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Requena M, Stanek M. Differential rates of induced abortion in Spain: educational attainment and age among native and immigrant women. GACETA SANITARIA 2024; 38:102419. [PMID: 39128445 DOI: 10.1016/j.gaceta.2024.102419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Analyzing the variations in induced abortion (IA) rates across different subpopulations in Spain based on country of origin, while considering educational and age composition. METHOD Using 2021 Voluntary Termination of Pregnancy register and 2021 Spanish Census microdata, we calculated crude IA rates and age-specific abortion rates. We used age-standardized IA rates (ASIAR) to account for the confounding effect of age composition. We compared seven subpopulations residing in Spain, taking into account simple ages and educational levels aggregated into four categories. RESULTS Immigrant women, especially those from Sub-Saharan and Latin American countries, consistently had higher IA rates compared to native Spanish women. According to age-specific IA rates, university-educated women had considerably fewer abortions than women with other education levels at any age. Age-standardized rates stratified by migratory origin revealed that native Spanish women with primary education or less had higher IA rates than their immigrant counterparts. There was a clear non-linear, association between educational level and IA rates among immigrants. The highest propensity for IA was found among secondary school graduates, while university graduates had the lowest IA rate. CONCLUSIONS The study demonstrated that variability in sociodemographic characteristics had an impact on IA rates. Young women with middle educational attainment and immigrant background had a higher likelihood of undergoing IA in Spain. The relationship between educational level and IA rates was complex, with variations observed among different groups and changes over time.
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Affiliation(s)
- Miguel Requena
- Grupo de Estudios "Población y Sociedad", Departamento de Sociología II, Universidad Nacional de Educación a Distancia, Spain
| | - Mikolaj Stanek
- Departamento de Sociología y Comunicación, Universidad de Salamanca, Salamanca, Spain.
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Shibre G. Unequal uptake of skilled maternal health care services in Ethiopia: cross-sectional data analyses informed by the intersectionality theory. BMJ Open 2024; 14:e077532. [PMID: 39043587 PMCID: PMC11268060 DOI: 10.1136/bmjopen-2023-077532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To investigate intersectional inequality encompassing socioeconomic, geographical and demographic variables in the use of competent birth and postnatal care services in Ethiopia. DESIGN Data for the study came from a series of the Ethiopia Demographic and Health Surveys. Four major surveys were taken place between 2000 and 2016 and all were included in the study. 9867, 9075, 10 592 and 9915 live births born 5 years preceding the surveys that were attended by skilled health workers in 2000, 2005, 2011 and 2016, respectively, were included in the study. For the postnatal care, only the 2016 survey was used due to sample size issues in the other surveys, and 3843 women having live births 2 years preceding the survey had complete data, allowing for fitting of a model. Since the outcome measures are binary, the logit model was used. Intersectionality was analysed by entering interactions into models. SETTINGS Population-based representative surveys encompassing all areas of Ethiopia. PARTICIPANTS The study subjects are women of reproductive age who had live births 2 years preceding the 2016 survey (for postnatal care) and live births born 5 years preceding the respective surveys (for birth care). OUTCOME MEASURES The outcome measures are skilled birth and postnatal care services. The postnatal care was for mothers within the first 2 days of giving birth and did not include care for the newborn. Competent maternal health care services are those that are provided by competent health workers: doctors, nurses, midwives and health officers. RESULTS It was observed that women at the crossroads of multiple axes of advantage and disadvantage had better and worse utilisation, respectively. For example, maternal education and residence intersected and predicted coverage of birth care was the highest among secondary schooling women who dwelt in urban settings with the values of 0.255; 95% CI 0.113 to 0.397 in 2000 and 0.589; 95% CI 0.359 to 0.819 in 2016 but was the lowest among non-educated women who lived in rural areas with the values of 0.0236; 95% CI 0.0154 to 0.0317 in 2000 and 0.203; 95% CI 0.177 to 0.229 in 2016. CONCLUSIONS It appeared that some women who were at the intersections of multiple axes of disadvantage had the lowest predicted coverage for maternal health care services. The study suggests that targeted interventions be developed for women who are at the intersection of multiple axes of marginalisation and that multiple sectors work in their sphere of resposibility to tackle social determinants of maternity care inequality. Policymakers may consider using intersectionality to inform development of targeted policies and or strategies. Further, future studies include structural drivers in the analysis of intersectionality to gain a better insight into the causes of disparities.
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Affiliation(s)
- Gebretsadik Shibre
- Addis Ababa University, College of Health Sciences, School of Public Health, Department of Reproductive, Family and Population Health, Addis Ababa, Ethiopia
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3
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Soares GH, Haag D, Bastos JL, Mejia G, Jamieson L. Triple Jeopardy in Oral Health: Additive Effects of Immigrant Status, Education, and Neighborhood. JDR Clin Trans Res 2024:23800844241253518. [PMID: 38877725 DOI: 10.1177/23800844241253518] [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: 06/16/2024] Open
Abstract
PURPOSE To estimate the additive effects of parent's nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia. METHODS Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI). RESULTS Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI3: -0.14; 95% confidence interval [CI]: -1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI3: 0.43; 95% CI: -2.08, 2.95). CONCLUSION Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds. KNOWLEDGE TRANSFER STATEMENT Our analysis underscores the necessity for policies and public health strategies targeting dental caries-related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.
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Affiliation(s)
- G H Soares
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - D Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - J L Bastos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - G Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - L Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
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Bogenschutz M, Johnson KR, Hall S, Lineberry S, Rand J, Rossetti Z, Shikarpurya S, Ticha R. An Equity-Based Research Agenda to Promote Social Inclusion and Belonging for People With IDD. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 62:186-199. [PMID: 38802094 DOI: 10.1352/1934-9556-62.3.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/24/2023] [Indexed: 05/29/2024]
Abstract
Having a sense of social inclusion and belonging, typically characterized by our personal relationships and community participation, is the central essence of life for most people, yet it remains elusive for many people with intellectual and developmental disabilities (IDD). This article summarizes the work of a diverse group of researchers and advocates to propose 6 big-picture, equity-based goals to drive future research in the field: (1) understanding the role of intersectionality, (2) understanding intimate relationships, (3) promoting formation of communities of care to support social inclusion, (4) understanding life course trajectories of social inclusion, (5) understanding social inclusion in virtual spaces, and (6) understanding how to promote social inclusion in the entire research process.
