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Chang RSW, Ow GM, Walker EJ, Brooks K, Lai AR. An Exercise in Clinical Reasoning: Use of Social Context in Diagnosing an Elevated Lactate. J Gen Intern Med 2024:10.1007/s11606-024-08831-6. [PMID: 39231848 DOI: 10.1007/s11606-024-08831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/20/2024] [Indexed: 09/06/2024]
Affiliation(s)
- Rachel Si-Wen Chang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gregory M Ow
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Evan J Walker
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Katherine Brooks
- Division of Hospital Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Andrew R Lai
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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2
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Moynihan KM, Sharma M, Mehta A, Lillie J, Ziegenfuss M, Festa M, Chan T, Thiagarajan R. Race-Conscious Research Using Extracorporeal Life Support Organization Registry Data: A Narrative Review. ASAIO J 2024; 70:721-733. [PMID: 38648078 PMCID: PMC11356683 DOI: 10.1097/mat.0000000000002206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Race-conscious research identifies health disparities with 1) rigorous and responsible data collection, 2) intentionality and considered analyses, and 3) interpretation of results that advance health equity. Individual registries must overcome specific challenges to promote race-conscious research, and this paper describes ways to achieve this with a focus on the international Extracorporeal Life Support Organization (ELSO) registry. This article reviews ELSO registry publications that studied race with outcomes to consider whether research outputs align with race-conscious concepts and describe the direction of associations reported. Studies were identified via secondary analysis of a comprehensive scoping review on ECMO disparities. Of 32 multicenter publications, two (6%) studied race as the primary objective. Statistical analyses, confounder adjustment, and inclusive, antibiased language were inconsistently used. Only two (6%) papers explicitly discussed mechanistic drivers of inequity such as structural racism, and five (16%) discussed race variable limitations or acknowledged unmeasured confounders. Extracorporeal Life Support Organization registry publications demonstrated more adverse ECMO outcomes for underrepresented/minoritized populations than non-ELSO studies. With the objective to promote race-conscious ELSO registry research outputs, we provide a comprehensive understanding of race variable limitations, suggest reasoned retrospective analytic approaches, offer ways to interpret results that advance health equity, and recommend practice modifications for data collection.
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Affiliation(s)
- Katie M Moynihan
- From the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Meesha Sharma
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, California
| | - Anuj Mehta
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Denver Health and Hospital Authority, Denver, Colorado
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jon Lillie
- Pediatric Intensive Care, Evelina London Children's Hospital, London, United Kingdom
| | - Marc Ziegenfuss
- Adult Intensive Care Services, Prince Charles Hospital, Queensland Intensive Care Clinical Network and State Emergency Coordination Centre, Brisbane, Australia
- Australian and New Zealand Intensive Care Society (ANZICS), Australia
| | - Marino Festa
- New South Wales Kids ECMO Referral Service, Australia
- Kids Critical Care Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Titus Chan
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ravi Thiagarajan
- From the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Labelle A. What Does It Mean to Be White in Veterinary Medicine? Vet Clin North Am Small Anim Pract 2024; 54:839-848. [PMID: 39004521 DOI: 10.1016/j.cvsm.2024.06.007] [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] [Indexed: 07/16/2024]
Abstract
Race is a pseudo-scientific system that was invented to sort people by skin color into different categories. Race has no biologic basis, meaning the phenotype of skin color cannot accurately separate humans into distinct categories. Contemporary Western veterinary medicine was founded by white European men to treat livestock and working horses; 150+ years later, the majority of veterinary graduates are white women working on domesticated family pets. The history of veterinary medicine informs our current reality.
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Affiliation(s)
- Amber Labelle
- Bright Light Veterinary Eye Care, Ottawa, Ontario, Canada.
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McDaniel CE, Truschel LL, Kerns E, Polanco YV, Liang D, Gutman CK, Cunningham S, Rooholamini SN, Thull-Freedman J, Jennings B, Magee S, Aronson PL. Disparities in Guideline Adherence for Febrile Infants in a National Quality Improvement Project. Pediatrics 2024; 154:e2024065922. [PMID: 39155728 PMCID: PMC11350103 DOI: 10.1542/peds.2024-065922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Interventions aimed to standardize care may impact racial and ethnic disparities. We evaluated the association of race and ethnicity with adherence to recommendations from the American Academy of Pediatrics' clinical practice guideline for febrile infants after a quality improvement (QI) intervention. METHODS We conducted a cross-sectional study of infants aged 8 to 60 days enrolled in a QI collaborative of 99 hospitals. Data were collected across 2 periods: baseline (November 2020-October 2021) and intervention (November 2021-October 2022). We assessed guideline-concordance through adherence to project measures by infant race and ethnicity using proportion differences compared with the overall proportion. RESULTS Our study included 16 961 infants. At baseline, there were no differences in primary measures. During the intervention period, a higher proportion of non-Hispanic white infants had appropriate inflammatory markers obtained (2% difference in proportions [95% confidence interval (CI) 0.7 to 3.3]) and documentation of follow-up from the emergency department (2.5%, 95% CI 0.3 to 4.8). A lower proportion of non-Hispanic Black infants (-12.5%, 95% CI -23.1 to -1.9) and Hispanic/Latino infants (-6.9%, 95% CI -13.8 to -0.03) had documented shared decision-making for obtaining cerebrospinal fluid. A lower proportion of Hispanic/Latino infants had appropriate inflammatory markers obtained (-2.3%, 95% CI -4.0 to -0.6) and appropriate follow-up from the emergency department (-3.6%, 95% CI -6.4 to -0.8). CONCLUSIONS After an intervention designed to standardize care, disparities in quality metrics emerged. Future guideline implementation should integrate best practices for equity-focused QI to ensure equitable delivery of evidence-based care.
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Affiliation(s)
- Corrie E. McDaniel
- Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington
| | - Larissa L. Truschel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Duke University School of Medicine, Duke University Health, Durham, North Carolina
| | - Ellen Kerns
- Division of Informatics and Health Systems Sciences, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Yenimar Ventura Polanco
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Danni Liang
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Colleen K. Gutman
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | | | - Sahar N. Rooholamini
- Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington
| | - Jennifer Thull-Freedman
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Sloane Magee
- American Academy of Pediatrics, Itasca, Illinois
| | - Paul L. Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Nik-Ahd F, Zhao S, Boscardin WJ, Wang L, Covinsky K, Suskind AM. Development of the UroARC Surgical Calculator: A Novel Risk Calculator for Older Adults Undergoing Surgery for Bladder Outlet Obstruction. J Urol 2024; 212:451-460. [PMID: 38920141 PMCID: PMC11343443 DOI: 10.1097/ju.0000000000003978] [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: 12/18/2023] [Accepted: 04/05/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Bladder outlet obstruction (BOO) is common in older adults. Many older adults who pursue surgery have additional vulnerabilities affecting surgical risk, including frailty. A clinical tool that builds on frailty to predict surgical outcomes for the spectrum of BOO procedures would be helpful to aid in surgical decision-making but does not currently exist. MATERIALS AND METHODS Medicare beneficiaries undergoing BOO surgery from 2014 to 2016 were identified and analyzed using the Medicare MedPAR, Outpatient, and Carrier files. Eight different BOO surgery categories were created. Baseline frailty was calculated for each beneficiary using the Claims-Based Frailty Index (CFI). All 93 variables in the CFI and the 17 variables in the Charlson Comorbidity Index were individually entered into stepwise logistic regression models to determine variables most highly predictive of complications. Similar and duplicative variables were combined into categories. Calibration curves and tests of model fit, including C statistics, Brier scores, and Spiegelhalter P values, were calculated to ensure the prognostic accuracy for postoperative complications. RESULTS In total, 212,543 beneficiaries were identified. Approximately 42.5% were prefrail (0.15 ≤ CFI < 0.25), 8.7% were mildly frail (0.25 ≤ CFI < 0.35), and 1.2% were moderately-to-severely frail (CFI ≥0.35). Using stepwise logistic regression, 13 distinct prognostic variable categories were identified as the most reliable predictors of postoperative outcomes. Most models demonstrated excellent model discrimination and calibration with high C statistic and Spiegelhalter P values, respectively, and high accuracy with low Brier scores. Calibration curves for each outcome demonstrated excellent model fit. CONCLUSIONS This novel risk assessment tool may help guide surgical prognostication among this vulnerable population.
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Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Shoujun Zhao
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - W. John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Lufan Wang
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Kenneth Covinsky
- Department of Geriatrics, University of California, San Francisco, San Francisco, California
| | - Anne M. Suskind
- Department of Urology, University of California, San Francisco, San Francisco, California
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6
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Wilby KJ, Bergin KM, Laffin B, Arya V, Black EK, Gebre A, Framp H. Through the Lens of Societal Norms and Experiences: Students' Conceptualization of Patient Case Data When Diversity is Apparent. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024:101282. [PMID: 39209157 DOI: 10.1016/j.ajpe.2024.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/14/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE There are increasing calls to improve representation of diversity within case-based learning materials, yet it is unclear how students interpret inclusion of diversity data when synthesizing case information. The objective of this study was to determine factors that influence students' interpretation of written case data for visualization of a patient case. METHODS This was a qualitative study using interviews. Entry-to-practice pharmacy students from Dalhousie University in Canada were recruited to review six cases, each with varying representations of diversity (e.g., race, sexual orientation, gender, relationship status, disability, or none). Students were prompted to state how they visualized the case patient and what factors influenced their perceptions. Interviews were audio-recorded and transcribed verbatim. A reflexive thematic analysis was conducted to interpret themes. RESULTS Interviews were conducted with 18 students. Students relied on five factors when interpreting case data in the presence of diversity. In addition to the case data itself, these included personal experience (relating to themselves or personal relationships), professional experience (through work or school), population stereotypes, and perceived societal norms. CONCLUSION This study found that students rely on their personal and professional experiences, perceptions, and social conditioning when interpreting the presence of diversity within learning materials. Findings support the notion that educators should deliberately and conscientiously expose students to a broad representation of diverse populations to increase students' knowledge and understanding of populations, and to create intentional time and space to challenge existing stereotypes that contribute to the inequities in healthcare.
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Affiliation(s)
- Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University.
| | | | - Breanna Laffin
- College of Pharmacy, Faculty of Health, Dalhousie University.
| | - Vibhuti Arya
- College of Pharmacy and Health Sciences, St. John's University.
| | - Emily K Black
- College of Pharmacy, Faculty of Health, Dalhousie University.
| | - Afomia Gebre
- College of Pharmacy, Faculty of Health, Dalhousie University.
| | - Heidi Framp
- College of Pharmacy, Faculty of Health, Dalhousie University.
