Racial Non-equivalence of Socioeconomic Status and Self-rated Health among African Americans and Whites

High Systolic Blood Pressure of High-Income African American Children

BACKGROUND

According to the Minorities' Diminished Returns (MDRs) theory, racism may reduce the health returns of family socioeconomic status (SEP) resources such as family income for racial minorities, particularly African Americans, compared to Whites. However, we are unaware of any previous studies on racial variation in the protective effects of family income on children's blood pressure.

AIM

We conducted this study to compare the overall effects of family income on pre-adolescents' systolic and diastolic blood pressure, test racial variation in this effect, and investigate whether racial variation in this regard is due to racial differences in body mass index.

METHODS

In this cross-sectional study, we analyzed data from 4007 racially diverse US children 9-10 years old. The independent variable was family income measured as a three-level categorical variable: less than $50 K USD, 50-100 K USD, and 100 + K USD. The primary outcomes were systolic and diastolic blood pressure measured up to three times at 1-min time intervals. Body mass index was the mediator. Mixed-effects regression models were used for data analysis to adjust for data nested to the centers, families, and individuals. Age, gender, parental education, family structure, and Latino ethnicity were covariates.

RESULTS

In the pooled sample and in the absence of interaction terms in the model, family income did not show an inverse association with children's systolic (for 100 + K USD family income: β =  - 0.71, p = 0.233 and for 50-100 K USD family income: β = 0.01, p = 0.989) or diastolic blood pressure (for 100 + K USD family income: β =  - 0.66, p = 0.172 and for 50-100 K USD family income: β = 0.23, p = 0.600). However, race showed a significant interaction with family income on systolic blood pressure (for 50-100 K USD × African American: β = 2.75, p = 0.034), suggesting higher systolic blood pressure of African American adolescents from high-income backgrounds. Racial variation in the protective effect of family income on systolic BP was no more significant (for 50-100 K USD × African American: β = 2.14, p = 0.149) after we controlled for body mass index (BMI), which was higher for African American than White adolescents.

CONCLUSION

The association between high family income and reduced systolic blood pressure in pre-adolescence might be weaker for African Americans compared to Whites, a difference that African American adolescents' higher body mass index can explain.

Racial and gender differences in discrimination and psychological distress among young adults

Racial and gender differences in the effects of discrimination on health are well-established. The evidence has derived largely from studies of older adults, with less attention paid to younger adults. The current study takes an intersectional approach to address this gap. Using nationally representative, longitudinal data from the 2017 and 2019 Panel Study of Income Dynamics Transitioning to Adulthood Supplement (PSID-TAS), we assess the effects of everyday discrimination on psychological distress among Black and White young adults aged 18-28 (n = 3894). We examine cumulative discrimination and individual items of the cumulative measure based on the Everyday Discrimination Scale. The analysis reveals that perceived discrimination is positively associated with psychological distress for each race-gender group. However, the magnitude of the association varied by group and dimension of discrimination. Black men and women reported more frequent experiences of each type of discrimination than their White counterparts. The positive association between discrimination and distress, however, was lower for Black men and women relative to White men- suggesting that White men may be more sensitive to and/or less resilient against the effects of perceived discrimination. In contrast, associations for White women did not differ significantly from those of White men. Our findings demonstrate that the health-harming effects of discrimination on psychological distress begin early in the life course and suggest that resilience-based coping mechanisms found in older samples of Black adults may also exist for younger adults.

Who Bears the Burden? Understanding the Socioeconomic Patterns of Educational Debt in Orthopaedic Surgery Residency Candidates

BACKGROUND

Educational debt is commonly observed among applicants to orthopaedic surgery residency programs; however, an understanding of the debt burden among minority and nonminority applicants is not well established. Thus, this study aimed to fill these knowledge gaps by examining the extent of and factors shaping educational debt among orthopaedic surgery applicants.

QUESTIONS/PURPOSES

(1) What is the educational debt burden among orthopaedic surgery residency applicants? (2) After controlling for relevant confounding variables, what factors are independently associated with increasing levels of educational debt? (3) After controlling for relevant confounding variables, are individuals classified as an underrepresented minority or those with educational debt and socioeconomic disadvantage less likely to match in orthopaedic surgery?

METHODS

A retrospective evaluation of orthopaedic surgery residency application data from the American Association of Medical Colleges was analyzed from 2011 to 2021. The American Association of Medical Colleges database was selected because every residency applicant must register and apply through the American Association of Medical Colleges. Therefore, these data exist for every residency applicant, and the sample was comprehensive. Self-reported data including premedical, medical, and total educational debt burden as well as classification as socioeconomically disadvantaged and application fee waiver use were collected. Applicants were dichotomously categorized as an underrepresented minority or a not underrepresented minority based upon self-identified race and ethnicity. Monetary values were reported in USD and inflation-adjusted to 2021 using the Consumer Price Index. We performed t-tests and chi-square tests for continuous and categorical variables, respectively. Significance was considered at p < 0.05. In all, 12,112 applicants were available in the initial cohort, and 67% (8170 of 12,112) of applicants with complete data were included from 2011 to 2021 in the final study cohort. Of these, 18% (1510 of 8170) were women, 14% (1114 of 8170) were classified as underrepresented minorities, and 8% (643 of 8170) were classified as socioeconomically disadvantaged. Sixty-one percent (4969 of 8170) of applicants reported receiving at least one scholarship, 34% (2746 of 8170) had premedical school debt, and 72% (5909 of 8170) had any educational debt including medical school. Among all applicants, the median (IQR) educational debt was USD 197,000 (25,000 to 288,000). Among those with scholarships, the median amount was USD 25,000 (9000 to 86,000).

RESULTS

After controlling for the potentially confounding variables of gender and socioeconomic disadvantage, classification as an underrepresented minority applicant was independently associated with higher scholarship amounts than applicants characterized as not underrepresented minorities (β = USD 20,908 [95% confidence interval (CI) 15,395 to 26,422]; p < 0.001), whereas underrepresented minority classification was not independently associated with a difference in total educational debt (β = USD 3719 [95% CI -6458 to 13,895]; p = 0.47). After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with higher scholarship amounts (β = USD 20,341 [95% CI 13,300 to 27,382]; p < 0.001) and higher total educational debt (β = USD 66,162 [95% CI 53,318 to 79,006]; p < 0.001) than applicants not classified as socioeconomically disadvantaged. After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with decreased match rates (OR 0.62 [95% CI 0.52 to 0.74]; p < 0.001).

CONCLUSION

These findings underscore the need for comprehensive scholarship initiatives to ensure equitable financial accessibility for applicants from all backgrounds.

CLINICAL RELEVANCE

In the future, orthopaedic surgery may benefit from research comparing the effectiveness of various initiatives aiming to improve fairness in the burden of debt among applicants to orthopaedic surgery residency programs.

Exploring the intersection of income and race in an age diverse sample of people with Type 1 diabetes

Prior literature suggests that the social gradient in health is racialised such that Black individuals receive fewer health benefits from socioeconomic status than White individuals, yet scarce research studies examine whether this relationship persists in the context of Type 1 diabetes (T1D). Further, most research studies on racial health disparities in T1D outcomes focus on health during early life. We used data from the 2017-2018 wave of the T1D Exchange Registry (N = 11,963) and examined the relationship between household income, race and HbA1c in an age diverse sample of people with T1D. Results revealed that the inverse association between income and HbA1c is stronger for Black T1Ds compared to White T1Ds. Despite this, Black T1Ds with an income of $100,000 or more had higher HbA1c values compared to White individuals with an income of less than $25,000. Further, Black adolescents with T1D had particularly high HbA1c values. There is an urgent need for more research on the interpersonal and structural barriers associated with suboptimal glycaemic control among Black individuals.