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Affiliation(s)
- Matthew Bogenschutz
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Khalilah Robinson Johnson
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Sarah Hall
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Sarah Lineberry
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Joseph Rand
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Zach Rossetti
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Sehrish Shikarpurya
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
| | - Renata Ticha
- Matthew Bogenschutz, Virginia Commonwealth University, School of Social Work, Khalilah Robinson Johnson, University of North Carolina at Chapel Hill, Division of Occupational Science and Occupational Therapy, Sarah Hall, University of Minnesota, Institute on Community Integration, Sarah Lineberry, Virginia Commonwealth University, Partnership for People with Disabilities, Joseph Rand, University of Minnesota, Extension, Center for Youth Development, Zach Rossetti, Boston University, Wheelock College of Education & Human Development, Sehrish Shikarpurya, University of Maryland, College of Education, and Renata Ticha, University of Minnesota, Institute on Community Integration
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Coughenour C, Chien LC, Gakh M, Labus B, McDonough IK, Grigsby TJ, Usufzy P. Food and Housing Insecurity in Nevada During the COVID-19 Pandemic. J Community Health 2024; 49:296-313. [PMID: 37932626 DOI: 10.1007/s10900-023-01284-8] [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] [Accepted: 08/31/2023] [Indexed: 11/08/2023]
Abstract
The COVID-19 pandemic intensified concerns regarding food and housing insecurity in the United States, particularly among vulnerable populations. After the pandemic prompted a shutdown of nonessential businesses in Nevada, unemployment rose dramatically as the gaming, tourism, and hospitality industries struggled. This study analyzed the results of two telephone surveys of Nevada adults' experiences in 2020 (n = 1000) and 2021 (n = 1002). The results demonstrate between 2020 and 2021 an 8.24 percentage point decline in food insecurity (FI) from 30.2% to 21.96% and a 12.58 percentage point increase in housing insecurity (HI) from 12.27% to 24.85%. Age, disability status, and certain categories of race/ethnicity and income were associated with both HI and FI in 2020, but disability was no longer significant in 2021. Instead, spouse/partner-status, living with children ≤ 18-years-old and receipt of SNAP benefits were significantly associated with FI in 2021. In particular, health status became a significant factor of both HI and FI. People of color experienced FI disparities compared to Whites. Asians/Hawaiians/Pacific Islanders were 3.22 times (95% CI 1.51, 6.86) more likely to experience FI in 2021 than Whites. A matched, longitudinal analysis also revealed that Whites experienced a significant 9.1 percentage point estimated decline in the probability of FI between 2020 and 2021. However, the reduction among non-White participants was statistically insignificant at 2.5 percentage points. Results indicate the importance of supporting the food and housing needs of people of color and individuals with disabilities. Further research should especially investigate the comparative FI rate among Asians/Hawaiians/Pacific Islanders in 2021 and offer solutions to the soaring prevalence of housing insecurity.
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Affiliation(s)
- Courtney Coughenour
- School of Public Health, University of Nevada Las Vegas, 4700 S. Maryland Parkway, Suite 335, Mailstop #3063, Las Vegas, NV, 89119, USA.
| | - Lung-Chang Chien
- School of Public Health, University of Nevada Las Vegas, 4700 S. Maryland Parkway, Suite 335, Mailstop #3063, Las Vegas, NV, 89119, USA
| | - Maxim Gakh
- School of Public Health, University of Nevada Las Vegas, 4700 S. Maryland Parkway, Suite 335, Mailstop #3063, Las Vegas, NV, 89119, USA
| | - Brian Labus
- School of Public Health, University of Nevada Las Vegas, 4700 S. Maryland Parkway, Suite 335, Mailstop #3063, Las Vegas, NV, 89119, USA
| | - Ian K McDonough
- Department of Economics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Timothy J Grigsby
- School of Public Health, University of Nevada Las Vegas, 4700 S. Maryland Parkway, Suite 335, Mailstop #3063, Las Vegas, NV, 89119, USA
| | - Pashtana Usufzy
- School of Public Health, University of Nevada Las Vegas, 4700 S. Maryland Parkway, Suite 335, Mailstop #3063, Las Vegas, NV, 89119, USA
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James D. Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1307-1325. [PMID: 38388762 PMCID: PMC10955034 DOI: 10.1007/s10508-023-02805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024]
Abstract
We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.
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Affiliation(s)
- Drexler James
- Department of Psychology, University of Minnesota, Twin Cities, 75 E River Rd, Minneapolis, MN, 55455-0366, USA.
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Eschliman EL, Patel EU, Murray SM, German D, Kirk GD, Mehta SH, Kaufman MR, Genberg BL. Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use. Subst Use Misuse 2024; 59:1210-1220. [PMID: 38519443 PMCID: PMC11194036 DOI: 10.1080/10826084.2024.2330906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
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Affiliation(s)
- Evan L. Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Hsieh N. Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:38-59. [PMID: 37776198 PMCID: PMC10922600 DOI: 10.1177/00221465231199276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.
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Affiliation(s)
- Ning Hsieh
- Michigan State University, East Lansing, MI, USA
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Belisle LA, Pinchevsky GM, Ortega G. Examining the prevalence of adverse childhood experiences (ACEs) among justice-involved youth in the U.S.: The importance of accounting for race/ethnicity, gender, and gendered racial/ethnic groups. CHILD ABUSE & NEGLECT 2024; 149:106514. [PMID: 38359774 DOI: 10.1016/j.chiabu.2023.106514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Youth in the U.S. juvenile justice system are exposed to adverse childhood experiences (ACEs) at higher rates than youth in the general public. Additionally, research has demonstrated ACEs can vary by race/ethnicity and gender. However, little is known about how ACEs are experienced across gendered racial/ethnic groups of justice-involved youth. OBJECTIVE To address this gap, this exploratory study is the first to apply an intersectional lens to examine the prevalence of ACEs among a group of justice-involved youth in the U.S. PARTICIPANTS & SETTING Using secondary data, this study examines ACEs by gender, race/ethnicity, and six gendered racial/ethnic groups of justice-involved youth referred to the Division of Youth and Family Services (DYFS) in Milwaukee, Wisconsin. METHODS Descriptive analyses are presented by gender and race/ethnicity separately, followed by gendered racial/ethnic groups to understand differential rates of exposure to ACEs. RESULTS The study's findings align with previous research and reinforce that justice-involved youth experience higher rates of adversity than the general public. The results also support the feminist pathway's perspective within an intersectional context, emphasizing the importance of accounting for race/ethnicity and gender simultaneously to identify the unique experiences of ACEs among justice-involved youth. CONCLUSION Recommendations related to these findings and considerations surrounding ACE measures are discussed. Specifically, findings from this study stress the importance of accounting for gender and race/ethnicity simultaneously when measuring experiences of adversity. This is a critical step to providing equitable treatment and services to address trauma-related needs across gendered racial/ethnic groups of system-involved youth.