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7
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Barlow M, Down L, Mounce LTA, Funston G, Merriel SWD, Watson J, Abel G, Kirkland L, Martins T, Bailey SER. The diagnostic performance of CA-125 for the detection of ovarian cancer in women from different ethnic groups: a cohort study of English primary care data. J Ovarian Res 2024; 17:173. [PMID: 39187847 PMCID: PMC11346194 DOI: 10.1186/s13048-024-01490-5] [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: 04/04/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND CA-125 testing is a recommended first line investigation for women presenting with possible symptoms of ovarian cancer in English primary care, to help determine whether further investigation for ovarian cancer is needed. It is currently not known how well the CA-125 test performs in ovarian cancer detection for patients from different ethnic groups. METHODS A retrospective cohort study utilising English primary care data linked to the national cancer registry was undertaken. Women aged ≥ 40 years with a CA-125 test between 2010 and 2017 were included. Logistic regression predicted one-year ovarian cancer incidence by ethnicity, adjusting for age, deprivation status, and comorbidity score. The estimated incidence of ovarian cancer by CA-125 level was modelled for each ethnic group using restricted cubic splines. RESULTS The diagnostic performance of CA-125 differed for women from different ethnicities. In an unadjusted analysis, predicted CA-125 levels for Asian and Black women were higher than White women at corresponding probabilities of ovarian cancer. The higher PPVs for White women compared to Asian or Black women were eliminated by inclusion of covariates. CONCLUSION The introduction of ethnicity-specific thresholds may increase the specificity and PPVs of CA-125 in ovarian cancer detection at the expense of sensitivity, particularly for Asian and Black women. As such, we cannot recommend the use of ethnicity-specific thresholds for CA-125.
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Affiliation(s)
- Melissa Barlow
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Liz Down
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Luke T A Mounce
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Garth Funston
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Samuel W D Merriel
- Centre for Primary Care & Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jessica Watson
- Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Gary Abel
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Lucy Kirkland
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Tanimola Martins
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah E R Bailey
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Milburn S, Bhutani VK, Weintraub A, Guttmann K. Implementation of Universal Screening for G6PD Deficiency in Newborns. Pediatrics 2024; 154:e2024065900. [PMID: 38988309 DOI: 10.1542/peds.2024-065900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/12/2024] Open
Abstract
We describe the implementation of universal glucose-6-phosphate dehydrogenase (G6PD) screening during the first year of New York State mandated testing, as well as operational challenges and clinical knowledge gained. All infants born at or transferred to our center between June 21, 2022 and June 30, 2023, underwent testing for G6PD enzyme deficiency and were included in the study cohort. Infant blood samples were collected and sent to a reference laboratory for quantitative assay. After initiation of universal screening, a quality improvement initiative was launched to: monitor and improve the suitability of blood sample collection to ensure timely return of results;improve the reliability and validity of the reference laboratory enzyme assay; andestablish accurate reference ranges for G6PD deficiency in newborns.A total of 5601 newborns were included. Within the first year of implementation, the percentage of samples yielding any test result increased from 76% to 85%, and most patients had a G6PD result available within 1 day of discharge. We established a more accurate threshold for G6PD deficiency in newborns of <4.9 U/g Hb and G6PD intermediate of <10.0 U/g Hb. Using the updated reference ranges, 224 patients in our cohort were identified as G6PD deficient or intermediate (4.0%). Through a quality-sensitive process, we identified the importance of a standardized approach, improved sample collection processes, decreased sample turnaround time, and established more accurate reference ranges. We hope our experiences will help others seeking to improve processes and implement similar programs at other institutions.
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Affiliation(s)
- Sarah Milburn
- Division of Newborn Medicine, Departments of Pediatrics
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford Medicine, and Lucile Packard Children's Hospital, Stanford, California
| | | | - Katherine Guttmann
- Division of Newborn Medicine, Departments of Pediatrics
- Brookdale Department of Geriatrics and Palliative Medicine, the Icahn School of Medicine, New York, New York
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Gonzalez CJ, Krishnamurthy S, Rollin FG, Siddiqui S, Henry TL, Kiefer M, Wan S, Weerahandi H. Incorporating Anti-racist Principles Throughout the Research Lifecycle: A Position Statement from the Society of General Internal Medicine (SGIM). J Gen Intern Med 2024; 39:1922-1931. [PMID: 38743167 PMCID: PMC11282034 DOI: 10.1007/s11606-024-08770-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024]
Abstract
Biomedical research has advanced medicine but also contributed to widening racial and ethnic health inequities. Despite a growing acknowledgment of the need to incorporate anti-racist objectives into research, there remains a need for practical guidance for recognizing and addressing the influence of ingrained practices perpetuating racial harms, particularly for general internists. Through a review of the literature, and informed by the Research Lifecycle Framework, this position statement from the Society of General Internal Medicine presents a conceptual framework suggesting multi-level systemic changes and strategies for researchers to incorporate an anti-racist perspective throughout the research lifecycle. It begins with a clear assertion that race and ethnicity are socio-political constructs that have important consequences on health and health disparities through various forms of racism. Recommendations include leveraging a comprehensive approach to integrate anti-racist principles and acknowledging that racism, not race, drives health inequities. Individual researchers must acknowledge systemic racism's impact on health, engage in self-education to mitigate biases, hire diverse teams, and include historically excluded communities in research. Institutions must provide clear guidelines on the use of race and ethnicity in research, reject stigmatizing language, and invest in systemic commitments to diversity, equity, and anti-racism. National organizations must call for race-conscious research standards and training, and create measures to ensure accountability, establishing standards for race-conscious research for research funding. This position statement emphasizes our collective responsibility to combat systemic racism in research, and urges a transformative shift toward anti-racist practices throughout the research cycle.
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Affiliation(s)
- Christopher J Gonzalez
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Sudarshan Krishnamurthy
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Francois G Rollin
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Siddiqui
- Division of General Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Meghan Kiefer
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Shaowei Wan
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Himali Weerahandi
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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10
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Quer G, Coughlin E, Villacian J, Delgado F, Harris K, Verrant J, Gadaleta M, Hung TY, Ter Meer J, Radin JM, Ramos E, Adams M, Kim L, Chien JW, Baca-Motes K, Pandit JA, Talantov D, Steinhubl SR. Feasibility of wearable sensor signals and self-reported symptoms to prompt at-home testing for acute respiratory viruses in the USA (DETECT-AHEAD): a decentralised, randomised controlled trial. Lancet Digit Health 2024; 6:e546-e554. [PMID: 39059887 PMCID: PMC11296689 DOI: 10.1016/s2589-7500(24)00096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/20/2024] [Accepted: 05/02/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Early identification of an acute respiratory infection is important for reducing transmission and enabling earlier therapeutic intervention. We aimed to prospectively evaluate the feasibility of home-based diagnostic self-testing of viral pathogens in individuals prompted to do so on the basis of self-reported symptoms or individual changes in physiological parameters detected via a wearable sensor. METHODS DETECT-AHEAD was a prospective, decentralised, randomised controlled trial carried out in a subpopulation of an existing cohort (DETECT) of individuals enrolled in a digital-only observational study in the USA. Participants aged 18 years or older were randomly assigned (1:1:1) with a block randomisation scheme stratified by under-represented in biomedical research status. All participants were offered a wearable sensor (Fitbit Sense smartwatch). Participants in groups 1 and 2 received an at-home self-test kit (Alveo be.well) for two acute respiratory viral pathogens: SARS-CoV-2 and respiratory syncytial virus. Participants in group 1 could be alerted through the DETECT study app to take the at-home test on the basis of changes in their physiological data (as detected by our algorithm) or due to self-reported symptoms; those in group 2 were prompted via the app to self-test only due to symptoms. Group 3 served as the control group, without alerts or home testing capability. The primary endpoints, assessed on an intention-to-treat basis, were the number of acute respiratory infections presented (self-reported) and diagnosed (electronic health record), and the number of participants using at-home testing in groups 1 and 2. This trial is registered with ClinicalTrials.gov, NCT04336020. FINDINGS Between Sept 28 and Dec 30, 2021, 450 participants were recruited and randomly assigned to group 1 (n=149), group 2 (n=151), or group 3 (n=150). 179 (40%) participants were male, 264 (59%) were female, and seven (2%) identified as other. 232 (52%) were from populations historically under-represented in biomedical research. 118 (39%) of the 300 participants in groups 1 and 2 were prompted to self-test, with 61 (52%) successfully completing self-testing. Participants were prompted to home-test more frequently due to symptoms (41 [28%] in group 1 and 51 [34%] in group 2) than due to detected physiological changes (26 [17%] in group 1). Significantly more participants in group 1 received alerts to test than did those in group 2 (67 [45%] vs 51 [34%]; p=0·047). Of the 61 individuals who were prompted to test and successfully did so, 19 (31%) tested positive for a viral pathogen-all for SARS-CoV-2. The individuals diagnosed as positive for SARS-CoV-2 in the electronic health record were eight (5%) in group 1, four (3%) in group 2, and two (1%) in group 3, but it was difficult to confirm if they were tied to symptomatic episodes documented in the trial. There were no adverse events. INTERPRETATION In this direct-to-participant trial, we showed early feasibility of a decentralised programme to prompt individuals to use a viral pathogen diagnostic test based on symptoms tracked in the study app or physiological changes detected using a wearable sensor. Barriers to adequate participation and performance were also identified, which would need to be addressed before large-scale implementation. FUNDING Janssen Pharmaceuticals.
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Affiliation(s)
- Giorgio Quer
- Scripps Research Translational Institute, La Jolla, CA, USA.
| | - Erin Coughlin
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Jorge Villacian
- Janssen Pharmaceutical Research and Development, San Diego, CA, USA
| | - Felipe Delgado
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Katherine Harris
- Janssen Pharmaceutical Research and Development, San Diego, CA, USA
| | - John Verrant
- Janssen Pharmaceutical Research and Development, San Diego, CA, USA
| | | | - Ting-Yang Hung
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Janna Ter Meer
- Scripps Research Translational Institute, La Jolla, CA, USA
| | | | - Edward Ramos
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Monique Adams
- Janssen Pharmaceutical Research and Development, San Diego, CA, USA
| | - Lomi Kim
- Janssen Pharmaceutical Research and Development, San Diego, CA, USA
| | - Jason W Chien
- Janssen Pharmaceutical Research and Development, San Diego, CA, USA
| | | | - Jay A Pandit
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Dmitri Talantov
- Janssen Pharmaceutical Research and Development, San Diego, CA, USA
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11
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Cribb Fabersunne C, Milliren C, Schuster MA, Elliott MN, Emery ST, Cuccaro PM, Davies SL, Richmond T. Sexual Debut in Early Adolescence and Individual, School, and Neighborhood Social Capital. J Adolesc Health 2024; 75:333-343. [PMID: 38842988 DOI: 10.1016/j.jadohealth.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 11/20/2023] [Accepted: 04/03/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Sexual debut in early adolescence is associated with poor health outcomes in adulthood. We examined the associations of social capital within families, schools, and neighborhoods with early sexual debut. METHODS Using data from the Healthy Passages cohort, a longitudinal multilevel study of adolescents, we performed a series of cross-classified multilevel logistic regression models to examine (1) the relative contribution of schools and neighborhoods to the variance and (2) the association of markers of social cohesion/social capital in families, schools, and neighborhoods with sexual debut by 10th grade. RESULTS There were 4,001 youth participants nested in 115 schools and 751 neighborhoods, with a high degree of cross-classification (1,340 unique combinations of school and neighborhoods). In models adjusting for individual demographics, neighborhoods contributed more to the variance (log odds U [95% confidence interval {CI}] [intra class correlation {ICC}%]) in sexual debut than schools: Uneighborhoods = 0.11 (0.02, 0.23) [3.2%] versus Uschools = 0.07 (0.01, 0.16) [2%]. Restriction of dating and family cohesion, markers of family social capital, were associated with reduced odds of sexual debut by 10th grade (odds ratio = 0.45 95% CI: 0.41-0.49 and 0.93, 95% CI: 0.86, 1.00). Neighborhood cohesion and education level were associated with early debut. Although reduced, there remained significant, unexplained variance in both the school and neighborhood level in the fully adjusted model (Uschool = 0.08 [0.01, 0.17] [2.3%], Uneighborhood = 0.08 [0.02, 0.17] [2.2%]). DISCUSSION Markers of social capital at the family and neighborhood levels were associated with sexual debut by 10th grade. Developers of public health programs aiming to delay sexual debut should consider family-focused and neighborhood-focused interventions.