Institutional Context Shapes the Physical Health of College Graduates Differently for U.S. White, Black, and Hispanic Adults

Greater educational attainment is generally associated with healthier and longer lives. However, important heterogeneity in who benefits from educational attainment, how much, and why remains underexplored. In particular, in the United States, the physical health returns to educational attainment are not as large for minoritized racial and ethnic groups compared with individuals racialized as White. Yet, our current understanding of ethnoracial differences in educational health disparities is limited by an almost exclusive focus on the quantity of education attained without sufficient attention to heterogeneity within educational attainment categories, such as different institution types among college graduates. Using biomarker data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we test whether the physical health of college graduates in early adulthood (aged 24-32) varies by institution type and for White, Black, and Hispanic adults. In considering the role of the college context, we conceptualize postsecondary institutions as horizontally stratified and racialized institutional spaces with different implications for the health of their graduates. Finally, we quantify the role of differential attendance at and returns to postsecondary institution type in shaping ethnoracialized health disparities among college graduates in early adulthood.

The Interplay of Race, Ethnicity, and Language in Caregiver Health: Insights from the National Social Life, Health, and Aging Project

Background

Recent socio-demographic shifts in the United States have underscored the growing importance of informal caregiving and raised concerns about caregivers' health and well-being. This study aims to deepen our understanding of the health dimensions of caregivers, considering their diverse backgrounds.

Objective

To examine five key health dimensions (physical, cognitive, mental, social, and sexual health) of caregivers, and to identify potential disparities based on ethnoracial and linguistic differences.

Methods

Using data from the National Social Life, Health, and Aging Project (NSHAP), this study explores the interconnections among the specified health dimensions of caregivers and their ethnoracial (Black, Hispanic, White, and others) and linguistic (Spanish, English) backgrounds, in addition to their social networks (N=1,309). Regression analysis was employed to discern the patterns and associations.

Results

The findings indicate that White caregivers generally report better physical, cognitive, and social health compared to their Black and Hispanic counterparts, but exhibit less favorable outcomes in sexual health than Hispanic caregivers. Spanish-speaking caregivers, while having lower cognitive and self-rated mental health than English-speaking caregivers, show stronger social health and greater relationship satisfaction. Notably, these correlations persist irrespective of the size of social networks, pointing to intrinsic links with health outcomes.

Conclusion

The study underscores the necessity of a comprehensive health evaluation for caregivers, acknowledging the intricate interplay between their health and various socio-demographic factors. It advocates for the development of targeted policies and interventions that address the complex health needs of caregivers, with an emphasis on their ethnoracial and linguistic contexts and social environments.

How Education Shapes Indigenous Health Inequalities in the USA and Mexico

Indigenous peoples around the world face significant health disparities relative to the dominant groups in their countries, yet the magnitude and patterns of health disparities vary across countries. We use data from the National Health Interview Survey and Mexican Family Life Survey to examine the health of Indigenous peoples in Mexico and American Indians and Alaska Natives in the USA and to evaluate how they fare relative to the majority populations in their countries (non-Indigenous Mexicans and non-Hispanic Whites, respectively). We assess disparities in self-rated health and activity limitations, with a focus on how Indigenous health disparities intersect with educational gradients in health. Regression analyses reveal three primary findings. First, Indigenous health disparities are larger in the USA than in Mexico. Second, differences in educational attainment account for most of the differences between Indigenous and non-Indigenous populations in Mexico, but less than half in the USA. Third, in both countries, health is moderated by educational attainment such that between-group disparities are largest at the highest levels of education. However, for Indigenous Mexicans there is a "cross-over" in which Indigenous Mexicans report better health at the lowest level of education. Overall, this study finds a weak relationship between education and Indigenous health, and raises the question about the validity of using traditional measures of SES in Indigenous contexts.

What is Common Becomes Normal; Black-White Variation in the Effects of Adversities on Subsequent Initiation of Tobacco and Marijuana During Transitioning into Adolescence

Background

While adversities across domains of finance, race, family, and life may operate as risk factors for initiation of substance use in adolescents, the influence of these factors may vary across racial groups of youth. Unfortunately, the existing knowledge is minimal about racial differences in the types of adversities that may increase the risk of subsequent substance use initiation during the transition into adolescence.

Aim

To compare racial groups for the effects of adversities across domains of finance, race, family, and life on subsequent substance use initiation among pre-adolescents transitioning into adolescence.

Methods

In this longitudinal study, we analyzed data from 6003 non-Latino White and 1562 non-Latino African American 9-10-year-old children transitioning into adolescence. Data came from the Adolescent Brain Cognitive Development (ABCD) study. Participants were followed for up to thirty-six months as they transitioned to adolescence. The independent variables were adversities related to the domains of finance, race, family, and life. The primary outcomes were time to first tobacco or marijuana use. Age, puberty, and gender were confounders. Cox regression models were used for data analysis.

Results

For White youth, tobacco use was under influence of having two parents in the household (HR = .611; 95% CI = .419-.891), parental education (HR = .900; 95% CI = .833-.972), household income (HR = .899; 95% CI = .817-.990), racial stress (HR = 1.569; 95% CI = 1.206-2.039), and life stress (HR =1.098 ; 95% CI = 1.024-1.178) and marijuana use was under influence of neighborhood income (HR = .576; 95% CI = .332-.999) and financial stress (HR =4.273; 95% CI = 1.280-17.422). No adverse condition predicted tobacco or marijuana use of African American youth.

Conclusion

The effects of adversities on substance use depend on race. While various types of adversities tend to increase subsequent initiation of tobacco and marijuana, such factors may be less influential for African American adolescents, who experience more of such adversities. What is common may become normal.

Poor health disparities among racialized students in a Canadian university

OBJECTIVE

The short report aims to examine differences in self-rated general health across racialized post-secondary students at a university in Ontario, Canada.

METHODS

Binary logistic regression analysis was used to examine poor health as an outcome among racialized students as whole, as well as across Asian, South Asian, Afro-Caribbean and Middle Eastern student groups in comparison to white Caucasian post-secondary students.

RESULTS

After adjusting for several covariates, racialized students as a whole had 2.43 times the odds of reporting poor general health compared to white Caucasian students. Asian (OR = 2.77; CI = 1.84-4.18; p < 0.05) and South Asian (OR = 2.52; CI = 1.56-4.08; p < 0.05) students were significantly more likely to report poor health compared to white Caucasian students.

CONCLUSION

The findings call for further attention to the health needs of racialized post-secondary students living in Canada and creating campuses where diverse student populations feel safe and systemically included.

Exposure to Adverse Life Events among Children Transitioning into Adolescence: Intersections of Socioeconomic Position and Race

Background

Racism is shown to diminish the protective effects of family socioeconomic position (SEP) resources for racial minorities compared to the majority groups, a pattern called minorities' diminished returns. Our existing knowledge is minimal about diminished returns of family SEP indicators on reducing exposure to adverse life events among children transitioning into adolescence.

Aim

To compare diverse racial groups for the effects of family income and family structure on exposure to adverse life events of pre-adolescents transitioning to adolescence.

Methods

In this longitudinal study, we analyzed data from 22,538 observations belonging to racially diverse groups of American 9-10-year-old children (n = 11,878) who were followed while transitioning to adolescence. The independent variables were family income and family structure. The primary outcome was the number of stressful life events with impact on adolescents, measured by the Life History semi-structured interview. Mixed-effects regression models were used for data analysis to adjust for data nested to individuals, families, and centers.

Results

Family income and married family structure had an overall inverse association with children's exposure to adverse life events during transition to adolescence. However, race showed significant interactions with family income and family structure on exposure to adverse life events. The protective effects of family income and married family structure were weaker for African American than White adolescents. The protective effect of family income was also weaker for mixed/other race than White adolescents.

Conclusion

While family SEP is protective against children's exposure to adverse life events, this effect is weaker for African American and mixed/other race compared to White youth.

Racial/ethnic and nativity differences in adversity profiles among middle-aged and older adults

OBJECTIVES

Focusing on the nexus of race/ethnicity and nativity, this study examined profiles of adversity and their mental health implications in five groups of middle-aged and older adults: native-born whites, native-born blacks, native-born Hispanics, foreign-born whites, and foreign-born Hispanics.

METHODS

Data were from the 2018 psychosocial assessment of the HRS (N = 5,223). Latent class analysis (LCA) was employed to identify patterns of eleven adversity indicators and to compare the latent structures and class prevalence across the race/ethnicity and nativity groups. Regressions were used to examine the associations between adversity profiles and depression and life satisfaction, respectively.