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Vervoort D, Elfaki LA, Servito M, Herrera-Morales KY, Kanyepi K. Redefining global cardiac surgery through an intersectionality lens. MEDICAL HUMANITIES 2024; 50:109-115. [PMID: 38388185 DOI: 10.1136/medhum-2023-012801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/24/2024]
Abstract
Although cardiovascular diseases are the leading cause of morbidity and mortality worldwide, six billion people lack access to safe, timely and affordable cardiac surgical care when needed. The burden of cardiovascular disease and disparities in access to care vary widely based on sociodemographic characteristics, including but not limited to geography, sex, gender, race, ethnicity, indigeneity, socioeconomic status and age. To date, the majority of cardiovascular, global health and global surgical research has lacked intersectionality lenses and methodologies to better understand access to care at the intersection of multiple identities and traditions. As such, global (cardiac) surgical definitions and health system interventions have been rooted in reductionism, focusing, at most, on singular sociodemographic characteristics. In this article, we evaluate barriers in global access to cardiac surgery based on existing intersectionality themes and literature. We further examine intersectionality methodologies to study access to cardiovascular care and cardiac surgery and seek to redefine the definition of 'global cardiac surgery' through an intersectionality lens.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lina A Elfaki
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Levandowski BA, Pro GC, Rietberg-Miller SB, Camplain R. We are complex beings: comparison of statistical methods to capture and account for intersectionality. BMJ Open 2024; 14:e077194. [PMID: 38296287 PMCID: PMC10828873 DOI: 10.1136/bmjopen-2023-077194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Intersectionality conceptualises how different parts of our identity compound, creating unique and multifaceted experiences of oppression. Our objective was to explore and compare several quantitative analytical approaches to measure interactions among four sociodemographic variables and interpret the relative impact of axes of marginalisation on self-reported health, to visualise the potential elevated impact of intersectionality on health outcomes. DESIGN Secondary analysis of National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional study of 36 309 non-institutionalised US citizens aged 18 years or older. PRIMARY OUTCOME MEASURES We assessed the effect of interactions among race/ethnicity, disability status, sexual orientation and income level on a self-reported health outcome with three approaches: non-intersectional multivariate regression, intersectional multivariate regression with a single multicategorical predictor variable and intersectional multivariate regression with two-way interactions. RESULTS Multivariate regression with a single multicategorical predictor variable allows for more flexibility in a logistic regression problem. In the fully fitted model, compared with individuals who were white, above the poverty level, had no disability and were heterosexual (referent), only those who were white, above the poverty level, had no disability and were gay/lesbian/bisexual/not sure (LGBQ+) demonstrated no significant difference in the odds of reporting excellent/very good health (aOR=0.90, 95% CI=0.71 to 1.13, p=0.36). Multivariate regression with two-way interactions modelled the extent that the relationship between each predictor and outcome depended on the value of a third predictor variable, allowing social position variation at several intersections. For example, compared with heterosexual individuals, LGBQ+ individuals had lower odds of reporting better health among whites (aOR=0.94, 95% CI=0.93 to 0.95) but higher odds of reporting better health among Black Indigenous People of Color (BIPOC) individuals (aOR=1.13, 95% CI=1.11 to 1.15). CONCLUSION These quantitative approaches help us to understand compounding intersectional experiences within healthcare, to plan interventions and policies that address multiple needs simultaneously.
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Affiliation(s)
- Brooke A Levandowski
- Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - George C Pro
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Ricky Camplain
- Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
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12
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Gompers A, Rossi A, Harding JL. Intersectional race and gender disparities in kidney transplant access in the United States: a scoping review. BMC Nephrol 2024; 25:36. [PMID: 38273245 PMCID: PMC10811805 DOI: 10.1186/s12882-023-03453-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Gender and racial disparities in kidney transplant access are well established, however how gender and race interact to shape access to kidney transplant is less clear. Therefore, we examined existing literature to assess what is known about the potential interaction of gender and race and the impact on access to kidney transplantation in the US. METHODS Following PRISMA guidelines, we conducted a scoping review and included quantitative and qualitative studies published in English between 1990 and May 31, 2023 among adult end-stage kidney disease patients in the US. All studies reported on access to specific transplant steps or perceived barriers to transplant access in gender and race subgroups, and the intersection between the two. We narratively synthesized findings across studies. RESULTS Fourteen studies met inclusion criteria and included outcomes of referral (n = 4, 29%), evaluation (n = 2, 14%), waitlisting (n = 4, 29%), transplantation (n = 5, 36%), provider perceptions of patient transplant candidacy (n = 3, 21%), and patient preferences and requests for a living donor (n = 5, 36%). Overall, we found that White men have the greatest access at all steps of the transplant process, from referral to eventual living or deceased donor transplantation. In contrast, women from racial or ethnic minorities tend to have the lowest access to kidney transplant, in particular living donor transplant, though this was not consistent across all studies. CONCLUSIONS Examining how racism and sexism interact to shape kidney transplant access should be investigated in future research, in order to ultimately shape policies and interventions to improve equity.