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Affiliation(s)
- Camila Cribb Fabersunne
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Carly Milliren
- Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Mark A Schuster
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Susan Tortolero Emery
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas
| | - Paula M Cuccaro
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas
| | - Susan L Davies
- Department of Health Behavior, University of Alabama Birmingham, Birmingham, Alabama
| | - Tracy Richmond
- Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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12
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Unaka N, Kahn RS, Spitznagel T, Henize AW, Carlson D, Michael J, Quinonez E, Anderson J, Beck AF. An Institutional Approach to Equity and Improvement in Child Health Outcomes. Pediatrics 2024; 154:e2023064994. [PMID: 38953125 DOI: 10.1542/peds.2023-064994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 07/03/2024] Open
Abstract
Pediatric health inequities are pervasive. Approaches by health care institutions to address inequities often, and increasingly, focus on social needs screening without linked, robust responses. Even when actions in pursuit of health equity do occur within health care institutions, efforts occur in isolation from each other, standing in the way of cross-learning and innovation. Learning network methods hold promise when institutions are confronted with complex, multidimensional challenges. Equity-oriented learning networks may therefore accelerate action to address complex factors that contribute to inequitable pediatric health outcomes, enabling rapid learning along the way. We established an institutional Health Equity Network (HEN) in pursuit of excellent and equitable health outcomes for children and adolescents in our region. The HEN supports action teams seeking to eliminate pediatric health inequities in their clinical settings. Teams deploy targeted interventions to meet patients' and families' needs, addressing both medical and social factors affecting health and wellbeing. The primary, shared HEN measure is the equity gap in hospitalization rates between Black patients and all other patients. The HEN currently has 10 action teams and promotes rapid learning and scaling of interventions via monthly "action period calls" and "solutions labs" focused on successes, challenges, and potential common solutions (eg, scaling of existing medical-legal partnership to subspecialty clinics). In this Advocacy Case Study, we detail the design, implementation, and early outcomes from the HEN, our equity-oriented learning network.
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Affiliation(s)
- Ndidi Unaka
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- Michael Fisher Child Health Equity Center
- Office of Population Health
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert S Kahn
- James M. Anderson Center for Health Systems Excellence
- Michael Fisher Child Health Equity Center
- Division of General and Community Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Adrienne W Henize
- Michael Fisher Child Health Equity Center
- Division of General and Community Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David Carlson
- James M. Anderson Center for Health Systems Excellence
- Michael Fisher Child Health Equity Center
| | - Joseph Michael
- James M. Anderson Center for Health Systems Excellence
- Michael Fisher Child Health Equity Center
| | - Elizabeth Quinonez
- James M. Anderson Center for Health Systems Excellence
- Michael Fisher Child Health Equity Center
| | - Jeffrey Anderson
- James M. Anderson Center for Health Systems Excellence
- Office of Population Health
- The Heart Institute, Cincinnati Children's, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- Michael Fisher Child Health Equity Center
- Office of Population Health
- Division of General and Community Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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13
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Borowsky HM, Schofield CL, Du T, Margo J, Williams KKA, Sloan D, Bullock K, Sanders JJ. Race Dialogues and Potential Application in Clinical Environments: A Scoping Review. J Gen Intern Med 2024:10.1007/s11606-024-08915-3. [PMID: 39042181 DOI: 10.1007/s11606-024-08915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Race dialogues, conversations about race and racism among individuals holding different racial identities, have been proposed as one component of addressing racism in medicine and improving the experience of racially minoritized patients. Drawing on work from several fields, we aimed to assess the scope of the literature on race dialogues and to describe potential benefits, best practices, and challenges of conducting such dialogues. Ultimately, our goal was to explore the potential role of race dialogues in medical education and clinical practice. METHODS Our scoping review included articles published prior to June 2, 2022, in the biomedicine, psychology, nursing and allied health, and education literatures. Ultimately, 54 articles were included in analysis, all of which pertained to conversations about race occurring between adults possessing different racial identities. We engaged in an interactive group process to identify key takeaways from each article and synthesize cross-cutting themes. RESULTS Emergent themes reflected the processes of preparing, leading, and following up race dialogues. Preparing required significant personal introspection, logistical organization, and intentional framing of the conversation. Leading safe and successful race dialogues necessitated trauma-informed practices, addressing microaggressions as they arose, welcoming participation and emotions, and centering the experience of individuals with minoritized identities. Longitudinal experiences and efforts to evaluate the quality of race dialogues were crucial to ensuring meaningful impact. DISCUSSION Supporting race dialogues within medicine has the potential to promote a more inclusive and justice-oriented workforce, strengthen relationships amongst colleagues, and improve care for patients with racially minoritized identities. Potential levers for supporting race dialogues include high-quality racial justice curricula at every level of medical education and valuation of racial consciousness in admissions and hiring processes. All efforts to support race dialogues must center and uplift those with racially minoritized identities.
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Affiliation(s)
- Hannah M Borowsky
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Catherine L Schofield
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H Chan School of Public Health, Boston, MA, USA
| | - Ting Du
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Judy Margo
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H Chan School of Public Health, Boston, MA, USA
| | | | - Danetta Sloan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Bullock
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Justin J Sanders
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H Chan School of Public Health, Boston, MA, USA
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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14
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Krishnan S, Guseh JS, Chukumerije M, Grant AJ, Dean PN, Hsu JJ, Husaini M, Phelan DM, Shah AB, Stewart K, Wasfy MM, Capers Q, Essien UR, Johnson AE, Levine BD, Kim JH. Racial Disparities in Sports Cardiology: A Review. JAMA Cardiol 2024:2820717. [PMID: 39018059 DOI: 10.1001/jamacardio.2024.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Importance Racial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings. Observations Drawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care. Conclusions and Relevance In sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.
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Affiliation(s)
- Sheela Krishnan
- Cardiovascular Services, Division of Cardiology, Maine Medical Center, Portland
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Merije Chukumerije
- Sports and Exercise Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Cedars-Sinai Medical Group, Los Angeles, California
| | | | - Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville
| | - Jeffrey J Hsu
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles
| | - Mustafa Husaini
- Division of Cardiovascular Medicine, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Dermot M Phelan
- The Gragg Center for Cardiovascular Performance, Atrium Health Sanger Heart & Vascular Institute, Charlotte, North Carolina
| | - Ankit B Shah
- Sports & Performance Cardiology, Georgetown University School of Medicine, Chevy Chase, Maryland
| | - Katie Stewart
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Quinn Capers
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Amber E Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas
- Department of Medicine and Cardiology, The University of Texas Southwestern Medical Center, Dallas
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
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15
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Cerdeña JP, Plaisime MV, Borrell LN. Race as a Risk Marker, Not a Risk Factor: Revising Race-Based Algorithms to Protect Racially Oppressed Patients. J Gen Intern Med 2024:10.1007/s11606-024-08919-z. [PMID: 38980468 DOI: 10.1007/s11606-024-08919-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
Emerging consensus in the medical and public health spheres encourages removing race and ethnicity from algorithms used in clinical decision-making. Although clinical algorithms remain appealing given their promise to lighten the cognitive load of medical practice and save time for providers, they risk exacerbating existing health disparities. Race is a strong risk marker of health outcomes, yet it is not a risk factor. The use of race as a factor in medical algorithms suggests that the effect of race is intrinsic to the patient or that its effects can be distinct or separated from other social and environmental variables. By contrast, incisive public health analysis coupled with a race-conscious perspective recognizes that race serves as a marker of countless other dynamic variables and that structural racism, rather than race, compromises the health of racially oppressed individuals. This perspective offers a historical and theoretical context for the current debates regarding the use of race in clinical algorithms, clinical and epidemiologic perspectives on "risk," and future directions for research and policy interventions that combat color-evasive racism and follow the principles of race-conscious medicine.
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Affiliation(s)
- Jessica P Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, CT, USA.
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
- Department of Anthropology, University of Connecticut, Storrs, CT, USA.
| | - Marie V Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Penn Program On Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, PA, USA
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
- Department of Surgery, Medical and Social Sciences, Universidad de Alcala, Henares Madrid, Spain
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16
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Arya S, Mahar A, Callum J, Haspel RL. Examining Injustices: Transfusion Medicine and Race. Transfus Med Rev 2024; 38:150822. [PMID: 38519336 DOI: 10.1016/j.tmrv.2024.150822] [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: 12/09/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 03/24/2024]
Abstract
Race and ethnicity are sociopolitical and not biological constructs, and assertions that these population descriptors have scientific meaning has caused significant harm. A critical assessment of the transfusion medicine literature is an important aspect of promoting race-conscious as opposed to race-based medicine. Utilizing current definitions and health equity frameworks, this review will provide a critical appraisal of transfusion medicine studies at the intersection of race and healthcare disparities, with a focus on larger methodological challenges facing the transfusion medicine community. Moving forward, risk modelling accounting for upstream factors, patient input, as well as an expert consensus on how to critically conduct and evaluate this type of literature are needed. Further, when using race and ethnicity in research contexts, investigators must be aware of existing guidelines for such reporting.
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Affiliation(s)
- Sumedha Arya
- Canadian Blood Services, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Alyson Mahar
- School of Nursing and Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jeannie Callum
- University of Toronto, Toronto, Ontario, Canada; Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Richard L Haspel
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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17
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Kennedy Wiradjuri M, Ninomiya MM, Ninomiya MM, Brascoupé Anishinabeg/Haudenausanee S, Smylie Mѐtis J, Calma Kungarakan Iwaidja T, Mohamed Narrunga Kaurna J, Stewart Taungurung PJ, Maddox Bagumani Modewa R. Knowledge translation in Indigenous health research: voices from the field. Med J Aust 2024; 221:61-67. [PMID: 38946651 DOI: 10.5694/mja2.52357] [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: 01/21/2024] [Accepted: 05/07/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES To better understand what knowledge translation activities are effective and meaningful to Indigenous communities and what is required to advance knowledge translation in health research with, for, and by Indigenous communities. STUDY DESIGN Workshop and collaborative yarning. SETTING Lowitja Institute International Indigenous Health Conference, Cairns, June 2023. PARTICIPANTS About 70 conference delegates, predominantly Indigenous people involved in research and Indigenous health researchers who shared their knowledge, experiences, and recommendations for knowledge translation through yarning and knowledge sharing. RESULTS Four key themes were developed using thematic analysis: knowledge translation is fundamental to research and upholding community rights; knowledge translation approaches must be relevant to local community needs and ways of mobilising knowledge; researchers and research institutions must be accountable for ensuring knowledge translation is embedded, respected and implemented in ways that address community priorities; and knowledge translation must be planned and evaluated in ways that reflect Indigenous community measures of success. CONCLUSION Knowledge translation is fundamental to making research matter, and critical to ethical research. It must be embedded in all stages of research practice. Effective knowledge translation approaches are Indigenous-led and move beyond Euro-Western academic metrics. Institutions, funding bodies, and academics should embed structures required to uphold Indigenous knowledge translation. We join calls for reimaging health and medical research to embed Indigenous knowledge translation as a prerequisite for generative knowledge production that makes research matter.
