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The Educational, Health, and Economic Impacts of COVID-19 Among Haitians in the USA: Time for Systemic Change. J Racial Ethn Health Disparities 2022; 9:2171-2179. [PMID: 34596889 PMCID: PMC8485767 DOI: 10.1007/s40615-021-01156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
Haitians are the fourth largest Afro-Caribbean immigrant group in the USA, and there is a dearth of research focusing on the factors impacting their lives. As a marginalized group with extensive pre-existing conditions, Haitian immigrants are disproportionately affected by the pandemic in areas such as education, health, and economics. This paper provides a summary of existing disparities among Haitians in the USA and how COVID-19 has significantly impacted this group. It concludes with an analysis of how the Strategic Framework for Improving Racial and Ethnic Minority Health and Eliminating Racial and Ethnic Health Disparities can be used to guide, organize, and coordinate systematic planning for sustainable changes to address these disparities. Addressing immigrant and minority health in the USA requires a deeper dive into the various immigrant groups. This paper concludes with recommendations for research and policy changes necessary to eliminate disparities in the USA.
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Zhao L, Zhang X, Chen Y, Wang Y, Zhang W, Lu W. Does self-reported symptom questionnaire play a role in nonadherence to colonoscopy for risk-increased population in the Tianjin colorectal cancer screening programme? BMC Gastroenterol 2021; 21:117. [PMID: 33750307 PMCID: PMC7944887 DOI: 10.1186/s12876-021-01701-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A colorectal cancer screening programme (CCSP) was implemented from 2012 to 2017 in Tianjin, China. Residents with a positive faecal immunochemical test (FIT) or positive self-reported symptom questionnaire (SRSQ) were recommended to undergo colonoscopy. The objective was to investigate the potential factors associated with nonadherence to colonoscopy among a risk-increased population. METHODS Data were obtained from the CCSP database, and 199,522 residents with positive FIT or positive SRSQ during two screening rounds (2012-2017) were included in the analysis. Logistic regression analysis was performed to assess the association between nonadherence to colonoscopy and potential predictors. RESULTS A total of 152,870 (76.6%) individuals did not undergo colonoscopy after positive FIT or positive SRSQ. Residents with positive SRSQ but without positive FIT were more likely not to undergo colonoscopy (negative FIT: OR, 2.35; 95% CI, 2.29-2.41, no FIT: OR, 1.27; 95% CI, 1.24-1.31). Patients without a cancer history were less likely to undergo colonoscopy even if they received risk-increased reports based on the SRSQ. CONCLUSION In the CCSP, seventy-seven percent of the risk-increased population did not undergo colonoscopy. FIT should be recommended since positive FIT results are related to improved adherence to colonoscopy. Residents with negative FIT but positive SRSQ should be informed of the potential cancer risk to ensure adherence to colonoscopy.
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Affiliation(s)
- Lizhong Zhao
- Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, China
| | - Xiaorui Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Weihua Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.
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Osagiede O, Spaulding AC, Cochuyt JJ, Naessens JM, Merchea A, Crandall M, Colibaseanu DT. Factors Associated With Minimally Invasive Surgery for Colorectal Cancer in Emergency Settings. J Surg Res 2019; 243:75-82. [PMID: 31158727 DOI: 10.1016/j.jss.2019.04.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/18/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is associated with improved colorectal cancer (CRC) outcomes, but it is used less frequently in emergency settings. We aimed to assess patient-level factors associated with emergency presentation for CRC and the use of MIS in emergency versus elective settings. METHODS This retrospective study examined the clinical data of patients who underwent emergency and elective resections for CRC from 2013 to 2015 using the Florida Inpatient Discharge Dataset. Multivariable analyses were performed to assess differences in gender, age, race, urbanization, region, insurance, and clinical characteristics associated with mode of presentation and surgical approach. In-hospital mortality and length of stay by mode of presentation were recorded. RESULTS Of 16,277 patients identified, 10,224 (61%) had elective surgery and 6503 (39%) had emergency surgery. Emergency presentations were more likely to be black (14.2% versus 9.5%), Hispanic (18.9% versus 15.4%), Medicaid-insured (9.7% versus 4.2%), and have metastatic cancer (34.4% versus 20.2%) or multiple comorbidities (12.6% versus 4.0%). MIS was the surgical approach in 31.8% of emergency cases versus 48.1% of elective cases. Factors associated with lower odds of MIS for emergencies include Medicaid (odds ratio (OR) 0.79, 95% confidence interval (CI) 0.63-0.99), metastases (OR 0.56, CI 0.5-0.63), and multiple comorbidities (OR 0.53, CI 0.4-0.7). Emergency cases experienced higher in-hospital mortality (3.7% versus 1.0%) and a longer median length of stay (10 d versus 5 d). CONCLUSIONS Emergency CRC presentations are associated with racial minorities, Medicaid insurance, metastatic disease, and multiple comorbidities. Odds of MIS in emergency settings are lowest for patients with Medicaid insurance and highest clinical disease burden.