RESULTS

Four adversity profiles emerged: low adversity (59.84%), low human capital (15.27%), socially marginalized (15.26%), and neighborhood adversity (9.63%). Regardless of nativity status, white older adults were most likely to have the low adversity profile (74 ∼ 75%). In contrast, all the racial/ethnic minority groups were more likely to have the other three adversity profiles. The adversity experienced by racial/ethnic minorities was further cofounded by their immigration status. Overall, having low adversity was associated with the best mental health outcomes and socially marginalized had the poorest outcomes. Even with the low adversity profile, native-born blacks had significantly more depressive symptoms than native-born whites.

CONCLUSION

Findings revealed heterogeneity in adversity profiles and their mental health implications in disadvantaged aging populations. Tailored programs are needed to address unique needs of different minority populations.

Race Disparities in Hypertension Prevalence Among Older Men

This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR  =  1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities.

Racial/Ethnic Heterogeneity in Parental Wealth and Substance Use from Adolescence to Young Adulthood

BACKGROUND

Substance use has a negative impact on health outcomes, at the individual and population levels. Little consensus exists regarding the relationship between socioeconomic position and substance use across race/ethnicity. This study examines how race/ethnicity and socioeconomic factors, especially parental wealth, are associated with substance use across an 18-year span from adolescence to young adulthood.

METHOD

Data were drawn from the National Longitudinal Survey of Youth 1997. Substance use behaviors were measured by self-reported heavy episodic drinking, daily cigarette smoking, and use of cannabis. Parental wealth and parental education were measured at baseline. Other socioeconomic factors included education, employment status, and household income. Two-level logistic regression was performed.

RESULTS

White respondents were more likely to drink, smoke cigarettes, and use cannabis compared to other racial/ethnic groups. More parental wealth was associated with greater odds of heavy episodic drinking, but lower odds of cigarette and cannabis usage. Race/ethnicity modifies the relationships between parental wealth and substance use. Whereas Black respondents from wealthier families had lower odds of heavy episodic drinking, the direction was opposite among white respondents. Wealth functioned as a protective factor against smoking for all groups, although to a lesser extent among respondents of color than for white respondents. Finally, wealthier Hispanics were more likely to smoke daily and use cannabis compared to other racial/ethnic groups.

CONCLUSION

These findings highlight a nuanced patterning of racial/ethnic heterogeneity in the relationship between parental wealth and substance use behaviors. Implications for policy and programming are discussed.

Racial and Ethnic Discrimination and Hypertension by Educational Attainment Among a Cohort of US Women

Importance

Although understudied, there are likely within-group differences among minoritized racial and ethnic groups in associations between racial and ethnic discrimination (RED) and hypertension risk, as minoritized individuals with higher educational attainment may more frequently encounter stress-inducing environments (eg, professional workplace settings, higher-income stores and neighborhoods) characterized by, for instance, exclusion and antagonism.

Objectives

To investigate educational attainment as a potential effect modifier of associations between RED and hypertension risk among US women; the study hypothesis was that the magnitude of associations would be stronger among participants with higher vs lower educational attainment.

Design, Setting, and Participants

This is a nested case-control study using Sister Study data collected at enrollment (2003-2009) and over follow-up visits until September 2019. Among eligible US Black or African American (hereafter Black), Latina, and non-Hispanic White women without prior hypertension diagnoses, incidence density sampling was performed to select self-reported hypertension cases that developed over a mean (SD) follow-up 11 (3) years. Data were analyzed August 2022 to February 2023.

Exposures

Participants reported lifetime everyday (eg, unfair treatment at a business) and major (eg, mistreatment by police) RED via a self-administered questionnaire.

Main Outcome and Measures

Adjusting for sociodemographic characteristics, conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for associations between RED and hypertension by educational attainment category at baseline (college or higher, some college, and high school or less) within racial and ethnic groups.

Results

Among 5179 cases (338 [6.5%] Black; 200 [3.9%] Latina; and 4641 [89.6%] non-Hispanic White) and 10:1 race and ethnicity- and age-matched control participants with a mean (SD) age of 55 (9) years at enrollment, half (49.9%) of women reported attaining college or higher education, and Black women with college or greater education had the highest burden of RED (eg, 83% of case participants with college or higher education reported everyday RED compared with 64% of case participants with high school or less education). Everyday RED was associated with higher hypertension risk among Black women with college or higher education (OR, 1.56 [95% CI, 1.06-2.29]) but not among Black women with some college (OR, 0.72 [95% CI, 0.47-1.11]), with evidence of both multiplicative and additive interaction. Results for Black women with high school or less education suggested increased risk, but confidence intervals were wide, and the result was not statistically significant but may be clinically significant (OR, 1.89 [95% CI, 0.83-4.31]). Educational attainment was not a modifier among other racial and ethnic groups or for associations with major RED.

Conclusions and Relevance

In this nested case-control study of RED and hypertension risk, chronic or everyday RED-associated hypertension disproportionately affected Black women with the highest levels of educational attainment.

Paving the way while playing catch up: mitochondrial genetics in African ancestry primary open-angle glaucoma

Glaucoma, the leading cause of irreversible blindness worldwide, disproportionately affects individuals of African descent. Specifically, previous research has indicated that primary open-angle glaucoma (POAG), the most common form of disease, is more prevalent, severe, early-onset, and rapidly-progressive in populations of African ancestry. Recent studies have identified genetic variations that may contribute to the greater burden of disease in this population. In particular, mitochondrial genetics has emerged as a profoundly influential factor in multiple neurodegenerative diseases, including POAG. Several hypotheses explaining the underlying mechanisms of mitochondrial genetic contribution to disease progression have been proposed, including nuclear-mitochondrial gene mismatch. Exploring the fundamentals of mitochondrial genetics and disease pathways within the understudied African ancestry population can lead to groundbreaking advancements in the research and clinical understanding of POAG. This article discusses the currently known involvements of mitochondrial genetic factors in POAG, recent directions of study, and potential future prospects in mitochondrial genetic studies in individuals of African descent.

Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus

OBJECTIVE

To estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social or structural characteristics as mediators.

METHODS

We conducted a retrospective cohort of individuals with GDM using linked 2009-2011 New York City birth and hospital data and 2009-2017 New York City A1c Registry data. We ascertained GDM and pregnancy characteristics from birth and hospital records. We classified type 2 diabetes as two hemoglobin A 1c test results of 6.5% or higher. We grouped pregnancy characteristics into clinical (body mass index [BMI], chronic hypertension, gestational hypertension, preeclampsia, preterm delivery, caesarean, breastfeeding, macrosomia, shoulder dystocia) and social or structural (education, Medicaid insurance, prenatal care, and WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] participation). We used Cox proportional hazards models to estimate associations between race and ethnicity and 8-year type 2 diabetes incidence, and we tested mediation of pregnancy characteristics, additionally adjusting for age and nativity (U.S.-born vs foreign-born).

RESULTS

The analytic data set included 22,338 patients with GDM. The 8-year type 2 diabetes incidence was 11.7% overall and 18.5% in Black, 16.8% in South and Southeast Asian, 14.6% in Hispanic, 5.5% in East and Central Asian, and 5.4% in White individuals with adjusted hazard ratios of 4.0 (95% CI 2.4-3.9), 2.9 (95% CI 2.4-3.3), 3.3 (95% CI 2.7-4.2), and 1.0 (95% CI 0.9-1.4) for each group compared with White individuals. Clinical and social or structural pregnancy characteristics explained 9.3% and 23.8% of Black, 31.2% and 24.7% of Hispanic, and 7.6% and 16.3% of South and Southeast Asian compared with White disparities. Associations between education, Medicaid insurance, WIC participation, and BMI and type 2 diabetes incidence were more pronounced among White than Black, Hispanic, and South and Southeast Asian individuals.

CONCLUSION

Population-based racial and ethnic inequities are substantial in type 2 diabetes after GDM. Characteristics at the time of delivery partially explain disparities, creating an opportunity to intervene on life-course cardiometabolic inequities, whereas weak associations of common social or structural measures and BMI in Black, Hispanic and South and Southeast Asian individuals demonstrate the need for greater understanding of how structural racism influences postpartum cardiometabolic risk in these groups.

