. White respondents reported the best and Black respondents reported the worst overall self-rated health, a disparity that was entirely attributable to income differences. Respondents who identified as both Black and White were significantly more likely than White respondents to report fair or poor mental health, a disparity that was partly attributable to income differences. After controlling for income, Black respondents were significantly less likely than White respondents to report fair or poor mental health. Educational attainment did not contribute to explaining any of these associations. Conclusion: Canadians who identify as both Black and White fall between Black Canadians and White Canadians in regards to self-rated overall health, report the worst self-rated mental health of the three populations, and, with White Canadians, are the least likely to report hypertension. These heterogeneous findings are indicative of a range of diverse processes operative in the production of Black-White health inequalities in Canada.
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Affiliation(s)
- Gerry Veenstra
- a Department of Sociology , University of British Columbia , Vancouver , Canada
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Abstract
In the past few decades, most new immigrants to Canada have originated from non-Christian countries. During the same period, the unaffiliation rates have sharply increased in Canada. This paper investigates whether there are any health inequalities associated with religious identity, including also the individuals who do not identify with organized religion in the analysis. The study uses the Canadian General Social Survey of 2012 (N = 23,093), focused on Caregiving and Care-receiving. Employing multivariate regression analysis and controlling for a large set of characteristics inclusive of the degree of religious commitment, individuals who identify as Protestant are found at a physical and mental health advantage, compared with Roman Catholics and most other groups. On the other hand, individuals who identify as Jehovah's Witnesses are found at a considerable physical health disadvantage. Among the unaffiliated individuals, those who have retained some ties with organized religion without formally identifying with it are found at a mental health disadvantage compared with all religious groups, as well as the secular individuals who are strictly committed to their nonreligious views. Possible causes and various implications are discussed.
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Affiliation(s)
- Maryam Dilmaghani
- Department of Economics, Sobey School of Business, Saint Mary's University, 923 Robie Street, Halifax, NS, B3H 3C3, Canada.
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29
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Lin CY, Loyola-Sanchez A, Hurd K, Ferucci ED, Crane L, Healy B, Barnabe C. Characterization of indigenous community engagement in arthritis studies conducted in Canada, United States of America, Australia and New Zealand. Semin Arthritis Rheum 2019; 49:145-155. [PMID: 30598333 DOI: 10.1016/j.semarthrit.2018.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/21/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Research adhering to community engagement processes leads to improved outcomes. The level of Indigenous communities' engagement in rheumatology research is unknown. OBJECTIVE To characterize the frequency and level of community engagement reporting in arthritis studies conducted in Australia (AUS), Canada (CAN), New Zealand (NZ) and the United States of America (USA). METHODS Studies identified through systematic reviews on topics of arthritis epidemiology, disease phenotypes and outcomes, health service utilization and mortality in Indigenous populations of AUS, CAN, NZ and USA, were evaluated for their descriptions of community engagement. The level of community engagement during inception, data collection and results interpretation/dissemination stages of research was evaluated using a custom-made instrument, which ranked studies along the community engagement spectrum (i.e. inform-consult-involve-collaborate-empower). Meaningful community engagement was defined as involving, collaborating or empowering communities. Descriptive analyses for community engagement were performed and secondary non-parametric inferential analyses were conducted to evaluate the possible associations between year of publication, origin of the research idea, publication type and region of study; and meaningful community engagement. RESULTS Only 34% (n = 69) of the 205 studies identified reported community engagement at ≥ 1 stage of research. Nearly all studies that engaged communities (99% (n = 68)) did so during data collection, while only 10% (n = 7) did so at the inception of research and 16% (n = 11) described community engagement at the results' interpretation/dissemination stage. Most studies provided community engagement descriptions that were assessed to be at the lower end of the spectrum. At the inception of research stage, 3 studies reported consulting communities, while 42 studies reported community consultation at data collection stage and 4 studies reported informing or consulting communities at the interpretation/dissemination of results stage. Only 4 studies described meaningful community engagement through all stages of the research. Inferential statistics identified that studies with research ideas that originated from the Indigenous communities involved were significantly more associated with achieving meaningful community engagement. CONCLUSIONS The reporting of Indigenous community engagement in published arthritis studies is limited in frequency and is most frequently described at the lower end of the community engagement spectrum. Processes that support meaningful community engagement are to be promoted.