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Affiliation(s)
- Annika Gompers
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Ana Rossi
- Piedmont Transplant Institute, 1968 Peachtree Rd NW Building 77, Atlanta, GA, 30309, USA
| | - Jessica L Harding
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
- Department of Surgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
- Health Services Research Center, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
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13
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Butler MS, Smart BP, Watson EJ, Narla SS, Keenan-Devlin L. U.S. Breastfeeding Outcomes at the Intersection: Differences in Duration Among Racial and Ethnic Groups With Varying Educational Attainment in a Nationally Representative Sample. J Hum Lact 2023; 39:722-732. [PMID: 37522342 DOI: 10.1177/08903344231186786] [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: 08/01/2023]
Abstract
BACKGROUND As breastfeeding rates in the United States increase, barriers persist for Black, Latine, and low-socioeconomic status household dyads when compared to White and high-socioeconomic status household dyads. Previous breastfeeding disparities research has almost exclusively considered the influence of race, ethnicity, and socioeconomic status separately, although these attributes are not randomly distributed across the population. RESEARCH AIM To identify breastfeeding duration patterns by race/ethnicity and educational attainment in a nationally representative U.S. National Immunization Survey sample. METHOD We conducted a cross-sectional, secondary analysis of the U.S. Centers for Disease Control and Prevention's 2020 National Immunization Survey-Child public-use data. To examine breastfeeding and exclusive breastfeeding durations at the intersection of race/ethnicity and educational attainment, we created a 12-item, cross-classified variable using three educational attainment groups and four race/ethnicity groups. We used linear regressions to test these associations. RESULTS In all, 83% of the sample breastfed. Mean durations of breastfeeding were 7.5 (SE = 1.95) months and exclusive breastfeeding duration was 4.9 (SE = 0.87) months. In adjusted models, multi-race/other high-educational attainment participants had the longest breastfeeding duration by almost 3 weeks (β: 19.53, 95% CI [5.27, 33.79]), and Black low-educational attainment participants exclusively breastfed for 1 month less than White high-educational attainment participants (β:-30.23, 95% CI [-40.87, -19.58]). CONCLUSIONS Examining race/ethnicity and educational attainment together provides an intersectional understanding of breastfeeding outcomes and can inform targeted, culturally appropriate interventions.
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Affiliation(s)
- Margaret S Butler
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elijah J Watson
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Shreya S Narla
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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14
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Tordoff DM, Fernandez A, Perry NL, Heberling WB, Minalga B, Khosropour CM, Glick SN, Barbee LA, Duerr A. A Quantitative Intersectionality Analysis of HIV/STI Prevention and Healthcare Access Among Transgender and Nonbinary People. Epidemiology 2023; 34:827-837. [PMID: 37756272 PMCID: PMC10539029 DOI: 10.1097/ede.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Transgender and nonbinary people experience substantial barriers to accessing healthcare, including prevention of HIV and other sexually transmitted infections (HIV/STI), due to structural inequities. We examined differences in insurance, HIV/STI prevalence, testing, and preexposure prophylaxis use among transgender and nonbinary people living in Washington State by race and ethnicity and gender. METHODS We pooled data from five 2019-2021 Washington State HIV/STI surveillance data sources to obtain a large and diverse sample of 1648 transgender and nonbinary participants. We calculated the risk difference (RD) for each outcome and used Poisson regression to estimate a surrogate measure of additive interaction-attributable proportion (AP)-that measures the proportion of the excess prevalence of the outcome observed at the intersection of gendered and racialized experience, beyond that expected from gender or race and ethnicity alone. RESULTS Participants reported overall high levels of poverty (29% incomes <$15,000 and 7% unstable housing). Certain groups, especially racial/ethnic minority transgender women, were disproportionately impacted by HIV/STIs (RDs from 20% to 43% and APs from 50% to 85%) and less likely to currently have insurance (RDs from 25% to 39% and APs from 74% to 93%) than that expected based on gendered or racialized experience alone. CONCLUSIONS Our findings highlight the heterogeneity in insurance access, HIV/STI positivity, and prevention utilization within transgender communities. We observed that a large proportion of increased HIV/STI prevalence among racial/ethnic minority transgender women was attributable to the intersection of gender and race and ethnicity. Our findings highlight the importance of trans-inclusive models of HIV/STI prevention that address multilevel barriers rooted in cissexism and structural racism.
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Affiliation(s)
- Diana M. Tordoff
- University of Washington, Department of Epidemiology, Seattle, WA
| | | | - Nicole Lynn Perry
- Lavender Rights Project, Washington Black Trans Task Force, Seattle, WA
| | | | | | | | - Sara N. Glick
- University of Washington, School of Medicine, Seattle, WA
- Public Health-Seattle & King County HIV/STD Program, Seattle, WA
| | - Lindley A. Barbee
- University of Washington, School of Medicine, Seattle, WA
- Public Health-Seattle & King County HIV/STD Program, Seattle, WA
| | - Ann Duerr
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
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15
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Mayer SE, Guan J, Lin J, Hamlat E, Parker JE, Brownell K, Price C, Mujahid M, Tomiyama AJ, Slavich GM, Laraia BA, Epel ES. Intergenerational effects of maternal lifetime stressor exposure on offspring telomere length in Black and White women. Psychol Med 2023; 53:6171-6182. [PMID: 36457292 PMCID: PMC10235210 DOI: 10.1017/s0033291722003397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Although maternal stressor exposure has been associated with shorter telomere length (TL) in offspring, this literature is based largely on White samples. Furthermore, timing of maternal stressors has rarely been examined. Here, we examined how maternal stressors occurring during adolescence, pregnancy, and across the lifespan related to child TL in Black and White mothers. METHOD Mothers (112 Black; 110 White; Mage = 39) and their youngest offspring (n = 222; Mage = 8) were part of a larger prospective cohort study, wherein mothers reported their stressors during adolescence (assessed twice during adolescence for the past year), pregnancy (assessed in midlife for most recent pregnancy), and across their lifespan (assessed in midlife). Mother and child provided saliva for TL measurement. Multiple linear regression models examined the interaction of maternal stressor exposure and race in relation to child TL, controlling for maternal TL and child gender and age. Race-stratified analyses were also conducted. RESULTS Neither maternal adolescence nor lifespan stressors interacted with race in relation to child TL. In contrast, greater maternal pregnancy stressors were associated with shorter child TL, but this effect was present for children of White but not Black mothers. Moreover, this effect was significant for financial but not social pregnancy stressors. Race-stratified models revealed that greater financial pregnancy stressors predicted shorter telomeres in offspring of White, but not Black mothers. CONCLUSIONS Race and maternal stressors interact and are related to biological aging across generations, but these effects are specific to certain races, stressors, and exposure time periods.