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18
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Awolope A, El-Sabrout H, Chattopadhyay A, Richmond S, Hessler-Jones D, Hahn M, Gottlieb L, Razon N. The Construction and Meaning of Race Within Hypertension Guidelines: A Systematic Scoping Review. J Gen Intern Med 2024:10.1007/s11606-024-08874-9. [PMID: 38954319 DOI: 10.1007/s11606-024-08874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Professional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. Amid increased recognition of the role racism plays in shaping inequitable healthcare delivery, many researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. Critiques highlight how racism influences the evidence that guidelines are based on and its interpretation. However, few have used a systematic methodology to examine race-based recommendations. This review examines hypertension guidelines, a condition affecting nearly half of all adults in the United States (US), to understand how guidelines reference and develop recommendations related to race. METHODS A systematic scoping review of all professional guidelines on the management of essential hypertension published between 1977 and 2022 to examine the use and meaning of race categories. RESULTS Of the 37 guidelines that met the inclusion criteria, we identified a total of 990 mentions of race categories. Black and African/African American were the predominant race categories referred to in guidelines (n = 409). Guideline authors used race in five key domains: describing the prevalence or etiology of hypertension; characterizing prior hypertension studies; describing hypertension interventions; social risk and social determinants of health; the complexity of race. Guideline authors largely used race categories as biological rather than social constructions. None of the guidelines discussed racism and the role it plays in perpetuating hypertension inequities. DISCUSSION Hypertension guidelines largely refer to race as a distinct and natural category rather than confront the longstanding history of racism within and beyond the medical system. Normalizing race as a biological rather than social construct fails to address racism as a key determinant driving inequities in cardiovascular health. These changes are necessary to produce meaningful structural solutions that advance equity in hypertension education, research, and care delivery.
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Affiliation(s)
- Anna Awolope
- School of Medicine, University of California, Davis (UC Davis), Sacramento, CA, USA
| | - Hannah El-Sabrout
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- School of Public Health, Joint Medical Program, University of California, Berkeley, CA, USA
| | | | - Stephen Richmond
- Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Danielle Hessler-Jones
- Department of Family and Community Medicine, UCSF, San Francisco, CA, USA
- Department of Family and Community Medicine and Social Interventions Research and Evaluation Network (SIREN), UCSF, San Francisco, CA, USA
| | - Monica Hahn
- Department of Family and Community Medicine, UCSF, San Francisco, CA, USA
| | - Laura Gottlieb
- Department of Family and Community Medicine, UCSF, San Francisco, CA, USA
- Department of Family and Community Medicine and Social Interventions Research and Evaluation Network (SIREN), UCSF, San Francisco, CA, USA
| | - Na'amah Razon
- Department of Family & Community Medicine, UC Davis, Sacramento, CA, USA.
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19
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Lewis TL, Tupas KD. Enhancing hypertension pharmacotherapeutics education by integrating social determinants of health. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100727. [PMID: 38844067 DOI: 10.1016/j.ajpe.2024.100727] [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: 09/15/2023] [Revised: 05/07/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Social determinants of health (SDOHs) play a significant role in hypertension management. Pharmacy program accreditation standards include that students should understand SDOHs. However, there are limited data regarding approaches to incorporating SDOHs within pharmacotherapeutics courses. This study evaluated the changes in student knowledge, understanding, perceptions, beliefs, and confidence by integrating SDOH topics in hypertension pharmacotherapeutics lectures. METHODS The study invited students enrolled in cardiovascular pharmacotherapeutics courses at 2 institutions to participate. Participation involved a preintervention questionnaire, a lecture on clinical management of hypertension incorporating SDOH concepts, an assignment involving reading a journal article and answering related questions, and a postintervention questionnaire. Data analysis was conducted using SPSS, with a predetermined α level of 0.05 for statistical significance. Mean composite questionnaire scores were calculated and compared with Wilcoxon signed rank test. RESULTS Of 109 students, the response rate was 85.3 % (93 participants). The combined questionnaire results demonstrated a statistically significant improvement in all questionnaire item composites. The open-ended knowledge assessment yielded a mean score of 5.75 (range 3-6). CONCLUSION The study intervention enhanced student knowledge, understanding, perceptions, beliefs, and confidence regarding the impact of SDOHs on hypertension. This practical and reproducible approach offers a valuable method for incorporating SDOH concepts into pharmacotherapeutics courses.
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Affiliation(s)
- Troy Lynn Lewis
- Wilkes University Nesbitt School of Pharmacy, Wilkes-Barre, PA, USA.
| | - Kris Denzel Tupas
- Roosevelt University College of Science, Health, and Pharmacy, Schaumburg, IL, USA
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20
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Omar S, Williams CC, Bugg LB, Colantonio A. Mapping the institutionalization of racism in the research about race and traumatic brain injury rehabilitation: implications for Black populations. Disabil Rehabil 2024:1-16. [PMID: 38950599 DOI: 10.1080/09638288.2024.2361803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/21/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Traumatic brain injury (TBI) is a chronic disease process and a public health concern that disproportionately impacts Black populations. While there is an abundance of literature on race and TBI outcomes, there is a lack of scholarship that addresses racism within rehabilitation care, and it remains untheorized. This article aims to illuminate how racism becomes institutionalized in the scientific scholarship that can potentially inform rehabilitation care for persons with TBI and what the implications are, particularly for Black populations. MATERIAL AND METHODS Applying Bacchi's What's the Problem Represented to be approach, the writings of critical race theory (CRT) are used to examine the research about race and TBI rehabilitation comparable to CRT in other disciplines, including education and legal scholarship. RESULTS A CRT examination illustrates that racism is institutionalized in the research about race and TBI rehabilitation through colourblind ideologies, meritocracy, reinforcement of a deficit perspective, and intersections of race and the property functions of whiteness. A conceptual framework for understanding institutional racism in TBI rehabilitation scholarship is presented. CONCLUSIONS The findings from this article speak to the future of TBI rehabilitation research for Black populations, the potential for an anti-racist agenda, and implications for research and practice.
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Affiliation(s)
- Samira Omar
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Laura B Bugg
- Global and Community Health, University of CA Santa Cruz, Santa Cruz, CA, USA
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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21
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Alizadeh F, Gauvreau K, Barreto JA, Hall M, Bucholz E, Nathan M, Newburger JW, Vitali S, Thiagarajan RR, Chan T, Moynihan KM. Child Opportunity Index and Pediatric Extracorporeal Membrane Oxygenation Outcomes; the Role of Diagnostic Category. Crit Care Med 2024:00003246-990000000-00351. [PMID: 38920540 DOI: 10.1097/ccm.0000000000006358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES To study the impact of social determinants of health (SDoH) on pediatric extracorporeal membrane oxygenation (ECMO) outcomes. DESIGN, SETTING, AND PATIENTS Retrospective study of children (< 18 yr) supported on ECMO (October 1, 2015 to March 1, 2021) using Pediatric Health Information System (44 U.S. children's hospitals). Patients were divided into five diagnostic categories: neonatal cardiac, pediatric cardiac, neonatal respiratory, pediatric respiratory, and sepsis. SDoH included the Child Opportunity Index (COI; higher indicates social advantage), race, ethnicity, payer, and U.S. region. Children without COI were excluded. Diagnostic category-specific clinical variables related to baseline health and illness severity were collected. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Children supported on ECMO experienced a 33% in-hospital mortality (2863/8710). Overall, children with lower COI, "other" race, Hispanic ethnicity, public insurance and from South or West regions had greater mortality. Associations between SDoH and ECMO outcomes differed between diagnostic cohorts. Bivariate analyses found that only pediatric cardiac patients had an association between COI or race and mortality. Multivariable logistic regression analyses examined relationships between SDoH, clinical variables and mortality within diagnostic categories. Pediatric cardiac patients had 5% increased odds of death (95% CI, 1.01-1.09) for every 10-point decrement in COI, while Hispanic ethnicity was associated with higher survival (adjusted odds ratio [aOR] 0.72 [0.57-0.89]). Children with heart disease from the highest COI quintile had less cardiac-surgical complexity and earlier cannulation. Independent associations with mortality were observed in sepsis for Black race (aOR 1.62 [1.06-2.47]) and other payer in pediatric respiratory patients (aOR 1.94 [1.23-3.06]). CONCLUSIONS SDoH are statistically associated with pediatric ECMO outcomes; however, associations differ between diagnostic categories. Influence of COI was observed only in cardiac patients while payer, race, and ethnicity results varied. Further research should investigate differences between diagnostic cohorts and age groups to understand drivers of inequitable outcomes.
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Affiliation(s)
- Faraz Alizadeh
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jessica A Barreto
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Emily Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Sally Vitali
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Anesthesia, Harvard Medical School, Boston, MA
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Titus Chan
- The Heart Center, Seattle Children's Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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22
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Chhabra K, Rajdeo H, McGuirk M, John D, Castaldi M. Race-Conscious Learning and Sociocultural Competence in an Academic Surgery Program: Diversity, Equity, and All-Inclusion Program. J Surg Res 2024; 301:88-94. [PMID: 38917578 DOI: 10.1016/j.jss.2024.03.042] [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: 03/06/2023] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Race-based associations in medicine are often taught and learned early in medical education. Students and residents enter training with implicit and explicit biases from their educational environments, further propagating biases in their practice of medicine. Health disparities described out of context can lead trainees to develop harmful stereotypes. Surgery leadership created a model to implement educational opportunities, resources, and outcomes in an academic Department of Surgery. METHODS An ad hoc committee of surgical faculty, residents, and medical students was assembled. Educational goals and objectives were established via Diversity, Equity & Inclusion (DEI) committee: 1) incorporate race-conscious awareness and learning into the academic surgery curriculum for residents and medical students, 2) cooperatively learn about race in clinical and surgical decision-making, 3) incorporate learning about social determinants of health that lead to racial and ethnic inequities, and 4) develop tailored learning in order to recognize and lessen health inequities. PHASE I DEI Committee formed of surgery faculty, residents, medical students, and support staff. Activities of the committee, goal development, a DEI mission statement, training, and education overview were formulated by committee members. PHASE II A strengths, weaknesses, opportunities, and threats analysis was created for assessment of diversity and inclusion, and race-conscious learning in the surgery clerkship and residency curriculum. Phase III: Baseline assessment to: 1) understand opinions on DEI in the Department of Surgery, 2) assess current representation within the department workforce, and 3) correlate workforce to the make-up of patient population served. Development and restructuring of the surgery education curriculum for medical students and residency created jointly with the Racism and Bias Task Force. RESULTS Educational programs have been implemented and delivered for: 1) appropriate inclusion of race-conscious learning such as image diversity, as well as race-based association, 2) social determinants of health in the care of patients, 3) racial disparities in surgical outcomes, 4) introduction of concepts on implicit bias, 5) opportunities for health equity rounds, and 6) inclusion in committees and leadership positions. CONCLUSIONS Awareness of clinical faculty and learners to race-conscious and antibias care is paramount to recognizing and addressing biases. Knowledge of sociocultural context may allow learners to develop a socioculturally sensitive approach for patient education, and to more broadly measure surgical outcomes. Race-conscious education should be implemented into teaching curriculum as well as professional development in attempts to close the gap in health-care equity.
