Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018

Workman's compensation as exclusion criteria in rotator cuff repair literature - are we inadvertently excluding race?

OBJECTIVE

Despite an equal willingness to participate in clinical trials, there is evidence that several minority populations are systematically under-represented in studies. One potential cause and frequently used exclusionary criterion in orthopedic trials is patients with active workman's compensation (WC) insurance claims. The purpose of this study is to determine demographic differences in patients undergoing arthroscopic rotator cuff repair with commercial and government insurance vs workers compensation claims.

METHODS

This was a retrospective review of patients who underwent primary arthroscopic rotator cuff repair at a single institution in the northeastern United States from 2018 to 2019. Patients undergoing revision cases were excluded. Chart review was used to extract demographic data such as age, gender, insurance, and reported race.

RESULTS

A total of 4553 patient records were reviewed and included. There were 742 WC patients and 3811 non-WC patients. Two hundred and forty-four patients did not report their race. Overall, WC patients differed from non-WC with respect to race (P < 0.001). One hundred and eleven (15.0%) of WC and 293 (7.7%) non-WC patients reported being 'Black' or 'African American' (P = 0.002). This compares to 368 (49.6%) WC and 2788 (73.2%) non-WC patients who reported 'White' (P < 0.001). About 16.8% of WC patients were identified as 'Hispanic or Latino,' compared to 5.2% of non-WC (P < 0.001).

CONCLUSION

African American and Hispanic/Latino patients are over-represented in workman's compensation patient populations relative to non-workman's compensation. Conversely, white patients are over-represented in non-WC patient populations, which serve as the basis for the majority of clinical study populations. Excluding workman's compensation patients from clinical trials may lead to an underrepresentation of African American and Hispanic/Latino patient populations in orthopedic clinical trials. In doing so, the generalizability of the results of rotator cuff repair clinical outcomes research to all races and ethnicities may be compromised.

Correlates of and Disparities in Cancellations or Delays of Prenatal Visits During the Covid-19 Pandemic: Emphasis on Racial/Ethnic Minorities and Persons with Low Socioeconomic Status

OBJECTIVES

To investigate barriers and disparities in prenatal visits across population subgroups.

METHODS

This pooled cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System for 2020 through 2021. Women who reported their experiences of cancellation or delay in prenatal visits were included. A multivariable regression analysis estimated adjusted prevalence ratios (aPR) for cancellations or delays in prenatal care.

RESULTS

Of a total of 11,427, one-third had cancelled or delayed care. Hispanics, compared to their white counterparts, were 22% likelier to have cancelled or delayed care. Women covered by Medicaid and those with depression had 17% and 34% greater likelihoods of cancellation or delay, respectively. Cancellations or delays were comparable for the years 2020 and 2021 across reasons, except for facility closures, which were more common in 2020 than in 2021. Hispanics tended to cancel or delay prenatal visits more often than whites for reasons, such as facility closures, COVID-19-related reasons, a lack of transportation, and loss of insurance, while transportation and insurance issues were greater barriers for blacks. Women with less than a high school diploma were more likely to report cancellations or delays due to transportation issues (aPR 2.86, 95%CI 1.47-5.57; p = 0.002) and loss of insurance (aPR 4.82, 95%CI 1.64-14.23; P = 0.004).

CONCLUSIONS

While a large proportion of women experienced disruptions in prenatal care, subsets of the population, including racial/ethnic minorities and the low socioeconomically disadvantaged, faced disproportionate challenges. The current findings provide practical implications for a tailored approach to reducing barriers and disparities in prenatal care.