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Affiliation(s)
- Stefanie E. Mayer
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143-0984, USA
| | - Joanna Guan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143-0984, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Elissa Hamlat
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143-0984, USA
| | - Jordan E. Parker
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - Kristy Brownell
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA
| | - Candice Price
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
| | - Mahasin Mujahid
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA
| | - A. Janet Tomiyama
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
| | - Barbara A. Laraia
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA
| | - Elissa S. Epel
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143-0984, USA
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Chatterjee P, Chen J, Yousafzai A, Kawachi I, Subramanian SV. When social identities intersect: understanding inequities in growth outcomes by religion- caste and religion-tribe as intersecting strata of social hierarchy for Muslim and Hindu children in India. Int J Equity Health 2023; 22:115. [PMID: 37316862 DOI: 10.1186/s12939-023-01917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/12/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Minority social status determined by religion, caste and tribal group affiliations, are usually treated as independent dimensions of inequities in India. This masks relative privileges and disadvantages at the intersections of religion-caste and religion-tribal group affiliations, and their associations with population health disparities. METHODS Our analysis was motivated by applications of the intersectionality framework in public health, which underlines how different systems of social stratification mutually inform relative access to material resources and social privilege, that are associated with distributions of population health. Based on this framework and using nationally representative National Family Health Surveys of 1992-93, 1998-99, 2005-06, 2015-16 and 2019-21, we estimated joint disparities by religion-caste and religion-tribe, for prevalence of stunting, underweight and wasting in children between 0-5 years of age. As indicators of long- and short-term growth interruptions, these are key population health indicators capturing developmental potential of children. Our sample included Hindu and Muslim children of < = 5 years, who belonged to Other (forward) castes (the most privileged social group), Other Backward Classes (OBCs), Schedule Castes (SCs) and Schedule Tribe (STs). Hindu-Other (forward) caste, as the strata with the dual advantages of religion and social group was specified as the reference category. We specified Log Poisson models to estimate multiplicative interactions of religion- caste and religion-tribe identities on risk ratio scales. We specified variables that may be associated with caste, tribe, or religion, as dimensions of social hierarchy, and/or with child growth as covariates, including fixed effects for states, survey years, child's age, sex, household urbanicity, wealth, maternal education, mother's height, and weight. We assessed patterns in growth outcomes by intersectional religion-caste and religion-tribe subgroups nationally, assessed their trends over the last 30 years, and across states. FINDINGS The sample comprised 6,594, 4,824, 8,595, 40,950 and 3,352 Muslim children, and 37,231, 24,551, 35,499, 1,87,573 and 171,055 Hindu children over NFHS 1, 2, 3, 4, and 5, respectively. As one example anthropometric outcome, predicted prevalence of stunting among different subgroups were as follows- Hindu Other: 34.7% (95%CI: 33.8, 35.7), Muslim Other: 39.2% (95% CI: 38, 40.5), Hindu OBC: 38.2 (95%CI: 37.1, 39.3), Muslim OBC: 39.6% (95%CI: 38.3, 41), Hindu SCs: 39.5% (95%CI: 38.2, 40.8), Muslims identifying as SCs: 38.5% (95%CI: 35.1, 42.3), Hindu STs: 40.6% (95% CI: 39.4, 41.9), Muslim STs: 39.7% (95%CI: 37.2, 42.4). Over the last three decades, Muslims always had higher prevalence of stunting than Hindus across caste groups. But this difference doubled for the most advantaged castes (Others) and reduced for OBCs (less privileged caste group). For SCs, who are the most disadvantaged caste group, the Muslim disadvantage reversed to an advantage. Among tribes (STs), Muslims always had an advantage, which reduced over time. Similar directions and effect sizes were estimated for prevalence of underweight. For prevalence of wasting, effect sizes were in the same range, but not statistically significant for two minority castes-OBCs and SCs. INTERPRETATION Hindu children had the highest advantages over Muslim children when they belonged to the most privileged castes. Muslim forward caste children were also disadvantaged compared to Hindu children from deprived castes (Hindu OBCs and Hindu SCs), in the case of stunting. Thus, disadvantages from a socially underprivileged religious identity, seemed to override relative social advantages of forward caste identity for Muslim children. Disadvantages born of caste identity seemed to take precedence over the social advantages of Hindu religious identity, for Hindu children of deprived castes and tribes. The doubly marginalized Muslim children from deprived castes were always behind their Hindu counter parts, although their differentials were less than that of Muslim-Hindu children of forward castes. For tribal children, Muslim identity seemed to play a protective role. Our findings indicate monitoring child development outcomes by subgroups capturing intersectional social experiences of relative privilege and access from intersecting religion and social group identities, could inform policies to target health disparities.
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Affiliation(s)
- Pritha Chatterjee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jarvis Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA 02138; and, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, MA 02115, Boston, USA
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17
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Cintron DW, Matthay EC, McCoach DB. Testing for intersectional measurement invariance with the alignment method: Evaluation of the 8-item patient health questionnaire. Health Serv Res 2023. [PMID: 37290788 DOI: 10.1111/1475-6773.14189] [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: 06/10/2023] Open
Abstract
OBJECTIVE To demonstrate the use of the alignment method to evaluate whether surveys function similarly (i.e., have evidence of measurement invariance) across culturally diverse intersectional groups. Intersectionality theory recognizes the interconnected nature of social categories such as race, gender, ethnicity, and socioeconomic status. DATA SOURCES A total of 30,215 American adult's responses to the eight-item Patient Health Questionnaire depression assessment scale (PHQ-8) from the 2019 National Health Interview Survey (NHIS). STUDY DESIGN Using the alignment method, we examined the measurement invariance (equivalence) of the PHQ-8 depression assessment scale across 16 intersectional subgroups defined at the intersection of age (under 52, 52 and older), gender (male, female), race (Black, non-Black), and education (no bachelor's degree, bachelor's degree). PRINCIPAL FINDINGS Overall, 24% of the factor loadings and 5% of the item intercepts showed evidence of differential functioning across one or more of the intersectional groups. These levels fall beneath the benchmark of 25% suggested for determining measurement invariance with the alignment method. CONCLUSIONS The results of the alignment study suggest that the PHQ-8 functions similarly across the intersectional groups examined, despite some evidence of different factor loadings and item intercepts in some groups (i.e., noninvariance). By examining measurement invariance through an intersectional lens, researchers can investigate how a person's multiple identities and social positions possibly contribute to their response behavior on an assessment scale.