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Affiliation(s)
| | - Heena Rajdeo
- New York Medical College, Surgery, Valhalla, New York
| | | | - Devon John
- New York Medical College, Surgery, Valhalla, New York
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23
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Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States. BMC Womens Health 2024; 24:362. [PMID: 38907205 PMCID: PMC11191319 DOI: 10.1186/s12905-024-03151-7] [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: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. METHODS We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. RESULTS Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. CONCLUSIONS Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Merrily LeBlanc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Emmett C Line
- Teachers College, Columbia University, New York, NY, USA
| | - Roberta E Goldman
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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24
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Nathan M, Bucholz E, Moynihan KM. Equitable Health Care for Children: The Next Horizon of Change. J Am Coll Cardiol 2024; 83:2455-2457. [PMID: 38866448 DOI: 10.1016/j.jacc.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, and Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
| | - Emily Bucholz
- Department of Cardiology, Children's Hospital Colorado, and Department of Pediatrics, University of Colorado, Denver Colorado, USA
| | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston, Massachusetts, USA; Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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25
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McCormack M, Kaminsky DA. Beyond Diagnostics - Removing Race from Lung-Function Test Interpretation. N Engl J Med 2024; 390:2122-2123. [PMID: 38767237 DOI: 10.1056/nejme2403770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Meredith McCormack
- From the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore (M.M.); and the Division of Pulmonary Disease and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington (D.A.K.)
| | - David A Kaminsky
- From the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore (M.M.); and the Division of Pulmonary Disease and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington (D.A.K.)
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26
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Goldstein BA, Mohottige D, Bessias S, Cary MP. Enhancing Clinical Decision Support in Nephrology: Addressing Algorithmic Bias Through Artificial Intelligence Governance. Am J Kidney Dis 2024:S0272-6386(24)00791-1. [PMID: 38851444 DOI: 10.1053/j.ajkd.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 06/10/2024]
Abstract
There has been a steady rise in the use of clinical decision support (CDS) tools to guide nephrology as well as general clinical care. Through guidance set by federal agencies and concerns raised by clinical investigators, there has been an equal rise in understanding whether such tools exhibit algorithmic bias leading to unfairness. This has spurred the more fundamental question of whether sensitive variables such as race should be included in CDS tools. In order to properly answer this question, it is necessary to understand how algorithmic bias arises. We break down 3 sources of bias encountered when using electronic health record data to develop CDS tools: (1) use of proxy variables, (2) observability concerns and (3) underlying heterogeneity. We discuss how answering the question of whether to include sensitive variables like race often hinges more on qualitative considerations than on quantitative analysis, dependent on the function that the sensitive variable serves. Based on our experience with our own institution's CDS governance group, we show how health system-based governance committees play a central role in guiding these difficult and important considerations. Ultimately, our goal is to foster a community practice of model development and governance teams that emphasizes consciousness about sensitive variables and prioritizes equity.
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Affiliation(s)
- Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina; AI Health, School of Medicine, Duke University, Durham, North Carolina.
| | - Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, New York; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sophia Bessias
- AI Health, School of Medicine, Duke University, Durham, North Carolina
| | - Michael P Cary
- AI Health, School of Medicine, Duke University, Durham, North Carolina; School of Nursing, Duke University, Durham, North Carolina
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27
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Berg KA, Bharmal N, Tereshchenko LG, Le P, Payne JY, Misra-Hebert AD, Rothberg MB. Racial and ethnic differences in uncontrolled diabetes mellitus among adults taking antidiabetic medication. Prim Care Diabetes 2024; 18:368-373. [PMID: 38423828 DOI: 10.1016/j.pcd.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 01/14/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
AIM To examine whether racial and ethnic disparities in uncontrolled type 2 diabetes mellitus (T2DM) persist among those taking medication and after accounting for other demographic, socioeconomic, and health indicators. METHODS Adults aged ≥20 years with T2DM using prescription diabetes medication were among participants assessed in a retrospective cohort study of the National Health and Nutrition Examination Survey 2007-2018. We estimated weighted sequential multivariable logistic regression models to predict odds of uncontrolled T2DM (HbA1c ≥ 8%) from racial and ethnic identity, adjusting for demographic, socioeconomic, and health indicators. RESULTS Of 3649 individuals with T2DM who reported taking medication, 27.4% had uncontrolled T2DM (mean HgA1c 9.6%). Those with uncontrolled diabetes had a mean BMI of 33.8, age of 57.3, and most were non-Hispanic white (54%), followed by 17% non-Hispanic Black, and 20% Hispanic identity. In multivariable analyses, odds of uncontrolled T2DM among those with Black or Hispanic identities lessened, but persisted, after accounting for other indicators (Black OR 1.38, 97.5% CI: 1.04, 1.83; Hispanic OR 1.79, 97.5% CI 1.25, 2.57). CONCLUSIONS Racial and ethnic disparities in T2DM control persisted among individuals taking medication. Future research might focus on developmental and epigenetic pathways of disparate T2DM control across racially and ethnically minoritized populations.
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Affiliation(s)
- Kristen A Berg
- Center for Health Care Research and Policy, Population Health Research Institute, The MetroHealth System at Case Western Reserve University, Cleveland, OH, USA.
| | - Nazleen Bharmal
- Community Health & Partnerships, Cleveland Clinic Community Care, Cleveland, OH, USA
| | | | - Phuc Le
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
| | - Julia Y Payne
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA; Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Anita D Misra-Hebert
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA; Healthcare Delivery & Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
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Rabay CJ, Lopez C, Streuli S, Mayes EC, Rajagopalan RM, Non AL. Clinicians' perspectives on race-specific guidelines for hypertensive treatment. Soc Sci Med 2024; 351:116938. [PMID: 38735272 DOI: 10.1016/j.socscimed.2024.116938] [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: 12/15/2023] [Revised: 04/08/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
Despite the general consensus that there is no biological basis to race, racial categorization is still used by clinicians to guide diagnosis and treatment plans for certain diseases. In medicine, race is commonly used as a rough proxy for unmeasured social, environmental, and genetic factors. The American College of Cardiology's Eighth Joint National Committee's (JNC 8) guidelines for the treatment of hypertension provide race-specific medication recommendations for Black versus non-Black patients, without strong evidence for race-specific physiological differences in drug response. Clinicians practicing family or geriatric medicine (n = 21) were shown a video of a mock hypertensive patient with genetic ancestry test results that could be viewed as discordant with their phenotype and self-identified race. After viewing the videos, we conducted in-depth interviews to examine how clinicians value and prioritize different cues about race -- namely genetic ancestry data, phenotypic appearance, and self-identified racial classifications - when making treatment decisions in the context of race-specific guidelines, particularly in situations when patients claim mixed-race or complex racial identities. Results indicate that clinicians inconsistently follow the race-specific guidelines for patients whose genetic ancestry test results do not match neatly with their self-identified race or phenotypic features. However, many clinicians also emphasized the importance of clinical experience, side effects, and other factors in their decision making. Clinicians' definitions of race, categorization of the patient's race, and prioritization of racial cues greatly varied. The existence of the race-specific guidelines clearly influences treatment decisions, even as clinicians' express uncertainty about how to incorporate consideration of a patient's genetic ancestry. In light of widespread debate about removal of race from medical diagnostics, researchers should revisit the clinical justification for maintaining these race-specific guidelines. Based on our findings and prior studies indicating a lack of convincing evidence for biological differences by race in medication response, we suggest removing race from the JNC 8 guidelines to avoid risk of perpetuating or exacerbating health disparities in hypertension.
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Affiliation(s)
- Chantal J Rabay
- Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Carolina Lopez
- Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Samantha Streuli
- Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; National Environmental Health Association, 720 S. Colorado Blvd. Suite 105A, Denver, CO, 80246-1910, USA
| | - E Carolina Mayes
- Department of Sociology, University of California, San Diego. 9500 Gilman Drive, La Jolla, CA, 92093, USA; Department of Science, Technology and Innovation Studies, School of Social and Political Science, University of Edinburgh. 2.05 Old Surgeons' Hall, High School Yards, Edinburgh, EH1 1LZ, GB, UK
| | - Ramya M Rajagopalan
- Wertheim School of Public Health and Human Longevity Science, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Center for Empathy and Technology, Sanford Institute for Empathy and Compassion, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Amy L Non
- Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
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29
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Maxwell LJ, Wright GC, Schultz G, Grosskleg S, Barton JL, Campbell W, Guillemin F, Hofstetter C, Shea BJ, Simon LS, Adebajo A, Barnabe C, Goel N, Hurley P, Nikiphorou E, Petkovic J, Tugwell P. Embracing unity at OMERACT: Valuing equity, promoting diversity, fostering inclusivity. Semin Arthritis Rheum 2024; 66:152422. [PMID: 38461757 DOI: 10.1016/j.semarthrit.2024.152422] [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: 10/23/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To increase awareness and understanding of the principles of Equity, Diversity, and Inclusivity (EDI) within Outcome Measures in Rheumatology's (OMERACT) members. For this, we aimed to obtain ideas on how to promote and foster these principles within the organization and determine the diversity of the current membership in order to focus future efforts. METHODS We held a plenary workshop session at OMERACT 2023 with roundtable discussions on barriers and solutions to increased diversity within OMERACT. We conducted an anonymous, web-based survey of members to record characteristics including population group, gender identity, education level, age, and ability. RESULTS The workshop generated ideas to increase diversity of participants across the themes of building relationships [12 topics], materials and methods [5 topics], and conference-specific [6 topics]. Four hundred and seven people responded to the survey (25 % response rate). The majority of respondents were White (75 %), female (61 %), university-educated (94 %), Christian (42 %), spoke English at home (60 %), aged 35 to 55 years (50 %), and did not report a disability (64 %). CONCLUSION OMERACT is committed to improving its diversity. Next steps include strategic recruitment of members to the EDI working group, drafting an EDI mission statement centering equity and inclusivity in the organization, and developing guidance for the OMERACT Handbook to help all working groups create actionable plans for promoting EDI principles.