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Affiliation(s)
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Jordan J Cochuyt
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - James M Naessens
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Amit Merchea
- Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Marie Crandall
- Department of Surgery, University of Florida, Jacksonville, Florida
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Osagiede O, Spaulding AC, Cochuyt JJ, Naessens JM, Merchea A, Kasi PM, Crandall M, Colibaseanu DT. Disparities in minimally invasive surgery for colorectal cancer in Florida. Am J Surg 2018; 218:293-301. [PMID: 30503514 DOI: 10.1016/j.amjsurg.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The cost of minimally invasive surgery (MIS) raises potential for racial and social disparities. The aim of this study was to identify the racial, socioeconomic and geographic disparities associated with MIS for colorectal cancer (CRC) in Florida. METHODS Using the Florida Inpatient Discharge Dataset, we examined the clinical data of patients who underwent elective resections for CRC during 2013-2015. Multivariable analysis was performed to identify differences in gender, age, race, urbanization, region, insurance and clinical characteristics associated with the surgical approach. RESULTS Of the 10,224 patients identified, 5308 (52%) had open surgery and 4916 (48%) had MIS. Females (p = 0.012), Medicare-insured patients (p = 0.001) and residents of South Florida were more likely to undergo MIS. Patients with Medicaid (p = 0.008), metastasis (p < 0.001) or 3-5 comorbidities (p = 0.004) had reduced likelihood of MIS. Hispanic patients in Southwest Florida had reduced likelihood of receiving MIS than whites (p < 0.017). Patients who underwent MIS had significantly reduced LOS (p < 0.001). CONCLUSIONS Consistent with national studies, MIS for CRC in Florida is associated with insurance status and geographic location. There are patient-level regional differences for racial disparities in MIS for CRC in Florida.
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Affiliation(s)
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Jordan J Cochuyt
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - James M Naessens
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Amit Merchea
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pashtoon M Kasi
- Department of Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Marie Crandall
- Department of Surgery, University of Florida, Jacksonville, FL, USA
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Pinheiro PS, Callahan KE, Ragin C, Hage RW, Hylton T, Kobetz EN. Black Heterogeneity in Cancer Mortality: US-Blacks, Haitians, and Jamaicans. Cancer Control 2016; 23:347-358. [PMID: 27842324 PMCID: PMC5321133 DOI: 10.1177/107327481602300406] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the United States is virtually unknown. METHODS We computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (United States, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan. RESULTS We analyzed 185,113 cancer deaths from 2008 to 2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97-2.17) and 1.6 (95% CI: 1.55-1.71) times higher for US-born blacks than black Caribbean men and women, respectively (P < .001). CONCLUSIONS Race alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for 2 obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of "aggressive" prostate cancer in the world, rather than Caribbean men.