Black-White differences in perceived lifetime discrimination by education and income in the MIDUS Study in the U.S

There is growing evidence on the negative effects of perceived discrimination on health outcomes and their interactions with indicators of socioeconomic status. However, less has been studied on whether income and education lead individuals of a different race to encounter different discriminatory experiences in their lifetime. Using data from the national survey of the Midlife Development in the United States-MIDUS 1 (1995-1996) and MIDUS Refresher (2011-2014)-on eight measures of perceived lifetime discrimination, this study compares discriminatory experiences of Black and White persons in two time periods. We applied generalized structural equation models and generalized linear models to test multiplicative effects of income and education by race on lifetime discrimination. In both periods, we find substantive disparities between White and Black people in all types of lifetime discrimination, with Black people reporting much higher levels of discrimination. Such disparities exacerbated in the top cohorts of society, yet these associations have changed in time, with White individuals reporting increasing levels of discrimination. Results show that, for Black people in the mid-1990s, perceived discrimination increased as education and income increased. This finding persisted for education by the early 2010s; income effects changed as now both, low- and high-income Black people, reported the highest levels of discrimination. These findings highlight a policy conundrum, given that increasing income and education represent a desirable course of action to improve overall discrimination and health outcomes. Yet, we show that they may unintendingly exacerbate racial disparities in discrimination. We also show that the U.S. is moving toward a stagnation period in health outcomes improvement, with racial disparities in discrimination shrinking at the expense of a deterioration of whites' lifetime discriminatory experiences. Our results highlight the need for a multi-systems policy approach to prevent all forms of discrimination including those due to historical, institutional, legal, and sociopolitical structures.

Differential Employment Quality and Educational Inequities in Mental Health: A Causal Mediation Analysis

BACKGROUND

In the United States, inequities in mental distress between those more and less educated have widened over recent years. Employment quality, a multidimensional construct reflecting the relational and contractual features of employer-employee relationships, may mediate this inequity throughout adulthood, yet no study has examined the extent of this mediation in the United States, or how it varies across racialized and gendered populations.

METHODS

Using the information on working-age adults from the 2001 to 2019 Panel Study of Income Dynamics, we construct a composite measure of employment quality via principal component analysis. Using this measure and the parametric mediational g-formula, we then estimate randomized interventional analogs for natural direct and indirect effects of low baseline educational attainment (≤high school: no/yes) on the end-of-follow-up prevalence of moderate mental distress (Kessler-6 Score ≥5: no/yes) overall and within subgroups by race and gender.

RESULTS

We estimate that low educational attainment would result in a 5.3% greater absolute prevalence of moderate mental distress at the end of follow-up (randomized total effect: 5.3%, 95% CI = 2.2%, 8.4%), with approximately 32% of this effect mediated by differences in employment quality (indirect effect: 1.7%, 95% CI = 1.0%, 2.5%). The results of subgroup analyses across race and gender are consistent with the hypothesis of mediation by employment quality, though not when selecting on full employment (indirect effect: 0.6%, 95% CI = -1.0%, 2.6%).

CONCLUSIONS

We estimate that approximately one-third of US educational inequities in mental distress may be mediated by differences in employment quality.

Self-Rated Health and Mortality: Moderation by Purpose in Life

Poor self-rated health consistently predicts reduced longevity, even when objective disease conditions and risk factors are considered. Purpose in life is also a reliable predictor of diverse health outcomes, including greater longevity. Given prior work in which we showed that purpose in life moderated the association between chronic conditions and health-related biological factors, the aim of the current study was to examine the role of purpose in life in moderating the relationship between subjective health and mortality. We also examined potential differences in these associations by race/ethnicity. Data were from two large national longitudinal studies-the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study-with a 12- to 14-year follow-up period for mortality estimates. Results of logistic regression analyses showed that purpose in life and self-rated health were both significantly positively associated with longevity, and that purpose in life significantly moderated the relationship between self-rated health and mortality. Stratified analyses showed similar results across all racial/ethnic groups, with the exception of Black MIDUS participants. These results suggest that greater purpose in life may provide a buffer against the greater probability of mortality associated with poor subjective health.

Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation

Racism drives population health inequities by shaping the unequal distribution of key social determinants of health, such as socioeconomic resources and exposure to stressors. Research on interrelationships among race, socioeconomic resources, stressors, and health has proceeded along two lines that have largely remained separate: one examining differential effects of socioeconomic resources and stressors on health across racialized groups (moderation processes), and the other examining the role of socioeconomic resources and stressors in contributing to racial inequities in health (mediation processes). We conceptually and analytically integrate these areas using race theory and a novel moderated mediation approach to path analysis to formally quantify the extent to which an array of socioeconomic resources and stressors-collectively and individually-mediate racialized health inequities among a sample of older adults from the Health and Retirement Study. Our results yield theoretical contributions by showing how the socioeconomic status-health gradient and stress processes are racialized (24% of associations examined varied by race), substantive contributions by quantifying the extent of moderated mediation of racial inequities (approximately 70%) and the relative importance of various social factors, and methodological contributions by showing how commonly used simple mediation approaches that ignore racialized moderation processes overestimate-by between 5% and 30%-the collective roles of socioeconomic status and stressors in accounting for racial inequities in health.

Individual and area-level socioeconomic correlates of hypertension prevalence, awareness, treatment, and control in uMgungundlovu, KwaZulu-Natal, South Africa

BACKGROUND

Hypertension is the second leading risk factor for death in South Africa, and rates have steadily increased since the end of Apartheid. Research on the determinants of hypertension in South Africa has received considerable attention due to South Africa's rapid urbanization and epidemiological transition. However, scant work has been conducted to investigate how various segments of the Black South African population experience this transition. Identifying the correlates of hypertension in this population is critical to the development of policies and targeted interventions to strengthen equitable public health efforts.

METHODS

This analysis explores the relationship between individual and area-level socioeconomic status and hypertension prevalence, awareness, treatment, and control within a sample of 7,303 Black South Africans in three municipalities of the uMgungundlovu district in KwaZulu-Natal province: the Msunduzi, uMshwathi, and Mkhambathini. Cross-sectional data were collected on participants from February 2017 to February 2018. Individual-level socioeconomic status was measured by employment status and educational attainment. Ward-level area deprivation was operationalized by the most recent (2011 and 2001) South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and diabetes diagnosis.

RESULTS

The prevalence of hypertension in the sample was 44.4% (n = 3,240). Of those, 2,324 were aware of their diagnosis, 1,928 were receiving treatment, and 1,051 had their hypertension controlled. Educational attainment was negatively associated with hypertension prevalence and positively associated with its control. Employment status was negatively associated with hypertension control. Black South Africans living in more deprived wards had higher odds of being hypertensive and lower odds of having their hypertension controlled. Those residing in wards that became more deprived from 2001 to 2011 had higher odds of being aware of their hypertension, yet lower odds of receiving treatment for it.

CONCLUSIONS

Results from this study can assist policymakers and practitioners in identifying groups within the Black South African population that should be prioritized for public health interventions. Black South Africans who have and continue to face barriers to care, including those with low educational attainment or living in deprived wards had worse hypertension outcomes. Potential interventions include community-based programs that deliver medication to households, workplaces, or community centers.

Pedestrian crash frequency: Unpacking the effects of contributing factors and racial disparities

In this paper, we unpack the magnitude effects of the determinants of pedestrian crashes using a multivariate analysis approach. We consider four sets of exogenous factors that characterize residential neighborhoods as well as potentially affect pedestrian crashes and the racial composition of such crashes: (1) crash risk exposure (CE) attributes, (2) cultural variables, (3) built environment (BE) features, and (4) sociodemographic (SD) factors. Our investigation uses pedestrian crash and related data from the City of Houston, Texas, which we analyze at the spatial Census Block Group (CBG) level. Our results indicate that social resistance considerations (that is, minorities resisting norms as they are perceived as being set by the majority group), density of transit stops, and road design considerations (in particular in and around areas with high land-use diversity) are the three strongest determinants of pedestrian crashes, particularly in CBGs with a majority of the resident population being Black. The findings of this study can enable policymakers and planners to develop more effective countermeasures and interventions to contain the growing number of pedestrian crashes in recent years, as well as racial disparities in pedestrian crashes. Importantly, transportation safety engineers need to work with social scientists and engage with community leaders to build trust before leaping into implementing planning countermeasures and interventions. Issues of social resistance, in particular, need to be kept in mind.