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Affiliation(s)
- Lara J Maxwell
- Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada.
| | - Grace C Wright
- Consultant Rheumatologist at Grace C Wright MD PC, Association of Women in Rheumatology, New York, USA
| | | | | | - Jennifer L Barton
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, VA Portland Health Care System
| | - Willemina Campbell
- Patient Research Partner, Toronto Western Hospital, University Health Network, Toronto ON Canada
| | | | | | - Beverley J Shea
- Clinical Scientist, Bruyère Research Institute, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | | | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield and Co-Lead for Ethnicity, Diversity and Health, NIHR Biomedical Research Centre, Sheffield, United Kingdom
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Niti Goel
- Patient Research Partner, Caduceus Biomedical Consulting, LLC, and Adjunct Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, UK and Rheumatology Department, King's College Hospital, London, UK
| | - Jennifer Petkovic
- Bruyere Research Institute, Ottawa Hospital Research Institute, Centre for Practice Changing Research and Centre for Global Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Professor, University of Ottawa, Division of Rheumatology, Department of Medicine, Faculty of Medicine, Ottawa, Canada; Bruyère Research Institute, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; University of Ottawa, School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Canada; WHO Collaborating Centre for Knowledge Translation and Health Assessment Technology in Health Equity, Bruyère Research Institute, Ottawa, Canada
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30
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Chew M, Samuel D, Mullan Z, Kleinert S. The Lancet Group's new guidance to authors on reporting race and ethnicity. Lancet 2024; 403:2360-2361. [PMID: 38823979 DOI: 10.1016/s0140-6736(24)01081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Mabel Chew
- The Lancet, Sydney, NSW 2067, Australia.
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31
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Safitri A, Konstantakopoulou E, Gazzard G, Hu K. Priorities for health outcomes in glaucoma in an ethnically diverse UK cohort: an observational study. BMJ Open 2024; 14:e081998. [PMID: 38772893 PMCID: PMC11110553 DOI: 10.1136/bmjopen-2023-081998] [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: 11/11/2023] [Accepted: 04/24/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES To assess whether patients from minority ethnic groups have different perceptions about the quality-of-life outcomes that matter most to them. DESIGN Cross-sectional observational study. SETTING High volume eye centres serving the most ethnically diverse region in the UK, recruiting from July 2021 to February 2022. PARTICIPANTS 511 patients with primary open-angle glaucoma and the predisease state of ocular hypertension. MAIN OUTCOME MEASURES The main outcome was participants' self-reported priorities for health outcomes. RESULTS Participants fell into one of four clusters with differing priorities for health outcomes, namely: (1) vision, (2) drop freedom, (3) intraocular pressure and (4) one-time treatment. Ethnicity was the strongest determinant of cluster membership after adjusting for potential confounders. Compared with white patients prioritising vision alone, the OR for black/black British patients was 7.31 (95% CI 3.43 to 15.57, p<0.001) for prioritising drop freedom; 5.95 (2.91 to 12.16, p<0.001) for intraocular pressure; and 2.99 (1.44 to 6.18, p=0.003) for one-time treatment. For Asian/Asian British patients, the OR was 3.17 (1.12 to 8.96, p=0.030) for prioritising intraocular pressure as highly as vision. Other ethnic minority groups also had higher ORs for prioritising health outcomes other than vision alone: 4.50 (1.03 to 19.63, p=0.045) for drop freedom and 5.37 (1.47 to 19.60, p=0.011) for intraocular pressure. CONCLUSIONS Ethnicity is strongly associated with differing perceptions about the health outcomes that matter. An individualised and ethnically inclusive approach is needed when selecting and evaluating treatments in clinical and research settings.
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Affiliation(s)
- Atika Safitri
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Evgenia Konstantakopoulou
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
- Division of Optics and Optometry, University of West Attica, Athens, Greece
| | - Gus Gazzard
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Kuang Hu
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Kannappan A, Batchelor E, Carmona H, Tatem G, Adamson R. Discussing and Teaching About Race and Health Inequities. Chest 2024; 165:1198-1206. [PMID: 38070767 DOI: 10.1016/j.chest.2023.12.001] [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: 07/10/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 01/04/2024] Open
Abstract
Health inequities are prevalent in our medical institutions and result in unfair access to and delivery of health care. Some of the most profound health disparities are related to race, which has erroneously been used to make biological inferences to explain disease states in medicine. Our profession continues to shift away from such race-based medical narratives, which do not examine how social determinants of health, social injustice, systemic racism, and existing power structures shape health outcomes toward a health equity mindset and race-conscious medicine. Clinician educators are responsible for teaching and engaging with learners around issues of inequity in medicine, although many may feel they lack the knowledge or skills to do so. Opportunities for conversations on health equity abound, either as a response to statements made by clinical peers or patients, or through direct clinical care of affected populations. In this paper, we focus our discussion of health equity around the topic of race corrections in spirometry, which is one of several salient areas of conversation in the field of pulmonary medicine undergoing reconciliation. We review basic definitions and concepts in health equity and apply three strategies to engage in conversations around equity with colleagues and learners: actively learning and reflecting on health inequities, recognizing and naming inequities, and consciously role-modeling equity-conscious language and care. We also will summarize strategies for implementing health equity concepts into the continuum of medical education and our clinical learning environments.
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Affiliation(s)
- Arun Kannappan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine.
| | | | - Hugo Carmona
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Geneva Tatem
- Division of Pulmonary and Critical Care Medicine, Henry Ford Health
| | - Rosemary Adamson
- Veterans Affairs Puget Sound Healthcare System and Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington School of Medicine
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Williams A, Little SE, Bryant AS, Smith NA. Mode of Delivery and Unplanned Cesarean: Differences in Rates and Indication by Race, Ethnicity, and Sociodemographic Characteristics. Am J Perinatol 2024; 41:834-841. [PMID: 35235955 DOI: 10.1055/a-1785-8843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE We aimed to examine the relationship of sociodemographic variables with racial/ethnic disparities in unplanned cesarean births in a large academic hospital system. Secondarily, we investigated the relationship of these variables with differences in cesarean delivery indication, cesarean delivery timing, length of second stage and operative delivery. STUDY DESIGN We conducted a retrospective cohort study of births >34 weeks between 2017 and 2019. Our primary outcome was unplanned cesarean delivery after a trial of labor. Multiple gestations, vaginal birth after cesarean, elective repeat or primary cesarean delivery, and contraindications for vaginal delivery were excluded. Associations between mode of delivery and patient characteristics were assessed using Chi-square, Fisher exact tests, or t-tests. Odds ratios were estimated by multivariate logistic regression. Goodness of fit was assessed with Hosmer Lemeshow test. RESULTS Among 18,946 deliveries, the rate of cesarean delivery was 14.8% overall and 21.3% in nulliparous patients. After adjustment for age, body mass index (BMI), and parity, women of Black and Asian races had significantly increased odds of unplanned cesarean delivery; 1.69 (95% CI: 1.45,1.96) and 1.23 (1.08, 1.40), respectively. Single Hispanic women had adjusted odds of 1.65 (1.08, 2.54). Single women had increased adjusted odds of cesarean delivery of 1.18, (1.05, 1.31). Fetal intolerance was the indication for 39% (613) of cesarean deliveries among White women as compared to 63% (231) of Black women and 49% (71) of Hispanic women (p <0.001). CONCLUSION Rates of unplanned cesarean delivery were significantly higher in Black and Asian compared to White women, even after adjustment for age, BMI, parity, and zip code income strata, and rates of unplanned cesarean delivery were higher for Hispanic women self-identifying as single. Racial and ethnic differences were seen in cesarean delivery indications and operative vaginal deliveries. Future work is urgently needed to better understand differences in provider care or patient attributes, and potential provider bias, that may contribute to these findings. KEY POINTS · Racial, ethnic, and socioeconomic differences exist in the odds of unplanned cesarean.. · Indications for unplanned cesarean delivery differed significantly among racial and ethnic groups.. · There may be unmeasured provider level factors which contribute to disparities in cesarean rates..
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Affiliation(s)
- Alexandria Williams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General, Boston, Massachusetts
| | - Sarah E Little
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison S Bryant
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General, Boston, Massachusetts
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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Katz-Wise SL, Shah SN, Melvin P, Boskey ER, Grice AW, Kornetsky S, Young Poussaint T, Whitley MY, Stack AM, Emans SJ, Hoerner B, Horgan JJ, Ward VL. Establishing a Pediatric Health Equity, Diversity, and Inclusion Research Review Process. Pediatrics 2024; 153:e2023062946. [PMID: 38651252 DOI: 10.1542/peds.2023-062946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/25/2024] Open
Abstract
Equity, diversity, and inclusion (EDI) research is increasing, and there is a need for a more standardized approach for methodological and ethical review of this research. A supplemental review process for EDI-related human subject research protocols was developed and implemented at a pediatric academic medical center (AMC). The goal was to ensure that current EDI research principles are consistently used and that the research aligns with the AMC's declaration on EDI. The EDI Research Review Committee, established in January 2022, reviewed EDI protocols and provided recommendations and requirements for addressing EDI-related components of research studies. To evaluate this review process, the number and type of research protocols were reviewed, and the types of recommendations given to research teams were examined. In total, 78 research protocols were referred for EDI review during the 20-month implementation period from departments and divisions across the AMC. Of these, 67 were given requirements or recommendations to improve the EDI-related aspects of the project, and 11 had already considered a health equity framework and implemented EDI principles. Requirements or recommendations made applied to 1 or more stages of the research process, including design, execution, analysis, and dissemination. An EDI review of human subject research protocols can provide an opportunity to constructively examine and provide feedback on EDI research to ensure that a standardized approach is used based on current literature and practice.
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Affiliation(s)
- Sabra L Katz-Wise
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Snehal N Shah
- Departments of Pediatrics
- Accountable Care and Clinical Integration
- Office of Health Equity and Inclusion
- Clinical Research Compliance
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Patrice Melvin
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
| | - Elizabeth R Boskey
- Gynecology/Department of Surgery
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Tina Young Poussaint
- Clinical Research Compliance
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Melicia Y Whitley
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
| | - Anne M Stack
- Emergency Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - S Jean Emans
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Hoerner
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - James J Horgan
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - Valerie L Ward
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Reliford A, Liu A, Dhir S, Schlechter A. Race, Ethnicity, and the Medical "One-Liner": How Child and Adolescent Psychiatry Can Chart Its Own Antiracist Path Forward. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:178-182. [PMID: 37993762 DOI: 10.1007/s40596-023-01904-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Aaron Reliford
- NYU Grossman School of Medicine, New York, NY, USA.
- Family Health Centers at NYU Langone Brooklyn, Brooklyn, NY, USA.
| | - Anni Liu
- NYU Grossman School of Medicine, New York, NY, USA
| | - Sakshi Dhir
- NYU Grossman School of Medicine, New York, NY, USA
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Rattani A, Mian Z, Farahani S, Ridge M, Uzamere T, Bajwa M. A systematic review of barriers to pursuing careers in medicine among Black premedical students. J Natl Med Assoc 2024; 116:95-118. [PMID: 38267334 DOI: 10.1016/j.jnma.2023.09.011] [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: 03/27/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 01/26/2024]
Abstract
Among the various etiologies of the exclusion of Black male physicians from the healthcare workforce, it is critical to identify and examine the barriers in their trajectory. Given that most medical school matriculants graduate and pursue residency training, medical school admission has been identified as the primary impediment to a career in medicine. Thus, this work aims to identify barriers in the journey of primarily Black, and secondarily underrepresented minority, premedical students. A systematic review of the medical literature was conducted for articles pertaining to the undergraduate/premedical period, Black experiences, and the medical school application process. The search yielded 5336 results, and 13 articles were included. Most papers corroborated common barriers, such as financial/socioeconomic burdens, lack of access to preparatory materials and academic enrichment programs, lack of exposure to the medical field, poor mentorship/advising experiences, systemic and interpersonal racism, and limited support systems. Common facilitators of interest and interventions included increasing academic enrichment programs, improving mentorship and career guidance quality and availability, and improving access to and availability of resources as well as exposure opportunities. No article explicitly discussed addressing racism. There is a dearth of studies exploring the premedical stage-the penultimate point of entry into medicine. Though interest in becoming a physician may be present, multiple and disparate impediments restrict Black men's participation in medicine. Addressing the barriers Black and underrepresented minority premedical students face requires an awareness of how multiple systems work together to discriminate and restrict access to careers in medicine beyond the traditional pipeline understanding.