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Affiliation(s)
- Dakota W Cintron
- Center for Integrative Developmental Science, Cornell University, Ithaca, New York, USA
- Department of Psychology, Cornell University, Ithaca, New York, USA
| | - Ellicott C Matthay
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - D Betsy McCoach
- Department of Educational Psychology, University of Connecticut, Storrs, Connecticut, USA
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18
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Emani S, Rodriguez JA, Bates DW. Racism and Electronic Health Records (EHRs): Perspectives for research and practice. J Am Med Inform Assoc 2023; 30:995-999. [PMID: 36869772 PMCID: PMC10114075 DOI: 10.1093/jamia/ocad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/17/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023] Open
Abstract
Informatics researchers and practitioners have started exploring racism related to the implementation and use of electronic health records (EHRs). While this work has begun to expose structural racism which is a fundamental driver of racial and ethnic disparities, there is a lack of inclusion of concepts of racism in this work. This perspective provides a classification of racism at 3 levels-individual, organizational, and structural-and offers recommendations for future research, practice, and policy. Our recommendations include the need to capture and use structural measures of social determinants of health to address structural racism, intersectionality as a theoretical framework for research, structural competency training, research on the role of prejudice and stereotyping in stigmatizing documentation in EHRs, and actions to increase the diversity of private sector informatics workforce and participation of minority scholars in specialty groups. Informaticians have an ethical and moral obligation to address racism, and private and public sector organizations have a transformative role in addressing equity and racism associated with EHR implementation and use.
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Affiliation(s)
- Srinivas Emani
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jorge A Rodriguez
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Taylor L, Gangnon R, Powell WR, Kramer J, Kind AJH, Bartels CM, Brennan MB. Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study. BMJ Open Diabetes Res Care 2023; 11:11/2/e003185. [PMID: 37072336 PMCID: PMC10124219 DOI: 10.1136/bmjdrc-2022-003185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Rural patients with diabetic foot ulcers, especially those identifying as black, face increased risk of major amputation. Specialty care can reduce this risk. However, care disparities might beget outcome disparities. We aimed to determine whether a smaller proportion of rural patients, particularly those identifying as black, receive specialty care compared with the national proportion. RESEARCH DESIGN AND METHODS This 100% national retrospective cohort examined Medicare beneficiaries hospitalized with diabetic foot ulcers (2013-2014). We report observed differences in specialty care, including: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, or vascular surgery. We used logistic regression to examine possible intersectionality between rurality and race, controlling for sociodemographics, comorbidities, and ulcer severity and including an interaction term between rurality and identifying as black. RESULTS Overall, 32.15% (n=124 487) of patients hospitalized with a diabetic foot ulcer received specialty care. Among rural patients (n=13 100), the proportion decreased to 29.57%. For patients identifying as black (n=21 649), the proportion was 33.08%. Among rural patients identifying as black (n=1239), 26.23% received specialty care. This was >5 absolute percentage points less than the overall cohort. The adjusted OR for receiving specialty care among rural versus urban patients identifying as black was 0.61 (95% CI 0.53 to 0.71), which was lower than that for rural versus urban patients identifying as white (aOR 0.85, 95% CI 0.80 to 0.89). This metric supported a role for intersectionality between rurality and identifying as black. CONCLUSIONS A smaller proportion of rural patients, particularly those identifying as black, received specialty care when hospitalized with a diabetic foot ulcer compared with the overall cohort. This might contribute to known disparities in major amputations. Future studies are needed to determine causality.
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Affiliation(s)
- Lindsay Taylor
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Population Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - W Ryan Powell
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | - Joseph Kramer
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | - Amy J H Kind
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | | | - Meghan B Brennan
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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20
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Eschliman EL, Poku OB, Winiker AK, Latkin CA, Tobin KE. Associations between social network characteristics and sexual minority disclosure concern among Black men who have sex with men living with and without HIV. THE JOURNAL OF SOCIAL ISSUES 2023; 79:390-409. [PMID: 37215260 PMCID: PMC10195063 DOI: 10.1111/josi.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/01/2022] [Indexed: 05/24/2023]
Abstract
In addition to the pervasive anti-Black racism faced by Black people in the United States, Black men who have sex with men (BMSM) face sexual minority stigma and, among BMSM living with HIV, HIV-related stigma. These multilevel social forces shape social networks, which are important sources of resources, support, and behavior regulation. This study quantitatively examined the relationship between social network characteristics and sexual minority stigma (e.g., homophobia, biphobia), assessed by reported concerns around disclosing one's sexual minority status, among BMSM in Baltimore, Maryland in 2014 (N = 336). A majority of participants (63.7%) reported experiencing medium or high levels of sexual minority disclosure concern. In a multiple linear regression model, participants with higher sexual minority disclosure concern reported lower network density and having fewer good friends who are gay or bisexual men. Stratifying the same multiple linear regression model by HIV status supports the importance of an intersectional understanding of sexual minority and HIV-related stigma. These findings can help health-related programs address the complex relationships between sexual minority stigma, social networks, and HIV status within this multiply-marginalized and high-priority population.
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Affiliation(s)
- Evan L. Eschliman
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health
| | - Ohemaa B. Poku
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Columbia University and New York Psychiatric Institute
| | - Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Carl A. Latkin
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health
| | - Karin E. Tobin
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health
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21
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Gesing P, Pant MD, Burbage AK. Health occupations salary outcomes: intersections of student race, gender, and first-generation status. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:223-241. [PMID: 35980515 PMCID: PMC9386665 DOI: 10.1007/s10459-022-10154-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/07/2022] [Indexed: 05/21/2023]
Abstract
Greater diversity in the healthcare workforce has been identified as a critical need in serving an increasingly diverse population. Higher education institutions have been tasked with increasing the number of underrepresented students in the health occupations pipeline to better align with the demographics of the general population and meet the need for a diverse health occupations workforce. This study used the National Science Foundation's National Survey of College Graduates dataset to capture data across time, examining the intersectionality of race, gender, and first-generation status on the salary outcomes of students who earn degrees related to health occupations. Results indicate that the intersecting identities of students who earn a bachelor's degree or higher in the health professions impact salary outcomes. Results of this study have implications for higher education policies that can impact increased diversity in the health occupations workforce pipeline.