Understanding the Impact of Contemporary Racism on the Mental Health of Middle Class Black Americans

Evidence from previous research indicates that while socioeconomic status (SES) narrows Black-White health inequities, these inequities do not completely disappear, and in some cases, worsen. Why do Black-White health inequities persist, even when controlling for SES? It is critical to examine how perceptions of unfair treatment, especially those that are nuanced and subtle, affect the mental health of Black Americans with greater levels of SES. This study, using a new sample composed exclusively of college-educated Black Americans, investigated whether experiences related to racism were associated with poorer mental health. Qualtrics provided the sample from their nationwide panelists that met the research criteria. Inclusion criteria included the following: (1) self-identified as Black or African American; (2) at least 24 years old; (3) completed a 4-year college degree or higher. The findings from this study indicated that the effects of unfair treatment are significantly associated with poorer mental health. These findings highlight the insidious nature of contemporary racism as the everyday experiences of unfair treatment have a tremendous effect on depressive symptoms among this sample of college-educated Black Americans. Efforts to simply improve SES among historically marginalized groups will not bring about health equity. Findings from this study indicate that there are mental health costs associated with upward social mobility. It is likely that these costs, particularly the experience of everyday unfair treatment, likely diminish the social, economic and health returns on the human capital.

Difference in All-Cause Mortality between Unemployed and Employed Black Men: Analysis Using the National Health and Nutrition Examination Survey (NHANES) III

The Black-White racial employment disparity and its link to mortality have demonstrated the health benefits obtained from employment. Further, racial/ethnic mortality disparities existing among men with different employment statuses have been previously documented. The purpose of this study was to examine the association between employment status and all-cause mortality among Black men. Data for the study was obtained from the National Health and Nutrition Examination Survey (NHANES) III 1988-1994 linked to the NHANES III Linked Mortality File. Cox proportional hazard models were specified to examine the association between health behaviors and mortality in Black men by employment status. Among those who were assumed alive (n = 1354), 41.9% were unemployed. In the fully adjusted model, unemployed Black men had an increased risk of all-cause mortality (Hazard Ratio [HR] 1.60, 95% confidence interval or CI [1.33, 1.92]) compared to Black men who were employed. These results highlight the impact of employment on all-cause mortality among unemployed Black men and underscore the need to address employment inequalities to reduce the mortality disparities among Black men.

Psychological health outcome of Sub-Saharan African migrants in Germany

African migrants living in Europe have an increased risk of adverse psychological health outcomes compared to people without a migration background. The increased vulnerability may be due to their migration experience and possible challenges in adapting and integrating into the host community. This study explores the association between community solidarity and psychological health outcome among Sub-Saharan African (SSA) migrants in Germany.<br /> The study used data from 518 SSA migrants in Germany collected in a cross-sectional survey across the 16 German federal states. A correlation matrix was computed to evaluate the bivariate relationship between psychological health, community solidarity, and socioeconomic, and demographic features. Furthermore, regression models were calculated to predict the effect of community solidarity on psychological health outcomes and the added predictive effects of socioeconomic and demographic characteristics.<br /> Community solidarity shows a moderately significant positive association with psychological health (r=.41; p≤.01). A linear regression model suggests that community solidarity, education and age explained 19% of the variance in psychological health scores for SSA migrants in Germany.<br /> These results confirm community solidarity as a significant but multi-layered determinant of various factors that affect migrants’ psychological wellbeing. It supports implementing policies that promote community solidarity to facilitate SSA migrants’ wellbeing.

An Intersectional Approach to Understanding Barriers to Healthcare for Women

Access to health care depends on multiple sociodemographic factors such as race/ethnicity, marital status, education, income, and insurance status. However, a paucity of research has examined access to healthcare disparities as they uniquely affect women, specifically women of color. National data were analyzed from the Medical Expenditure Panel Survey (MEPS) utilizing an 11-year sample (2005-2015) of women ages 18-74 (N = 128,355). More recent data were not included due to changes in how sampling was conducted after 2015. Predictor variables included race/ethnicity cross-classified with marital status, education, income, or insurance status, controlling for age. A dichotomous outcome variable called "any barriers to healthcare" was created based on usual source of care, delayed medical care, delayed dental care and delayed prescription care. Multivariate logistic regression models were used to identify associations with barriers to care. The foundation of this methodology is intersectionality and how it impacts access to care for women across social identities. Hispanic women (OR 1.08, 95% CI 1.02-1.14) had higher odds of having a barrier to care compared to White women. However, Black women (OR 0.92, 95% CI 0.87-0.97) had lower odds of having a barrier to care compared to White women. Race/ethnicity also significantly moderated the relationship between socioeconomic variables (marital status, income, education and insurance status) and having a barrier to care. To achieve a healthy community, addressing these racial/ethnic and socioeconomic inequalities helps to support the people who live and work within these communities.

Intersectional Approaches to Minority Aging Research

Purpose of Review

Growing racial/ethnic diversity among America's older adults necessitates additional research specifically focused on health and well-being among aging minoritized populations. Although Black and Latinx adults in the USA tend to face worse health outcomes as they age, substantial evidence points to unexpected health patterns (e.g., the race paradox in mental health, the Latino health paradox) that challenge our understanding of health and aging among these populations. In this review, we demonstrate the value of intersectionality theory for clarifying these health patterns and highlight the ways that intersectionality has been applied to minority aging research. To advance the field, we also make several recommendations for incorporating intersectional approaches in future scholarship on minority aging.

Recent Findings

Scholars have applied intersectional approaches to health and aging to unravel how social statuses and social conditions, such as race, ethnicity, gender, nativity, incarceration history, geographic region, and age, produce distinct shared experiences that shape health trajectories through multiple mechanisms.

Summary

We highlight common intersectional approaches used in minority aging research and underscore the value of this perspective for elucidating the complex, and often unexpected, health patterns of aging minoritized populations. We identify several key lessons and propose recommendations to advance scholarship on minority aging.

Greater social adversity is associated with more disordered eating attitudes and behaviors among children from Southeast Michigan

OBJECTIVE

The objective of this study is to examine the association between indicators of social adversity, including socioeconomic status and race/ethnicity, and children's disordered eating behaviors and attitudes.

METHODS

Children ages 8-10 years old (n = 183) were recruited from Michigan. Data were collected through in-home surveys. The Children's Eating Attitudes Test (ChEAT-24) measured disordered eating attitudes and behaviors in the sample. Cumulative social adversity was considered the sum of four binary variables: caregiver race/ethnicity, caregiver education, household income, and child-reported food security status. Linear mixed models examined the association between social adversity indicators and ChEAT-24 scores.

RESULTS

Children of primary caregivers of color had significantly higher ChEAT-24 scores than children of white caregivers (p = .03). Children who reported food insecurity had significantly higher ChEAT-24 scores compared to children who reported food security (p = .01). Compared to children with the lowest social adversity score, children with the highest score had a 4.8-unit higher ChEAT-24 score (95% CI .3-9.4), after adjusting for covariates. A significant trend was observed for greater social adversity and higher ChEAT-24 score (p-trend = .02).

CONCLUSION

A linear association was observed between greater social adversity and more disordered eating behaviors and attitudes among children in this sample. These findings emphasize the need for eating disorder research in children from racial/ethnic minorities and socioeconomically disadvantaged populations to support future prevention efforts.

PUBLIC SIGNIFICANCE

Greater exposure to social adversity was associated with more disordered eating behaviors among preadolescent children. Given that eating disorders are understudied in lower-income and minority racial/ethnic populations, this study highlights the need for additional research to better support prevention and treatment efforts among children from socioeconomically diverse backgrounds.