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Affiliation(s)
- Chu Yang Lin
- Faculty of Medicine & Dentistry, University of Alberta, Canada.
| | | | - Kelle Hurd
- Cumming School of Medicine, University of Calgary, Canada.
| | | | | | - Bonnie Healy
- Alberta First Nations Information Governance Center, Canada.
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary and Rheumatologist, Alberta Health Services, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada.
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Loggins Clay S, Griffin M, Averhart W. Black/White disparities in pregnant women in the United States: An examination of risk factors associated with Black/White racial identity. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:654-663. [PMID: 29488271 DOI: 10.1111/hsc.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
This paper explores racial disparities and risk factors of adverse pregnancy outcomes in Black and White pregnant women in the US. The study uses a cross-sectional approach to explore Black and White disparities using data from the 2012 National Survey on Drug Use and Health (NSDUH), which collects interview data from approximately 70,000 randomly selected participants. We included several self-reported conditions that we categorised as individual and social stressors (e.g. measures of institutionalised racism, individual health behaviours, access to quality care and social context factors). We used descriptive statistics, univariate and multivariate analyses in risk factors of adverse pregnancy outcomes between Black and White women. Black women who were pregnant had a lower socioeconomic status and experienced more measures of institutionalised racism compared to White women who were pregnant. More white women who were pregnant were married, had higher levels of educational attainment, higher income levels, and greater employment opportunities. White pregnant women also had higher levels of private health insurance and less dependency on government programmes for access to healthcare. Results from the regressions indicated that Black pregnant women were less likely to be married (OR = 0.01), less likely to have higher income levels (OR = 0.31) and less likely to be employed (OR = 0.52). However, Black pregnant women were more likely to be younger (OR = 1.82). For the health-eroding behaviours, Black pregnant women were less likely to smoke (OR = 0.53) and use alcohol (0.52). After assessing the SES Household-level stressors (access to healthcare), Black pregnant women were more likely to have Medicaid/CHIP (OR = 3.21) and health coverage through government assistant programmes (OR = 3.80); however, less likely to have private health insurance (OR = 0.38). There are differences in risk factors of adverse pregnancy outcomes between White and Black pregnant women based on measures of individual level/social stressors, institutionalised racism, health behaviours and access to care.
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Affiliation(s)
- Shondra Loggins Clay
- Counseling Center, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Marquianna Griffin
- Chapin Hall Center for Children, Data and Research Technology Liason, Oak Park, IL, USA
| | - Wanda Averhart
- Department of Pediatrics' General Pediatrics Division, University of Florida, Gainesville, FL, USA
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Trinh E, Na Y, Sood MM, Chan CT, Perl J. Racial Differences in Home Dialysis Utilization and Outcomes in Canada. Clin J Am Soc Nephrol 2017; 12:1841-1851. [PMID: 28835369 PMCID: PMC5672971 DOI: 10.2215/cjn.03820417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Data on racial disparities in home dialysis utilization and outcomes are lacking in Canada, where health care is universally available. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied patients starting maintenance dialysis between 1996 and 2012 in the Canadian Organ Replacement Register, stratified by race: white, Asian, black, Aboriginal, Indian subcontinent, and other. The association between race and treatment with home dialysis was examined using generalized linear models. Secondary outcomes assessed racial differences in all-cause mortality and technique failure using a Fine and Gray competing risk model. RESULTS 66,600 patients initiated chronic dialysis between 1996 and 2012. Compared with whites (n=46,092), treatment with home dialysis was lower among Aboriginals (n=3866; adjusted relative risk, RR, 0.71; 95% confidence interval, CI, 