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Affiliation(s)
- Peggy Gesing
- Medical and Health Professions Education Program, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501, USA.
| | - Mohan D Pant
- Master of Public Health, Eastern Virginia Medical School, Norfolk, USA
| | - Amanda K Burbage
- Medical and Health Professions Education Program, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501, USA
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22
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Kapral MK. Kenton Award Lecture-Stroke Disparities Research: Learning From the Past, Planning for the Future. Stroke 2023; 54:379-385. [PMID: 36689593 DOI: 10.1161/strokeaha.122.039562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/15/2022] [Indexed: 01/24/2023]
Abstract
Inequities in stroke care and outcomes have been documented both within and among countries based on factors, such as race, geography, and socioeconomic status. Research can help us to identify, understand, and address inequities, and this article offers considerations for scientists working in this area. These include designing research aimed at identifying the underlying causes of inequities, recognizing the importance of the social determinants of health, considering interventions that go beyond the individual patient and provider to include policies and systems, acknowledging the role of structural racism, performing community-engaged participatory research, considering intersecting social identities, learning from cross-national comparisons, maintaining the data sources needed for inequities research, using terminology that advances health equity, and improving diversity across the research enterprise.
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Affiliation(s)
- Moira K Kapral
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada (M.K.K.)
- ICES, Toronto, Canada (M.K.K.)
- Toronto General Hospital Research Institute, Canada (M.K.K.)
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Relationship between intersectionality and cancer inequalities: a scoping review protocol. BMJ Open 2023; 13:e066637. [PMID: 36707112 PMCID: PMC9884887 DOI: 10.1136/bmjopen-2022-066637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Persistent inequalities in cancer care and cancer outcomes exist within and between countries. However, the evidence pertaining to the root causes driving cancer inequalities is mixed. This may be explained by the inadequate attention paid to experiences of patients with cancer living at the intersection of multiple social categories (eg, social class, ethnicity). This is supported by the intersectionality framework. This framework offers an alternative lens through which to analyse and understand how these interlocking systems of oppression uniquely shape the experiences of patients with cancer and drive inequalities. In this protocol, we outline a scoping review that will systematically map what is known about the relationship between intersectionality and inequalities in care experience and cancer outcomes of patients with cancer; and to determine how the intersectionality framework has been applied in studies across the cancer care pathway and across countries. METHODS AND ANALYSIS This study will be guided by Arksey and O'Malley's, and Levac et al's frameworks for scoping reviews. We will identify and map the evidence on cancer inequalities and intersectionality from 1989 to present date. Electronic databases (EMBASE, PsychINFO, CINAHL, Medline, Web of Science, ProQuest) and a systematic search strategy using a combination of keywords and Boolean operators AND/OR will be used to identify relevant studies. Screening of eligible papers and data extraction will be conducted by two independent reviewers, and disagreements resolved by discussion with the research team. We will use an iterative process to data charting using a piloted form. Findings will be collated into a narrative report. ETHICS AND DISSEMINATION Ethical approval is not required since data used are from publicly available secondary sources. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder meetings. Further, findings will inform the next phases of a multistage research project aimed at understanding inequalities among patients with breast cancer.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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Alang S, Haile R, Hardeman R, Judson J. Mechanisms Connecting Police Brutality, Intersectionality, and Women's Health Over the Life Course. Am J Public Health 2023; 113:S29-S36. [PMID: 36696613 PMCID: PMC9877369 DOI: 10.2105/ajph.2022.307064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 01/27/2023]
Abstract
Police brutality harms women. Structural racism and structural sexism expose women of color to police brutality through 4 interrelated mechanisms: (1) desecration of Black womanhood, (2) criminalization of communities of color, (3) hypersexualization of Black and Brown women, and (4) vicarious marginalization. We analyze intersectionality as a framework for understanding racial and gender determinants of police brutality, arguing that public health research and policy must consider how complex intersections of these determinants and their contextual specificities shape the impact of police brutality on the health of racially minoritized women. We recommend that public health scholars (1) measure and analyze multiple sources of vulnerability to police brutality, (2) consider policies and interventions within the contexts of intersecting statuses, (3) center life course experiences of marginalized women, and (4) assess and make Whiteness visible. People who hold racial and gender power-who benefit from racist and sexist systems-must relinquish power and reject these benefits. Power and the benefits of power are what keep oppressive systems such as racism, sexism, and police brutality in place. (Am J Public Health. 2023;113(S1):S29-S36. https://doi.org/10.2105/AJPH.2022.307064).
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Affiliation(s)
- Sirry Alang
- Sirry Alang is with the Department of Sociology and the Program in Health Medicine and Society at Lehigh University, Bethlehem, PA. Rahwa Haile is with the Department of Public Health at the State University of New York, Old Westbury, NY. Rachel Hardeman is with the Center for Antiracism Research for Health Equity and the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Jé Judson is with the University of Minnesota School of Public Health
| | - Rahwa Haile
- Sirry Alang is with the Department of Sociology and the Program in Health Medicine and Society at Lehigh University, Bethlehem, PA. Rahwa Haile is with the Department of Public Health at the State University of New York, Old Westbury, NY. Rachel Hardeman is with the Center for Antiracism Research for Health Equity and the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Jé Judson is with the University of Minnesota School of Public Health
| | - Rachel Hardeman
- Sirry Alang is with the Department of Sociology and the Program in Health Medicine and Society at Lehigh University, Bethlehem, PA. Rahwa Haile is with the Department of Public Health at the State University of New York, Old Westbury, NY. Rachel Hardeman is with the Center for Antiracism Research for Health Equity and the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Jé Judson is with the University of Minnesota School of Public Health
| | - Jé Judson
- Sirry Alang is with the Department of Sociology and the Program in Health Medicine and Society at Lehigh University, Bethlehem, PA. Rahwa Haile is with the Department of Public Health at the State University of New York, Old Westbury, NY. Rachel Hardeman is with the Center for Antiracism Research for Health Equity and the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Jé Judson is with the University of Minnesota School of Public Health
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Hoang TMH, Wong A. Exploring the Application of Intersectionality as a Path toward Equity in Perinatal Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:685. [PMID: 36613005 PMCID: PMC9819722 DOI: 10.3390/ijerph20010685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To conduct a scoping review to determine how past studies have applied the theory of intersectionality, a critical feminist research paradigm, to understand the physical health and mental health outcomes of perinatal people as a step toward addressing maternal health disparities and injustice. The study includes a review of existing research on maternal physical and mental health outcomes, presents the strengths and limitations of existing studies, and provides recommendations on best practices in applying intersectionality in research to address systemic issues and improve outcomes for the perinatal population. METHODS We conducted an extensive literature search across four search engines, yielding 28 publications using the intersectionality framework that focused on the outcomes of perinatal people, with a total sample of 9,856,042 participants. We examined how these studies applied intersectionality and evaluated them based on three areas: conceptualization, research method, and interpretation/findings. RESULTS Our findings indicate that maternal health researchers have provided good descriptions of the interaction of systemic inequalities and have used analysis that allows for the examination of interlocking and mutually reinforcing social positions or systems. We find that improvement is needed in the areas of conceptualization, reflexivity, and understanding of power structure. Recommendations are provided in the form of a checklist to guide future research toward an impactful approach to addressing perinatal health disparities. RELEVANCE Our scoping review has implications for improving applied health research to address perinatal health disparities, mortality, and morbidity. Recommendations are given along with references to other tools, and a guidance checklist is provided to support scholars in creating an impactful approach to applying intersectionality in the goal of addressing maternal health disparities.