Immigration Status, Socioeconomic Status, and Self-Rated Health in Europe

The literature has established a protective effect of socioeconomic status (SES) indicators on health. However, at least in the US, these SES indicators tend to generate fewer health gains for marginalized groups including immigrants. As this literature mainly originated in the US, it is necessary to study whether these indicators similarly correlate with the health of foreign-born and native-born individuals in Europe. The current study was based on the Marginalization-related Diminished Returns (MDRs) theory and compared the effects of three SES indicators, namely parental education, own education and income, on self-rated health (SRH) of immigrant and native-born individuals. We used data from the European Social Survey 2020 (ESS 2020). Participants included 14,213 individuals who identified as either native-born (n = 9052) or foreign-born (n = 508). Education, income, and parental education were the independent variables. Self-rated health (SRH) was the outcome. Age and sex were covariates. Linear regression and logistic regression were used for data analysis. Overall, high education, income, and parental education were associated with lower odds of poor SRH. We documented a statistical interaction between immigration status and parental education, indicating a weaker inverse association between parental education and poor SRH for foreign-born than native-born individuals. The links between some but not all SES indicators vary across foreign-born and native-born individuals in Europe. Host countries seem to undervalue the parental educational attainment of foreign-born families. Future research should explore the role of time, period, cohort and country of origin as well as host country and associated policies in equalizing returns of SES indicators on the health of population subgroups. The results are important given that most studies on MDRs are developed in the US, and less is known about Europe. The results are also very important given the growing anti-immigrant sentiment and nationalist movements in Europe and the rest of the world.

Examining Racial Disparities in Historical Change of Mental and Physical Health Across Midlife and Old Age in the United States

OBJECTIVES

To examine whether racial disparities are narrowing or widening with historical time among U.S. middle-aged and older adults, and test the extent to which educational attainment moderates racial disparities over historical time.

METHODS

Multilevel models were applied to longitudinal data on middle-aged (ages 40-65) and older adults (ages 66 and older) from the Health and Retirement Study. Historical change was indexed as cohort or birth year. The outcomes of focus were depressive symptoms, episodic memory, health conditions, functional limitations, and self-rated health.

RESULTS

Results revealed a differential pattern of racial disparities in historical change between midlife and old age. Across midlife and old age, on average, Blacks and Hispanics reported poorer levels of mental and physical health, compared with Whites. In midlife, racial disparities narrowed with historical time; later-born cohorts of Hispanics but not Whites reported fewer depressive symptoms than their earlier-born peers. Likewise, historical improvements in health were stronger among Hispanics and Blacks than Whites. Conversely, in old age, later-born cohorts across race consistently showed historical improvements in each of the outcomes examined. Regarding educational attainment, we observed little consistent evidence that health-promoting effects of educational attainment differ across race and cohort. Examining questions about heterogeneity, results revealed that in midlife and old age there was greater heterogeneity between race across each of the outcomes.

DISCUSSION

Our discussion elaborates on reasons behind the documented racial differences in historical changes among U.S. middle-aged and older adults, and how the protective role of education is changing over time.

Association of Race and Area Deprivation With Breast Cancer Survival Among Black and White Women in the State of Georgia

Importance

Increasing evidence suggests that low socioeconomic status and geographic residence in disadvantaged neighborhoods contribute to disparities in breast cancer outcomes. However, little epidemiological research has sought to better understand these disparities within the context of location.

Objective

To examine the association between neighborhood deprivation and racial disparities in mortality among Black and White patients with breast cancer in the state of Georgia.

Design, Setting, and Participants

This population-based cohort study collected demographic and geographic data from patients diagnosed with breast cancer between January 1, 2004, and February 11, 2020, in 3 large health care systems in Georgia. A total of 19 580 patients with breast cancer were included: 12 976 from Piedmont Healthcare, 2285 from Grady Health System, and 4319 from Emory Healthcare. Data were analyzed from October 2, 2020, to August 11, 2022.

Exposures

Area deprivation index (ADI) scores were assigned to each patient based on their residential census block group. The ADI was categorized into quartile groups, and associations between ADI and race and ADI × race interaction were examined.

Main Outcomes and Measures

Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% CIs associating ADI with overall mortality by race. Kaplan-Meier curves were used to visualize mortality stratified across racial and ADI groups.

Results

Of the 19 580 patients included in the analysis (mean [SD] age at diagnosis, 58.8 [13.2] years), 3777 (19.3%) died during the course of the study. Area deprivation index contributed differently to breast cancer outcomes for Black and White women. In multivariable-adjusted models, living in a neighborhood with a greater ADI (more deprivation) was associated with increased mortality for White patients with breast cancer; compared with the ADI quartile of less than 25 (least deprived), increased mortality HRs were found in quartiles of 25 to 49 (1.22 [95% CI, 1.07-1.39]), 50 to 74 (1.32 [95% CI, 1.13-1.53]), and 75 or greater (1.33 [95% CI, 1.07-1.65]). However, an increase in the ADI quartile group was not associated with changes in mortality for Black patients with breast cancer (quartile 25 to 49: HR, 0.81 [95% CI, 0.61-1.07]; quartile 50 to 74: HR, 0.91 [95% CI, 0.70-1.18]; and quartile ≥75: HR, 1.05 [95% CI, 0.70-1.36]). In neighborhoods with an ADI of 75 or greater, no racial disparity was observed in mortality (HR, 1.11 [95% CI, 0.92-1.36]).

Conclusions and Relevance

Black women with breast cancer had higher mortality than White women in Georgia, but this disparity was not explained by ADI: among Black patients, low ADI was not associated with lower mortality. This lack of association warrants further investigation to inform community-level approaches that may mitigate the existing disparities in breast cancer outcomes in Georgia.

Variations in the association between education and self-reported health by race/ethnicity and structural racism

Research has documented a longstanding association between education achievement and physical health outcomes. However, research has suggested that the health benefits gained from education differ by race, with minoritized racial groups generally experiencing poorer health and fewer health benefits from education. One potential explanation for this phenomena of “diminished returns” is the influence of structural racism. The purpose of this paper is to assess how structural factors at the state level are associated with self-reported health and the association between education and health. Utilizing a sample (N = 6819) from the NLSY dataset, measures of structural racism (political participation, employment and job status, education attainment and judicial treatment) were used to assess the hypotheses. Results indicated significant differences in key areas, with some nuanced findings – indicating that structural racism is an important health factor. These indicators of structural racism are discussed in the context of complexity of linked lives. Further research regarding structural racism, education, health and developmental stages is warranted.

The mediation effect of indoor air quality on health: A comparison of homeowners and renters

This research aims to explore whether there is a health disparity between homeowners and renters affected by the indoor air quality of their dwellings. By proxying the presence of mold and smoke as conjoint facilitators of poor indoor air quality, we design a mediation model that previously has not been explored empirically. The structural path model in this study shows that there is indeed a disparity in health between homeowners and renters by demography, socioeconomic status, and dwelling condition. Our study argues that renters whose living conditions are generally worse off than homeowners are also unequal in their health status due to exacerbating effects from poor indoor air quality, which is endogenous to the state of the renter. The originality of this study is that it is the first study that empirically tests the mediation effect of poor indoor air quality of homeowners and renters using a structural equation path model.

Association of area-level socioeconomic status and non-small cell lung cancer stage by race/ethnicity and health care-level factors: Analysis of the National Cancer Database

BACKGROUND

This study examined whether the association of socioeconomic status (SES) and non-small cell lung cancer (NSCLC) stage varied by race/ethnicity and health care access measures.

METHODS

This study used data from the 2004-2016 National Cancer Database for patients aged 18-89 years who had been diagnosed with Stage 0-IV NSCLC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for the associations of area-level SES with an advanced stage at diagnosis via multilevel, multivariable logistic regression. The stage at diagnosis was dichotomized into early (0-II) and advanced (III-IV) stages, and area-level SES was categorized on the basis of the patient's zip code level: (1) the proportion of adults aged ≥25 years without a high school degree and (2) the median household income. The models were stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander), insurance status (none, government, and private), and health care facility type (community, comprehensive community, academic/research, and integrated network).

RESULTS

The study population included 1,329,972 patients. Although only 17% of the NH White patients were in the lowest income quartile, 50% of the NH Black patients were in this group. Lower area-level education and income were associated with higher odds of an advanced-stage diagnosis (aOR for education, 1.12; 95% CI, 1.10-1.13; aOR for income, 1.13; 95% CI, 1.11-1.14). These associations persisted among NH White, NH Black, Hispanic, and Asian patients; among those with government and private insurance (but not the uninsured); and among those treated at each facility type.

CONCLUSIONS

Area-level income and education are strongly associated with an advanced NSCLC diagnosis regardless of the facility type and among those with government and private insurance.