0.66 to 0.76) and higher in Asians (n=4157; adjusted RR, 1.28; 95% CI, 1.22 to 1.35) and others (n=2170; adjusted RR, 1.12; 95% CI, 1.04 to 1.20) but similar in blacks (n=2143) and subcontinent Indians (n=2809). Black (adjusted hazard ratio, HR, 1.31; 95% CI, 1.16 to 1.48) and Aboriginal (adjusted HR, 1.19; 95% CI, 1.06 to 1.33) patients treated with peritoneal dialysis had a significantly higher adjusted risk of technique failure compared with whites, whereas Asians had a lower risk (adjusted HR, 0.89; 95% CI, 0.82 to 0.99). In patients on peritoneal dialysis, the risk of death was significantly lower in Asians (adjusted HR, 0.83; 95% CI, 0.75 to 0.92), blacks (adjusted HR, 0.71; 95% CI, 0.59 to 0.85), and others (adjusted HR, 0.79; 95% CI, 0.68 to 0.92) but higher in Aboriginals (adjusted HR, 1.16; 95% CI, 1.02 to 1.32) compared with whites. Among patients on home hemodialysis, no significant racial differences in patient and technique survival were observed, which may be limited by the low number of events among each subgroups. CONCLUSIONS With the exception of Aboriginals, all racial minority groups in Canada were as likely to be treated with home dialysis compared with whites. However, significant racial differences exist in outcomes.
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Yingbo Na
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
| | - Manish M. Sood
- Division of Nephrology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jeffrey Perl
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
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Siddiqi A, Shahidi FV, Ramraj C, Williams DR. Associations between race, discrimination and risk for chronic disease in a population-based sample from Canada. Soc Sci Med 2017; 194:135-141. [PMID: 29100138 DOI: 10.1016/j.socscimed.2017.10.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/11/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022]
Abstract
A major epidemiological finding emerging from studies using U.S. samples is that racial differences in experiences of discrimination are associated with racial differences in health. A newer area of research is exploring the population-level dynamics between race, discrimination, and health status in various societies. The objective of this study is to assess for the first time in a national sample from Canada: (a) racial differences in experiences of discrimination and, (b) the association between discrimination and chronic conditions and their major risk factors. Data were obtained from the 2013 Canadian Community Health Survey (n = 16,836). Race was categorized as Aboriginal, Asian, Black, or White. Discrimination was measured using the Williams Everyday Discrimination Scale. Outcomes included having any chronic condition or major risk factors (obesity, hypertension, smoking, binge drinking, infrequent physical activity, and poor self-rated health). Crude and adjusted (for age, sex, immigrant status, socioeconomics) logistic regressions modeled the association between (a) race and discrimination and, (b) discrimination and each outcome. Results indicated that Blacks were most likely to experience discrimination, followed by Aboriginals. For example, Blacks were almost twice as likely (OR: 1.92, 95% CI: 1.19-3.11), and Aboriginals 75 percent more likely (OR: 1.75, 95% CI: 1.37-2.22) to report being treated with less courtesy or respect than others. Blacks were more than four times as likely (OR: 4.27, 95% CI: 2.23-8.19), and Aboriginals more than twice as likely (OR: 2.26, 95% CI: 1.66-3.08) to report being feared by others. Asians were not statistically different from Whites. With two exceptions (binge drinking and physical activity), discrimination was associated with chronic conditions and their risk factors (OR for any chronic condition: 1.78, 95% CI: 1.52-2.08). Initial results suggest that in Canada, experience of discrimination is a determinant of chronic disease and chronic disease risk factors, and Blacks and Aboriginals are far more exposed to experiences of discrimination.
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Affiliation(s)
- Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, United States.
| | - Faraz Vahid Shahidi
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Chantel Ramraj
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Boston, United States; Departments of African and African American Studies and Sociology, Harvard University, Cambridge, United States
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