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Affiliation(s)
- Tuyet-Mai H. Hoang
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Ainslee Wong
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
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Lederer V, Messing K, Sultan-Taïeb H. How Can Quantitative Analysis Be Used to Improve Occupational Health without Reinforcing Social Inequalities? An Examination of Statistical Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:19. [PMID: 36612341 PMCID: PMC9819275 DOI: 10.3390/ijerph20010019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Taking account of sex and gender in occupational health studies poses statistical challenges. Other sociodemographic variables, such as racialization, class, and age, also affect the relations between workplace exposures and health and interact with sex and gender. Our objective was to perform a critical review of conventional and emerging statistical tools, examining whether each analysis takes account of sociodemographic variables (1) in a way that contributes to identification of critical occupational determinants of health (2) while taking account of relevant population characteristics to reflect intersectional approaches to health and (3) using sample sizes and population characteristics available to researchers. A two-step search was conducted: (1) a scientific watch concerning the statistical tools most commonly used in occupational health over the past 20 years; (2) a screening of the 1980-2022 literature with a focus on emerging tools. Our examination shows that regressions with adjustment for confounders and stratification fail to reveal the sociodemographic mechanisms that interact with occupational health problems, endangering the identification of occupational risks. Multilevel (notably MAIHDA) analyses, decision tree, cluster, and latent analyses are useful methods to consider when seeking to orientate prevention. Researchers should consider methods that adequately reveal the mechanisms connecting sociodemographic variables and occupational health outcomes.
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Affiliation(s)
- Valérie Lederer
- Department of Industrial Relations, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - Karen Messing
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, QC H3C 3P8, Canada
| | - Hélène Sultan-Taïeb
- Department of Organization and Human Resources, School of Management (ESG-UQAM), Université du Québec à Montréal, Montreal, QC H3C 3P8, Canada
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Burnette CB, Luzier JL, Weisenmuller CM, Boutté RL. A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States. Int J Eat Disord 2022; 55:423-454. [PMID: 35288967 PMCID: PMC8988395 DOI: 10.1002/eat.23699] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.
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Affiliation(s)
- C. Blair Burnette
- Charleston Area Medical CenterCharlestonWest VirginiaUSA,Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jessica L. Luzier
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
| | - Chantel M. Weisenmuller
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
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Brennan MB, Powell WR, Kaiksow F, Kramer J, Liu Y, Kind AJH, Bartels CM. Association of Race, Ethnicity, and Rurality With Major Leg Amputation or Death Among Medicare Beneficiaries Hospitalized With Diabetic Foot Ulcers. JAMA Netw Open 2022; 5:e228399. [PMID: 35446395 PMCID: PMC9024392 DOI: 10.1001/jamanetworkopen.2022.8399] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/03/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Patients identifying as Black and those living in rural and disadvantaged neighborhoods are at increased risk of major (above-ankle) leg amputations owing to diabetic foot ulcers. Intersectionality emphasizes that the disparities faced by multiply marginalized people (eg, rural US individuals identifying as Black) are greater than the sum of each individual disparity. Objective To assess whether intersecting identities of Black race, ethnicity, rural residence, or living in a disadvantaged neighborhood are associated with increased risk in major leg amputation or death among Medicare beneficiaries hospitalized with diabetic foot ulcers. Design, Setting, and Participants This retrospective cohort study used 2013-2014 data from the US National Medicare Claims Data Database on all adult Medicare patients hospitalized with a diabetic foot ulcer. Statistical analysis was conducted from August 1 to October 27, 2021. Exposures Race was categorized using Research Triangle Institute variables. Rurality was assigned using Rural-Urban Commuting Area codes. Residents of disadvantaged neighborhoods comprised those living in neighborhoods at or above the national 80th percentile Area Deprivation Index. Main Outcomes and Measures Major leg amputation or death during hospitalization or within 30 days of hospital discharge. Logistic regression was used to explore interactions among race, ethnicity, rurality, and neighborhood disadvantage, controlling for sociodemographic characteristics, comorbidities, and ulcer severity. Results The cohort included 124 487 patients, with a mean (SD) age of 71.5 (13.0) years, of whom 71 286 (57.3%) were men, 13 100 (10.5%) were rural, and 21 649 (17.4%) identified as Black. Overall, 17.6% of the cohort (n = 21 919), 18.3% of rural patients (2402 of 13 100), and 21.9% of patients identifying as Black (4732 of 21 649) underwent major leg amputation or died. Among 1239 rural patients identifying as Black, this proportion was 28.0% (n = 347). This proportion exceeded the expected excess for rural patients (18.3% - 17.6% = 0.7%) plus those identifying as Black (21.9% - 17.6% = 4.3%) by more than 2-fold (28.0% - 17.6% = 10.4% vs 0.7% + 4.3% = 5.0%). The adjusted predicted probability of major leg amputation or death remained high at 24.7% (95% CI, 22.4%-26.9%), with a significant interaction between race and rurality. Conclusions and Relevance Rural patients identifying as Black had a more than 10% absolute increased risk of major leg amputation or death compared with the overall cohort. This study suggests that racial and rural disparities interacted, amplifying risk. Findings support using an intersectionality lens to investigate and address disparities in major leg amputation and mortality for patients with diabetic foot ulcers.
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Affiliation(s)
| | - W. Ryan Powell
- Department of Medicine, University of Wisconsin, Madison
| | - Farah Kaiksow
- Department of Medicine, University of Wisconsin, Madison
| | - Joseph Kramer
- Department of Medicine, University of Wisconsin, Madison
| | - Yao Liu
- Department of Ophthalmology, University of Wisconsin, Madison
| | - Amy J. H. Kind
- Department of Medicine, University of Wisconsin, Madison
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, Department of Veterans Affairs, Madison, Wisconsin
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