Racial identity as a moderator of the association between socioeconomic status and quality of life

Research in social and humanitarian science has identified socioeconomic status (SES) as one of the essential determinants of quality of life (QoL). Similarly, racial identity is assumed to predict SES outcomes in multiracial settings. Therefore, understanding how racial identity moderates the association between SES and QoL may provide essential insights into the mechanisms generating socioeconomic inequalities and their implication on life outcomes. The current study employs a cross-sectional study designed to investigate the moderating effect of racial identity on the association between SES and QoL in a sample of 1,049 South Africans. A correlation matrix was computed to explore the bivariate associations between QoL, socioeconomic, and sociodemographic features. ANOVA was used to evaluate racial differences in QoL and SES. A moderator analysis was adopted to determine a possible moderating effect of racial identity on the connection between SES and QoL. Findings show a significant difference in QoL and SES based on race. While racial identity was a significant moderator of the association between QoL and SES for Black Africans, no significant moderating effect was reported for other racial groups. These results highlight the importance of racial identity for life outcomes and emphasis the unique experience associated with Black racial identity and its implications for SES, QoL, and their association in South Africa. This study explains the necessity to improve the QoL of minority groups, such as Black South Africans, and offers detailed explanations of their perceived disadvantage.

Racial and Ethnic Disparities in Healthcare Rating, Diabetes Self-efficacy, and Diabetes Management Among Non-pregnant Women of Childbearing Age: Does Socioeconomic Status Matter?

OBJECTIVE

Patient perceptions of healthcare ratings, diabetes self-efficacy, and diabetes management play a role in diabetes-related outcomes, particularly among women of childbearing age. Guided by a modified Interaction Model of Client Health Behavior framework, the objective was to compare differences in perceptions of health care ratings, diabetes self-efficacy, and diabetes management among non-Hispanic Black, Hispanic, and non-Hispanic White women of childbearing age.

METHODS

The sample comprised 7 years (2012-2018) of Medical Expenditure Panel Survey data. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 691; weighted n = 932,426). Dependent variables were health care rating, diabetes self-efficacy, and diabetes care management. The key independent variable was race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White). We adjusted for sociodemographic characteristics and perceived health status using multiple linear and multivariable logistic regressions.

RESULTS

Non-Hispanic Black women (41.6%) self-reported their health status as fair or poor (44.9%) compared to non-Hispanic White (33.3%) and Hispanic (37.6%). In adjusted models, non-Hispanic Black women had 46% lower odds (95% CI = 0.31, 0.94) of reporting high health care ratings compared to non-Hispanic White women. Non-Hispanic Black women had 43% lower odds (95% CI = 0.35, 0.95) and Hispanic women had 47% lower odds (95% CI = 0.34, 0.80) of reporting higher levels of diabetes care management than non-Hispanic White women.

CONCLUSIONS

This study provides important information regarding diabetes health care ratings, self-efficacy, and self-management behaviors. Because of the increasing prevalence of diabetes among women of childbearing age, it is important to improve health care particularly for racial/ethnic minority women with diabetes.

When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men

There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men’s AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the “quality” rather than the “quantity” of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.

Environmental Justice in Greater Los Angeles: Impacts of Spatial and Ethnic Factors on Residents' Socioeconomic and Health Status

Environmental justice advocates that all people are protected from disproportionate impacts of environmental hazards. Despite this ideal aspiration, social and environmental inequalities exist throughout greater Los Angeles. Previous research has identified and mapped pollutant levels, demographic information, and the population’s socioeconomic status and health issues. Nevertheless, the complex interrelationships between these factors remain unclear. To close this knowledge gap, we first measured the spatial centrality using sDNA software. These data were then integrated with other socioeconomic and health data collected from CalEnvironScreen, with census tract as the unit of analysis. Finally, structural equation modeling (SEM) was executed to explore direct, indirect, and total effects among variables. The results show that the White population tends to reside in the more segregated areas and lives closer to green space, contributing to higher housing stability, financial security, and more education attainment. In contrast, people of color, especially Latinx, experience the opposite of the environmental benefits. Spatial centrality exhibits a significant indirect effect on environmental justice by influencing ethnicity composition and pollution levels. Moreover, green space accessibility significantly influences environmental justice via pollution. These findings can assist decision-makers to create a more inclusive society and curtail social segregation for all individuals.

Anxiety, Depression, Quality of Life, Caregiver Burden, and Perceptions of Caregiver-Centered Communication among Black and White Hospice Family Caregivers

Background: Anxiety, depression, and reduced quality of life (QOL) are common problems for hospice family caregivers, but it is unknown if disparities in these experiences exist among Black and White caregivers. Objectives: To compare anxiety, depression, QOL, caregiver burden, and perceptions of caregiver-centered hospice team communication between Black and White hospice family caregivers. Design: Secondary analysis of baseline data from two randomized clinical trials. Setting/Subjects: Seven hundred twenty-two Black and White hospice family caregivers ages 18+ from Midwestern and Northeastern United States. Measurements: Measures included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Caregiver Quality-of-Life Index-Revised (CQLI-R), Zarit Burden Interview (ZBI-7), and Caregiver-Centered Communication Questionnaire (CCCQ). Results: Black and White caregivers differed across demographic and socioeconomic variables. Nearly one-third of hospice family caregivers reported moderate-to-severe anxiety (32.1%) and moderate-to-severe depressive symptoms (32.0%). White caregivers reported lower QOL than Black caregivers (p = 0.04), specifically in emotional (p = 0.02) and social (p = 0.0005) domains. In multiple regression analyses controlling for caregiver and patient factors, we found no racial differences in depression, anxiety, QOL, caregiver burden, or perceptions of caregiver-centered hospice communication. Conclusions: Despite demographic and socioeconomic differences, Black and White hospice family caregivers experience similarly high levels of anxiety, depression, burden, and perceptions of hospice communication. Interventions to support hospice family caregivers across racial groups and research that identifies factors that mediate social determinants of health in this population are needed. The development and validation of culture-concordant mental health screening tools in racially diverse populations is recommended. Trial registration: ClinicalTrials.gov NCT02929108 and ClinicalTrials.gov NCT01444027.

Occupations and Sickness-Related Absences during the COVID-19 Pandemic

Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.

Everyday discrimination and cancer metaphor preferences: The mediating effects of needs for personal significance and cognitive closure

Metaphors are often used to describe cancer experiences (e.g., battle, journey). Few studies explore how social threats (e.g., discrimination) shape metaphor preferences. We examined the relationship between discrimination and preferences for cancer battle metaphors (i.e., concrete, action-based) versus journey metaphors (i.e., open-ended, reflective) and mediating effects of needs for personal significance and cognitive closure. We also stratified the analysis when discrimination was/was not attributed to race and by racial/ethnic group. Four-hundred twenty-seven U.S. participants completed an online survey. Items included everyday discrimination, need for personal significance, need for cognitive closure, and preference for cancer scenarios using battle or journey metaphors. Multigroup structural equation modeling examined: serial mediation (i.e., discrimination predicting metaphor preference via needs for personal significance and cognitive closure) stratified by discrimination attribution; and single mediation (i.e., discrimination predicting need for cognitive closure via need for personal significance) stratified by racial/ethnic group. Discrimination was associated with battle metaphor preferences through serial mediation when discrimination was not attributed to race (β = 0.02, 95% CI [0.01,0.05]). Discrimination was directly associated with journey metaphor preferences (β = -0.20, 95% CI [-0.37,-0.06]) and the serial mediation was nonsignificant when discrimination was attributed to race. The single mediation model varied across racial/ethnic groups and was strongest for Non-Hispanic White participants (β = 0.17, 95% CI [0.07,0.30]). Discrimination may shape cancer metaphor preferences through needs for personal significance and cognitive closure, yet these relationships differ based on whether discrimination is attributed to race and racial/ethnic group. Given that the U.S. health system often focuses on battle metaphors when framing cancer treatment and screenings, individuals who prefer journey metaphors (i.e., those who experienced more frequent racial discrimination in the present study) may experience a systematic disadvantage in cancer communication. A more careful consideration of cultural, racial, and ethnic differences in metaphor use may be a crucial step towards reducing cancer disparities.