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Affiliation(s)
- Abbas Rattani
- Department of Radiation Oncology, Tufts Medical Center, 800 Washington St., Boston, MA 02111, United States of America.
| | - Zoha Mian
- University of Louisville School of Medicine, A Building, Suite 110, 500 S. Preston Street, Louisville, KY 40204, United States of America
| | | | - Margaret Ridge
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, OH, 45229, United States of America
| | - Theodore Uzamere
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Suite W6104, Houston, TX, 77030, United States of America
| | - Moazzum Bajwa
- Department of Family Medicine at the University of California Riverside, 900 University Avenue Riverside, CA, 92521, United States of America
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Balasubramanian A, Wise RA, Stanojevic S, Miller MR, McCormack MC. FEV 1Q: a race-neutral approach to assessing lung function. Eur Respir J 2024; 63:2301622. [PMID: 38485146 PMCID: PMC11027150 DOI: 10.1183/13993003.01622-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Forced expiratory volume in 1 s quotient (FEV1Q) is a simple approach to spirometry interpretation that compares measured lung function to a lower boundary. This study evaluated how well FEV1Q predicts survival compared with current interpretation methods and whether race impacts FEV1Q. METHODS White and Black adults with complete spirometry and mortality data from the National Health and Nutrition Examination Survey (NHANES) III and the United Network for Organ Sharing (UNOS) database for lung transplant referrals were included. FEV1Q was calculated as FEV1 divided by 0.4 L for females or 0.5 L for males. Cumulative distributions of FEV1 were compared across races. Cox proportional hazards models tested mortality risk from FEV1Q adjusting for age, sex, height, smoking, income and among UNOS individuals, referral diagnosis. Harrell's C-statistics were compared between absolute FEV1, FEV1Q, FEV1/height2, FEV1 z-scores and FEV1 % predicted. Analyses were stratified by race. RESULTS Among 7182 individuals from NHANES III and 7149 from UNOS, 1907 (27%) and 991 (14%), respectively, were Black. The lower boundary FEV1 values did not differ between Black and White individuals in either population (FEV1 first percentile difference ≤0.01 L; p>0.05). Decreasing FEV1Q was associated with increasing hazard ratio (HR) for mortality (NHANES III HR 1.33 (95% CI 1.28-1.39) and UNOS HR 1.18 (95% CI 1.12-1.23)). The associations were not confounded nor modified by race. Discriminative power was highest for FEV1Q compared with alternative FEV1 approaches in both Black and White individuals. CONCLUSIONS FEV1Q is an intuitive and simple race-neutral approach to interpreting FEV1 that predicts survival better than current alternative methods.
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Affiliation(s)
- Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Martin R Miller
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Siddique SM, Tipton K, Leas B, Jepson C, Aysola J, Cohen JB, Flores E, Harhay MO, Schmidt H, Weissman GE, Fricke J, Treadwell JR, Mull NK. The Impact of Health Care Algorithms on Racial and Ethnic Disparities : A Systematic Review. Ann Intern Med 2024; 177:484-496. [PMID: 38467001 DOI: 10.7326/m23-2960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND There is increasing concern for the potential impact of health care algorithms on racial and ethnic disparities. PURPOSE To examine the evidence on how health care algorithms and associated mitigation strategies affect racial and ethnic disparities. DATA SOURCES Several databases were searched for relevant studies published from 1 January 2011 to 30 September 2023. STUDY SELECTION Using predefined criteria and dual review, studies were screened and selected to determine: 1) the effect of algorithms on racial and ethnic disparities in health and health care outcomes and 2) the effect of strategies or approaches to mitigate racial and ethnic bias in the development, validation, dissemination, and implementation of algorithms. DATA EXTRACTION Outcomes of interest (that is, access to health care, quality of care, and health outcomes) were extracted with risk-of-bias assessment using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool and adapted CARE-CPM (Critical Appraisal for Racial and Ethnic Equity in Clinical Prediction Models) equity extension. DATA SYNTHESIS Sixty-three studies (51 modeling, 4 retrospective, 2 prospective, 5 prepost studies, and 1 randomized controlled trial) were included. Heterogenous evidence on algorithms was found to: a) reduce disparities (for example, the revised kidney allocation system), b) perpetuate or exacerbate disparities (for example, severity-of-illness scores applied to critical care resource allocation), and/or c) have no statistically significant effect on select outcomes (for example, the HEART Pathway [history, electrocardiogram, age, risk factors, and troponin]). To mitigate disparities, 7 strategies were identified: removing an input variable, replacing a variable, adding race, adding a non-race-based variable, changing the racial and ethnic composition of the population used in model development, creating separate thresholds for subpopulations, and modifying algorithmic analytic techniques. LIMITATION Results are mostly based on modeling studies and may be highly context-specific. CONCLUSION Algorithms can mitigate, perpetuate, and exacerbate racial and ethnic disparities, regardless of the explicit use of race and ethnicity, but evidence is heterogeneous. Intentionality and implementation of the algorithm can impact the effect on disparities, and there may be tradeoffs in outcomes. PRIMARY FUNDING SOURCE Agency for Healthcare Quality and Research.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania; and Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (S.M.S.)
| | - Kelley Tipton
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Brian Leas
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Christopher Jepson
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Jaya Aysola
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Division of General Internal Medicine, University of Pennsylvania; and Penn Medicine Center for Health Equity Advancement, Penn Medicine, Philadelphia, Pennsylvania (J.A.)
| | - Jordana B Cohen
- Division of Renal-Electrolyte and Hypertension, University of Pennsylvania; and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania (J.B.C.)
| | - Emilia Flores
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Michael O Harhay
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Center for Evidence-Based Practice, Penn Medicine; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (M.O.H.)
| | - Harald Schmidt
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania (H.S.)
| | - Gary E Weissman
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W.)
| | - Julie Fricke
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Jonathan R Treadwell
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Nikhil K Mull
- Center for Evidence-Based Practice, Penn Medicine; and Division of Hospital Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (N.K.M.)
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Siegel B, Taylor LS, Alizadeh F, Barreto JA, Daniel D, Alexander PMA, Lipsitz S, Moynihan K. Formal Ethics Consultation in Extracorporeal Membrane Oxygenation Patients: A Single-Center Retrospective Cohort of a Quaternary Pediatric Hospital. Pediatr Crit Care Med 2024; 25:301-311. [PMID: 38193777 DOI: 10.1097/pcc.0000000000003422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To examine characteristics associated with formal ethics consultation (EC) referral in pediatric extracorporeal membrane oxygenation (ECMO) cases, and document ethical issues presented. DESIGN Retrospective cohort study using mixed methods. SETTING Single-center quaternary pediatric hospital. PATIENTS Patients supported on ECMO (January 2012 to December 2021). INTERVENTIONS We compared clinical variables among ECMO patients according to the presence of EC. We defined optimal cutoffs for EC based on run duration, ICU length of stay (LOS), and sum of procedures or complications. To identify independent explanatory variables for EC, we used a forward stepwise selection multivariable logistic regression model. EC records were thematically characterized into ethical issues. MEASUREMENTS AND MAIN RESULTS Of 601 ECMO patients and 225 patients with EC in 10 years, 27 ECMO patients received EC (4.5% of ECMO patients, 12% of all ECs). On univariate analysis, use of EC vs. not was associated with multiple ECMO runs, more complications/procedures, longer ICU LOS and ECMO duration, cardiac admissions, decannulation outcome, and higher mortality. Cutoffs for EC were ICU LOS >52 days, run duration >160 hours, and >6 complications/procedures. Independent associations with EC included these three cutoffs and older age. The model showed good discrimination (area under the curve 0.88 [0.83, 0.93]) and fit. The most common primary ethical issues were related to end-of-life, ECMO discontinuation, and treatment decision-making. Moral distress was cited in 22 of 27 cases (82%). CONCLUSION EC was used in 4.5% of our pediatric ECMO cases, with most ethical issues related to end-of-life care or ECMO discontinuation. Older age, longer ICU LOS, prolonged runs, and multiple procedures/complications were associated with greater odds for EC requests. These data highlight our single-center experience of ECMO-associated ethical dilemmas. Historical referral patterns may guide a supported decision-making framework. Future work will need to include quality improvement projects for timely EC, with evaluation of impacts on relevant endpoints.
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Affiliation(s)
- Bryan Siegel
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Lisa S Taylor
- Office of Ethics, Boston Children's Hospital, Boston, MA
| | - Faraz Alizadeh
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jessica A Barreto
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Dennis Daniel
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Anesthesia and Critical Care, Boston Children's Hospital, Boston, MA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Peta M A Alexander
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Stuart Lipsitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Katie Moynihan
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Marcelin JR, Hicks LA, Evans CD, Wiley Z, Kalu IC, Abdul-Mutakabbir JC. Advancing health equity through action in antimicrobial stewardship and healthcare epidemiology. Infect Control Hosp Epidemiol 2024; 45:412-419. [PMID: 38351853 PMCID: PMC11318565 DOI: 10.1017/ice.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Jasmine R. Marcelin
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lauri A. Hicks
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher D. Evans
- Healthcare-Associated Infections and Antimicrobial Resistance Program, Tennessee Department of Health, Nashville, Tennessee
| | - Zanthia Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ibukunoluwa C. Kalu
- Division of Pediatric Infectious Disease, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jacinda C. Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California
- Division of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, California
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Cleveland Manchanda EC, Aikens B, De Maio F, Jordan W, Brown JT, Sivashanker K, Maybank A. Efforts in Organized Medicine to Eliminate Harmful Race-Based Clinical Algorithms. JAMA Netw Open 2024; 7:e241121. [PMID: 38441900 PMCID: PMC10915685 DOI: 10.1001/jamanetworkopen.2024.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/14/2024] [Indexed: 03/07/2024] Open
Abstract
This survey study describes efforts to eliminate harmful race-based clinical algorithms among state or territorial medical associations and specialty societies in the US.