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Affiliation(s)
- Paulo S. Pinheiro
- University of Nevada Las Vegas, School of Community Health Sciences, African-Caribbean Cancer Consortium, Contact Info: 4505 S Maryland Pkwy, Las Vegas, NV 89154, , (702) 895-5717
| | - Karen E. Callahan
- University of Nevada Las Vegas, School of Community Health Sciences, Contact Info: 4505 S Maryland Pkwy, Las Vegas, NV 89154, , (702) 895-5717
| | - Camille Ragin
- Temple University, College of Public Health, Fox Chase Cancer Center - Temple Health, African-Caribbean Cancer Consortium, Contact Info: 333 Cottman Avenue, Philadelphia, PA 19111, , (215) 728-1148
| | - Robert W. Hage
- St. George's University, Department of Anatomy, African-Caribbean Cancer Consortium, Contact Info: St. George’s, Grenada, West Indies, , (473) 444-4175 ext. 2007
| | - Tara Hylton
- Florida Department of Health, Contact Info: 4052 Bald Cypress Way, Bin #A-12, Tallahassee, FL 32399-1720, , (850) 245-4444 ext. 2441
| | - Erin N. Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Contact Info: 1120 NW 14Street, Miami, Florida, 33136, , (305) 243-6185
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Wilcox ML, Acuña JM, Ward-Peterson M, Alzayed A, Alghamdi M, Aldaham S. Racial/ethnic disparities in annual mammogram compliance among households in Little Haiti, Miami-Dade County, Florida: An observational study. Medicine (Baltimore) 2016; 95:e3826. [PMID: 27399061 PMCID: PMC5058790 DOI: 10.1097/md.0000000000003826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 04/27/2016] [Accepted: 05/10/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed cancer and the 2nd leading cause of cancer-related deaths among women in the U.S. Although routine screening via mammogram has been shown to increase survival through early detection and treatment of breast cancer, only 3 out of 5 women age ≥40 are compliant with annual mammogram within the U.S. and the state of Florida. A breadth of literature exists on racial/ethnic disparities in compliance with mammogram; however, few such studies include data on individual Black subgroups, such as Haitians. This study assessed the association between race/ethnicity and annual mammogram compliance among randomly selected households residing in the largely Haitian community of Little Haiti, Miami-Dade County (MDC), Florida. METHODS This study used cross-sectional, health data from a random-sample, population-based survey conducted within households residing in Little Haiti between November 2011 and December 2012 (n = 951). Mammogram compliance was defined as completion of mammogram by all female household members within the 12 months prior to the survey. The association between mammogram compliance and race/ethnicity was assessed using binary logistic regression models. Potential confounders were identified as factors that were conservatively associated with both compliance and race/ethnicity (P ≤ 0.20). Analyses were restricted to households containing at least 1 female member age ≥40 (n = 697). RESULTS Overall compliance with annual mammogram was 62%. Race/ethnicity was significantly associated with mammogram compliance (P = 0.030). Compliance was highest among non-Hispanic Black (NHB) households (75%), followed by Hispanic (62%), Haitian (59%), and non-Hispanic White (NHW) households (51%). After controlling for educational level, marital status, employment status, the presence of young children within the household, health insurance status, and regular doctor visits, a borderline significant disparity in mammogram compliance was observed between Haitian and NHB households (adjusted odds ratio = 1.63, P = 0.11). No other racial/ethnic disparities were observed. DISCUSSION Compliance with annual mammogram was low among the surveyed households in Little Haiti. Haitian households underutilized screening by means of annual mammogram compared with NHB households, although this disparity was not significant. Compliance rates could be enhanced by conducting individualized, mammogram screening-based studies to identify the reasons behind low rate of compliance among households in this underserved, minority population.