Occupations and Sickness-Related Absences during the COVID-19 Pandemic

Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.

The Influence of Race and Gender on Receiving Assistance with Daily Activities among Older Americans

Background and Objectives

Nearly 8.2 million community-dwelling, older Medicare beneficiaries receive support from long-term services and supports (LTSS) with routine daily activities. Prior work demonstrates disability-related disparities; however, it is unclear whether these patterns persist among LTSS recipients and across specific sets of activities. We examine race and gender differences in receiving help with self-care (e.g., eating), mobility (e.g., getting around the house), and household (e.g., shopping) activities in a nationally representative sample of community-dwelling Medicare beneficiaries receiving LTSS.

Research Design and Methods

Cross-sectional analysis of 1,808 White and Black older adults receiving assistance with routine daily activities in the 2015 National Health and Aging Trends Study. Bivariate statistics were used to describe the sample and provide comparisons of characteristics by race and gender. Logistic regression models examined race and gender differences in receiving assistance with self-care, mobility, and household activities after adjusting for sociodemographic and health characteristics.

Results

Race and gender differences were observed across all sociodemographic and health characteristics, as well as for all forms of assistance. Relative to White men, Black men had lower odds of receiving help with self-care activities. White and black women had higher odds and Black men had lower odds of getting help with mobility activities than White men. Black men and White and Black women all had higher odds of receiving assistance with household tasks compared to White men.

Discussion and Implications

Our findings indicate that, despite prior evidence of disability-related disparities, the receipt of help with self-care, mobility, and household activities varies by race and gender. Findings reveal several target areas for future research. Future work should examine the role of cultural and social preferences for care, as well as the appropriateness of help, as evidenced by health service use and changes in quality of life.

Family's Subjective Economic Status and Children's Matrix Reasoning: Blacks' Diminished Returns

BACKGROUND

Due to a pattern known as Marginalization-related Diminished Returns (MDRs), historically oppressed non-Hispanic Black Americans show weaker effects of economic status on health and development, when compared to socially privileged non-Hispanic White Americans. Such MDRs are also documented for the effects of economic status on the school performance of non-Hispanic Black children. However, the existing knowledge is minimal on similar diminished returns on children's intelligence.

AIM

To compare racial and ethnic groups for the effect of subjective economic status on children's cognitive performance, we compared non-Hispanic White and non-Hispanic Black children for the effects of subjective economic status on children's matrix reasoning.

METHODS

This cross-sectional study included 7898 children from the Adolescent Brain Cognitive Development (ABCD) study. The predictor variable was subjective economic status, which was treated as a continuous measure. The primary outcome was children's matrix reasoning, a domain of cognitive performance, measured by the Wechsler Intelligence Scales for Children-IV (WISC-V) matrix reasoning total score.

RESULTS

Overall, high subjective economic status was associated with higher matrix reasoning score. Race showed a statistically significant interaction with subjective economic status on children's matrix reasoning score. This interaction suggested that high subjective economic status has a smaller boosting effect on increasing matrix reasoning score for non-Hispanic Black children relative to non-Hispanic White children.

CONCLUSION

The degree by which subjective economic status correlates with matrix reasoning score, an important domain of cognitive performance, depends on race and racialization. Non-Hispanic Black children may show weaker gains in matrix reasoning from their subjective economic status than their non-Hispanic White counterparts. To minimize the racial gap in cognitive performance, we need to address diminished returns that occur as a result of the racialization of racial and ethnic minority children. Not only should we equalize economic status, but also increase the marginal returns of economic status for racial minorities, particularly non-Hispanic Black families. Such efforts require public policies that go beyond access and also consider how we can empower non-Hispanic Black communities and families so they can more effectively leverage and utilize their economic resources to secure measurable and tangible outcomes. Structural and societal barriers such as residential and school segregation may hinder non-Hispanic Black children from receiving the full effects of their family-level economic status on a variety of outcomes, including their cognitive performance.

Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language

BACKGROUND

Despite past and ongoing efforts to achieve health equity in the USA, racial and ethnic disparities persist and appear to be exacerbated by COVID-19.

OBJECTIVE

Evaluate neighborhood-level deprivation and English language proficiency effect on disproportionate outcomes seen in racial and ethnic minorities diagnosed with COVID-19.

DESIGN

Retrospective cohort study SETTING: Health records of 12 Midwest hospitals and 60 clinics in Minnesota between March 4, 2020, and August 19, 2020 PATIENTS: Polymerase chain reaction-positive COVID-19 patients EXPOSURES: Area Deprivation Index (ADI) and primary language MAIN MEASURES: The primary outcome was COVID-19 severity, using hospitalization within 45 days of diagnosis as a marker of severity. Logistic and competing-risk regression models assessed the effects of neighborhood-level deprivation (using the ADI) and primary language. Within race, effects of ADI and primary language were measured using logistic regression.

RESULTS

A total of 5577 individuals infected with SARS-CoV-2 were included; 866 (n = 15.5%) were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 vs. 40.4 years, p < 0.001) and more likely to be male (n = 425 [49.1%] vs. 2049 [43.5%], p = 0.002). Of those requiring hospitalization, 43.9% (n = 381), 19.9% (n = 172), 18.6% (n = 161), and 11.8% (n = 102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID-19 severity: Hispanic patients (OR 3.8, 95% CI 2.72-5.30), Asians (OR 2.39, 95% CI 1.74-3.29), and Blacks (OR 1.50, 95% CI 1.15-1.94). ADI was not associated with hospitalization. Non-English-speaking (OR 1.91, 95% CI 1.51-2.43) significantly increased odds of hospital admission across and within minority groups.

CONCLUSIONS

Minority populations have increased odds of severe COVID-19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes. Non-English-speaking accounts for differences across and within minority populations. These results support the ongoing need to determine the mechanisms that contribute to disparities during COVID-19 while also highlighting the underappreciated role primary language plays in COVID-19 severity among minority groups.

Association Between Parental Educational Attainment and Children's Negative Urgency: Sex Differences

Background and aims

Negative urgency reflects a specific facet of impulsivity and correlates with a wide range of health-related risk behaviors, including, but not limited to, problematic substance use. Negative urgency is also shaped by family socioeconomic position (SEP), such as parental educational attainment (PEA). This study aimed to explore sex differences regarding protective effects of PEA on children's negative urgency in the US.

Methods

This cross-sectional study used the Adolescent Brain Cognitive Development (ABCD) study data. Baseline ABCD data included 10,535 American children in the age range of 9-10 years old. The independent variable was PEA, treated as a 5-level categorical variable. The primary outcome was negative urgency measured by the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (UPPS-SS). Mixed-effects regression models were applied for data analysis.

Results

In sex-stratified regression models, high PEA was predictive of lower levels of negative urgency in female but not male children. In the overall sample, sex showed a statistically significant interaction with PEA on children's negative urgency, indicating a stronger protective effect of high PEA for female compared to male children.

Conclusion

PEA was a more salient determinant of negative urgency in female children than male ones. Our results also showed that American boys tend to have high levels of negative urgency, which is a risk factor of drug use, at all parental education levels.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

Familial Financial Assistance and Body Mass Index in Black College Graduates

Racial disparities in obesity are larger between Black and White college graduates compared to disparities among those who did not complete high school. A possible explanation is that Black adults with higher socioeconomic status (SES) experience unique obesogenic determinants. Black adults who have completed a 4-year college degree can report "uplift stress" from providing financial assistance to family members. The aim of this study is to determine whether the association between familial financial assistance and body mass index (BMI) varies among college-educated Black women and men. This study utilized data from an online survey of Qualtrics standing panels including 451 non-Hispanic Black college graduates. Respondents were asked if they had provided or received any monetary gift or financial help from a family member in the past 12 months as well as their height and weight. Using linear regression and multiplicative interaction terms, the association between familial financial assistance and BMI was assessed by sex. Those who reported both giving and receiving familial financial assistance had higher BMI than those who neither gave nor received assistance (β = 2.80, standard error (s.e.) = 1.16). There was a significant interaction such that this association was observed among women only (β = 6.67, s.e. = 2.32). Future studies should seek to understand the gendered impact of familial financial assistance on BMI in college-educated Black women.