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Affiliation(s)
- Emily C. Cleveland Manchanda
- American Medical Association, Chicago, Illinois
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
| | | | - Fernando De Maio
- American Medical Association, Chicago, Illinois
- Department of Sociology, DePaul University, Chicago, Illinois
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Cerdeña J, Plaisime MV, Belcher HME, Wright JL. A PLAN for Race-Conscious Medicine in Pediatrics. Pediatrics 2024; 153:e2023061893. [PMID: 38425225 DOI: 10.1542/peds.2023-061893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Jessica Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, Connecticut
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP)
- Department of Anthropology, University of Connecticut, Storrs, Connecticut
| | - Marie V Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Penn Program on Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harolyn M E Belcher
- Kennedy Krieger Institute, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph L Wright
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
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Yaeger JP, Fiscella KA, Ertefaie A, Alio AP. Persistent challenges in adjusting for race in analyses and a path forward. J Hosp Med 2024; 19:239-242. [PMID: 38017671 DOI: 10.1002/jhm.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Amina P Alio
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
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Major-Kincade TL. Obstetric Racism, Education, and Racial Concordance. MCN Am J Matern Child Nurs 2024; 49:74-80. [PMID: 38108513 DOI: 10.1097/nmc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
ABSTRACT The United States holds the distinction of being the developed country with the worst perinatal outcomes despite spending the most per capita on health care. Black women are three to four times more likely than White women to experience adverse birth outcomes. These outcomes persist despite access to prenatal care, insurance, and college education. A long overdue racial reckoning has arrived, beginning with acknowledging the fallacy of race-based medicine and the role of enduring systemic racism as foundational to obstetric racism in the reproductive lives of Black women. Centering voices of Black women and honoring their lived experiences are essential to providing respectful maternity care. Naming micro- and macroaggressions experienced by Black women allows for dismantling of systemic barriers which perpetuate inequitable outcomes and enable substandard care. Racial concordance (shared racial identity) is one tool to consider in creating safe health care spaces for Black women. Improving diversity of the nursing workforce specifically, and the health care workforce in general, is necessary to affect racial concordance. Application of skills in cultural humility can mitigate challenges associated with adverse patient encounters for Black women as diversity pipeline strategies are explored. Histories of foundational fallacy, their impact on care and outcomes, and patient-driven indicators for improving pregnancy care experiences for women of color are explored through the lens of a Black physician and the collective reproductive health workforce.
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Affiliation(s)
- Terri L Major-Kincade
- Terri L. Major-Kincade is an Associate Professor, Department of Pediatrics, Director, Pediatric Palliative Care Service Memorial Hermann Children's Hospital, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX. Dr. Major-Kincade can be reached at
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Fuentes A, Espinoza UJ, Cobbs V. Follow the citations: Tracing pathways of "race as biology" assumptions in medical algorithms in eGFR and spirometry. Soc Sci Med 2024; 346:116737. [PMID: 38447335 DOI: 10.1016/j.socscimed.2024.116737] [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: 01/07/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Despite overwhelming evidence to the contrary, the concept of 'race' as a biological unit continues to persist in various scientific disciplines, notably in the field of medicine. This paper explores the persistence of 'race as biology' in medical research via examining select citational practices that have perpetuated this problematic concept. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. By analyzing citation threads and historical patterns, we aim to shed light on the creation and perpetuation of false scientific truths and their impact on medical research, training, and practice. We focus on two prominent examples, eGFR and Spirometry, and trace key articles' citational histories, highlighting the flawed evidence in support of racial corrections in medical assessments. The eGFR equation incorporates 'race' as a factor based on the erroneous belief that Black individuals have higher muscle mass than white individuals. Our analysis reveals that key cited sources for this belief lack robust and well-developed datasets. Similarly, Spirometry measurements incorporate racial correction factors, relying on questionable evidence dating back to the Civil War era. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. They play a crucial role in shaping theoretical positions and validating data and assumed knowledge. Evaluating citation threads and key articles consistently referenced over time can reveal how falsehoods and erroneous assertions are constructed and maintained in scientific fields. This study underscores the need for critical examination of citational practices in medical research and urges a shift toward a more cautious approach when citing sources that support 'race as biology.' The paper calls for a reevaluation of pedagogical approaches and assigned readings in medical education to prioritize an anti-racist perspective in future research endeavors.
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Al-Jawad M, Chawla G, Singh N. Creating comics, songs and poems to make sense of decolonising the curriculum: a collaborative autoethnography patchwork. MEDICAL HUMANITIES 2024; 50:1-11. [PMID: 37863646 DOI: 10.1136/medhum-2023-012660] [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: 09/21/2023] [Indexed: 10/22/2023]
Abstract
Decolonising the curriculum is a complex endeavour, with the potential to cause harm as well as benefit. People doing the work might find themselves questioning their personal and political identities and motives, it is common for people to get disillusioned. While surveys and toolkits are important to help us start the work, we are interested in finding out how decolonising practices can be sustained. We believe to practise meaningfully in this area we need to understand ourselves as practitioners, make sense of the work and have deep connections with colleagues and possibly our institutions.This research uses collaborative autoethnography; our personal experiences, reflected through the lenses of each other's point of view; to help us know ourselves and make sense of our practice. We also show how art, in the form of comics, poems and a song, can be used to deepen our research by adding meaning, connection and joy. We present this research as a patchwork text of writing, art and conversations. Our work is underpinned by theory, particularly drawing on Sara Ahmed and bell hooks. It is produced by the three of us to illuminate the process of decolonising a curriculum. We see this paper as part of our collective resistance: resistance to colonialism, to scientism and to inhumanity. We hope you will find resonances with your practice, and perhaps discover new ways to find meaning and connections.
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Affiliation(s)
- Muna Al-Jawad
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Gaurish Chawla
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Neil Singh
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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Kaminsky DA. Justifying the Use of Global Lung Function-Global by Considering Race-Conscious Medicine. Chest 2024; 165:e62. [PMID: 38336451 DOI: 10.1016/j.chest.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- David A Kaminsky
- Pulmonary Disease and Critical Care Medicine, University of Vermont, Larner College of Medicine, Burlington, VT.
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Tong M, Hurtado A, Deshpande R, Pietrzak RH, He C, Kaplan C, Kaplan S, Akhtar S, Feder A, Feingold JH, Ripp JA, Peccoralo LA. Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic. J Gen Intern Med 2024; 39:450-459. [PMID: 37845586 PMCID: PMC10897117 DOI: 10.1007/s11606-023-08422-x] [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: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs). OBJECTIVE To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout. DESIGN A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022. PARTICIPANTS Frontline HCWs at an urban tertiary care hospital in New York City. MAIN MEASURES Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout. KEY RESULTS Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001). CONCLUSIONS Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.
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Affiliation(s)
- Michelle Tong
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Richa Deshpande
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Sabrina Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Saadia Akhtar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan A Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Huang E, Albrecht L, O’Hearn K, Nicolas N, Armstrong J, Weinberg M, Menon K. Reporting of social determinants of health in randomized controlled trials conducted in the pediatric intensive care unit. Front Pediatr 2024; 12:1329648. [PMID: 38361997 PMCID: PMC10867174 DOI: 10.3389/fped.2024.1329648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The influence of social determinants of health (SDOH) on access to care and outcomes for critically ill children remains an understudied area with a paucity of high-quality data. Recent publications have highlighted the importance of incorporating SDOH considerations into research but the frequency with which this occurs in pediatric intensive care unit (PICU) research is unclear. Our objective was to determine the frequency and categories of SDOH variables reported and how these variables were defined in published PICU randomized controlled trials (RCTs). Methods We searched Medline, Embase, Lilacs, and Central from inception to Dec 2022. Inclusion criteria were randomized controlled trials of any intervention on children or their families in a PICU. Data related to study demographics and nine WHO SDOH categories were extracted, and descriptive statistics and qualitative data generated. Results 586 unique RCTs were included. Studies had a median sample size of 60 patients (IQR 40-106) with 73.0% of studies including ≤100 patients and 41.1% including ≤50 patients. A total of 181 (181/586, 30.9%) studies reported ≥1 SDOH variable of which 163 (163/586, 27.8%) reported them by randomization group. The most frequently reported categories were food insecurity (100/586, 17.1%) and social inclusion and non-discrimination (73/586, 12.5%). Twenty-five of 57 studies (43.9%) investigating feeding or nutrition and 11 of 82 (13.4%) assessing mechanical ventilation reported baseline nutritional assessments. Forty-one studies investigated interventions in children with asthma or bronchiolitis of which six reported on smoking in the home (6/41, 14.6%). Discussion Reporting of relevant SDOH variables occurs infrequently in PICU RCTs. In addition, when available, categorizations and definitions of SDOH vary considerably between studies. Standardization of SDOH variable collection along with consistent minimal reporting requirements for PICU RCT publications is needed.
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Affiliation(s)
- Emma Huang
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Albrecht
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Katie O’Hearn
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Naisha Nicolas
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jennifer Armstrong
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Maya Weinberg
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Kusum Menon
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
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Iverson KM, Livingston WS, Vogt D, Smith BN, Kehle-Forbes SM, Mitchell KS. Prevalence of Sexual Violence and Intimate Partner Violence Among US Military Veterans: Findings from Surveys with Two National Samples. J Gen Intern Med 2024; 39:418-427. [PMID: 38010460 PMCID: PMC10897119 DOI: 10.1007/s11606-023-08486-9] [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: 03/13/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups. OBJECTIVE To estimate the prevalence of SV before, during, and after military service and lifetime and past-year IPV for women and men, and explore differences across sociodemographic groups. DESIGN Data are from two national cross-sectional surveys conducted in 2020. Weighted prevalence estimates of SV and IPV experiences were computed, and weighted logistic regression models were used for comparisons across gender, race, ethnicity, sexual orientation, and age. PARTICIPANTS Study 1 included veterans of all service eras (N = 1187; 50.0% women; 29% response rate). Study 2 included recently separated post-9/11 veterans (N = 1494; 55.2% women; 19.4% response rate). MAIN MEASURES SV was assessed with the Deployment Risk and Resilience Inventory-2 (DRRI-2). IPV was assessed with the extended Hurt-Insult-Threaten-Scream Tool. KEY RESULTS Women were more likely than men to experience pre-military SV (study 1: 39.9% vs. 8.7%, OR = 6.96, CIs: 4.71-10.28; study 2: 36.2% vs. 8.6%, OR = 6.04, CIs: 4.18-8.71), sexual harassment and/or assault during military service (study 1: 55.0% vs. 16.8%, OR = 6.30, CIs: 4.57-8.58; study 2: 52.9% vs. 26.9%, OR = 3.08, CIs: 2.38-3.98), and post-military SV (study 1: 12.4% vs. 0.9%, OR = 15.49, CIs: 6.42-36.97; study 2: 7.5% vs. 1.5%, OR = 5.20, CIs: 2.26-11.99). Women were more likely than men to experience lifetime IPV (study 1: 45.7% vs. 37.1%, OR = 1.38, CIs: 1.04-1.82; study 2: 45.4% and 34.8%, OR = 1.60, CIs: 1.25-2.04) but not past-year IPV (study 1: 27.9% vs. 28.3%, OR = 0.95, CIs: 0.70-1.28; study 2: 33.1% vs. 28.5%, OR = 1.24, CIs: 0.95-1.61). When controlling for gender, there were few differences across other sociodemographic groups, with the exception of sexual orientation. CONCLUSIONS Understanding veterans' experiences of SV and IPV can inform identification and intervention efforts, especially for women and sexual minorities.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Whitney S Livingston
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dawne Vogt
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Brian N Smith
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Shannon M Kehle-Forbes
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Karen S Mitchell
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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