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Affiliation(s)
- Meredith Leigh Wilcox
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work
| | - Juan Manuel Acuña
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine
- Department of Human and Molecular Genetics, Florida International University, Miami, Florida, USA
| | - Melissa Ward-Peterson
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work
| | - Abdullah Alzayed
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mushref Alghamdi
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sami Aldaham
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Miranda-Diaz C, Betancourt E, Ruiz-Candelaria Y, Hunter-Mellado RF. Barriers for Compliance to Breast, Colorectal, and Cervical Screening Cancer Tests among Hispanic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010021. [PMID: 26703676 PMCID: PMC4730412 DOI: 10.3390/ijerph13010021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 11/16/2022]
Abstract
Hispanics are less likely to undergo screening tests for colorectal cancer and cervical cancer than non-Hispanic whites. Compliance with mammography, fecal occult blood testing (FOBT), colonoscopy, and cervical smears (PAP) and barriers for compliance were studied. A descriptive study was performed with 194 ambulatory patients while they attended routine medical visits. Women are more likely than men to undergo a colonoscopy. Conversely, FOBT was most likely reported by men. Reasons for compliance with FOBT differed by gender. Men were most likely to avoid FOBT due to lack of knowledge whereas women reported that physicians do not recommend the procedure. Both men and women reported that lack of physician's recommendation was their primary reason for not undergoing a colonoscopy. Men tend to report lack of knowledge about colonoscopy procedure. A higher mammogram utilization rate was reported by women older than 40 years. PAP smears were reported by 74% of women older than 21 years. The major reasons for avoiding mammography and PAP tests were having a busy schedule, fear, and feeling uncomfortable during the procedure. In a multivariate regression analysis, occupational status was found to be a predictor for compliance with FOBT and colonoscopy.
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Affiliation(s)
- Christine Miranda-Diaz
- Universidad Central del Caribe, School of Medicine, Cancer Research Unit, Internal Medicine Department, P.O. BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Elba Betancourt
- Universidad Central del Caribe, School of Medicine, Cancer Research Unit, Internal Medicine Department, P.O. BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Yelitza Ruiz-Candelaria
- Universidad Central del Caribe, School of Medicine, Cancer Research Unit, Internal Medicine Department, P.O. BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Robert F Hunter-Mellado
- Universidad Central del Caribe, School of Medicine, Cancer Research Unit, Internal Medicine Department, P.O. BOX 60327, Bayamon 00960-6032, Puerto Rico.
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Coughlin SS, Lubetkin EI, Hay JL, Raphael R, Smith SA. Promoting colorectal cancer screening among Haitian Americans. JOURNAL OF THE GEORGIA PUBLIC HEALTH ASSOCIATION 2015; 5:149-152. [PMID: 26819972 PMCID: PMC4725319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Few studies have examined colorectal cancer screening among Haitian Americans, although striking disparities in colorectal cancer screening and mortality are well-documented among U.S. Blacks. Race, socioeconomic status, and place of birth are factors associated with colorectal cancer incidence and mortality patterns. METHODS In this article, we summarize published studies on colorectal cancer screening among Haitian Americans, identified through bibliographic searches in PubMed and CINAHL through August 2015, and offer recommendations for further research. RESULTS Only one qualitative study and three quantitative surveys have examined colorectal cancer screening among Haitian Americans. A qualitative study found important differences in perceptions of the curability of colorectal cancer, preventive practices, and preferred sources of information among Haitian Americans and other ethnic subgroups of U.S. Blacks. Awareness of colorectal cancer screening tests, risk perception, healthcare provider recommendation, and self-reported use of screening are suboptimal among Haitian Americans and other subgroups. In preliminary quantitative studies, Haitian immigrants have been found to have lower colorectal cancer screening rates than other groups such as African Americans. CONCLUSIONS Culturally appropriate educational interventions are needed to encourage Haitian American adults aged ≥ 50 years to undergo screening for colorectal cancer and to ensure that they are well informed about the value of healthy eating and physical activity.
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Affiliation(s)
- Steven S Coughlin
- Department of Community Health and Sustainability, Division of Public Health, University of Massachusetts, Lowell, MA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Erica I Lubetkin
- Sophie Davis School of Biomedical Education at The City College of New York, Department of Community Health and Social Medicine, New York, NY
| | - Jennifer L Hay
- Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY
| | - Renald Raphael
- Haitian American Public Health Initiatives, Mattapan, MA
| | - Selina A Smith
- Institute of Public and Preventive Health, and Department of Family Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA
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