Promoting Heart Health: Raising Screening Awareness at a Brisbane Medical Center

Background Atherosclerotic cardiovascular disease (CVD) is a largely preventable, chronic, and progressive medical condition. There appears to be a general lack of knowledge about CVD prevention in the community. This pilot study was carried out to investigate the level of knowledge of CVD prevention among patients visiting a general practitioner (GP) practice in Brisbane. Aim To investigate the level of knowledge of CVD prevention among people visiting a local medical clinic in Brisbane, and to identify the factors responsible for any knowledge deficits. Material and methods A cross-sectional survey was conducted among Brisbane residents aged 45 years and older visiting a local medical center. This study surveyed 105 Australian individuals via an online survey or a hard copy questionnaire for those without online access. A combination of closed-ended questions and multiple-choice questionnaires was utilized to collect the data. Questions were formulated to assess the level of knowledge of CVD prevention among this demographic, exploring the subjects' awareness of the screening program, their adherence, factors behind non-adherence, and understanding the influence of education level and occupation on adherence. Results A total of 105 Brisbane adults completed the survey, of which 56 (53.3%) were male. The study found that 61 (58.1%) of the participants were aware of the CVD prevention screening program, but only 22 (21.9%) were compliant with it. Twelve (11.4%) participants attended these preventive screenings less frequently than recommended, while the remaining 69 (66.6%) had never undergone cardiovascular health checks. Conclusion Analysis of data from this population suggests that there is a knowledge deficit among Brisbane residents regarding CVD prevention programs. Enhanced efforts by clinicians to make patients aware of these screening tools and to employ early intervention strategies, especially lifestyle choices at an earlier age, would help lower the burden of CVD.

MivacunaLA (MyshotLA): A Community-Partnered Mobile Phone Intervention to Improve COVID-19 Vaccination Behaviors among Low-Income, Spanish-Speaking, and Immigrant Latino Parents or Caregivers

We developed and tested MivacunaLA/MyshotLA, a community-informed mobile phone intervention, to increase COVID-19 vaccination among Latino parents/caretakers of minors in under-resourced areas of Los Angeles by addressing misinformation and building trust. We recruited Latino parents/caregivers with at least one unvaccinated child in East and South Los Angeles in the summer of 2021 and evaluated MivacunaLA as a randomized controlled trial with a wait-list control group. A difference-in-difference analysis showed Latino parents/caregivers that participated in MivacunaLA (n = 246), in comparison to the control group, were 15 percentage points more likely (p = 0.04) to report vaccination of minors aged 12-17 years, and 12 percentage points more likely (p = 0.03) to report a positive intention to vaccinate minors aged 2-11 years (when COVID-19 vaccines became available). Mobile phone-delivered digital interventions using videos and culturally tailored educational material to promote COVID-19 vaccine confidence can be an effective way to combat misinformation and deliver timely information to marginalized communities. Community-based participatory research approaches are crucial to advance health equity among minority communities, especially immigrant Spanish-speaking underserved communities.

Promoting Artificial Intelligence for Global Breast Cancer Risk Prediction and Screening in Adult Women: A Scoping Review

Background: Artificial intelligence (AI) algorithms can be applied in breast cancer risk prediction and prevention by using patient history, scans, imaging information, and analysis of specific genes for cancer classification to reduce overdiagnosis and overtreatment. This scoping review aimed to identify the barriers encountered in applying innovative AI techniques and models in developing breast cancer risk prediction scores and promoting screening behaviors among adult females. Findings may inform and guide future global recommendations for AI application in breast cancer prevention and care for female populations. Methods: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results. Results: In the field of breast cancer risk detection and prevention, the following AI techniques and models have been applied: Machine and Deep Learning Model (ML-DL model) (n = 1), Academic Algorithms (n = 2), Breast Cancer Surveillance Consortium (BCSC), Clinical 5-Year Risk Prediction Model (n = 2), deep-learning computer vision AI algorithms (n = 2), AI-based thermal imaging solution (Thermalytix) (n = 1), RealRisks (n = 2), Breast Cancer Risk NAVIgation (n = 1), MammoRisk (ML-Based Tool) (n = 1), Various MLModels (n = 1), and various machine/deep learning, decision aids, and commercial algorithms (n = 7). In the 11 included studies, a total of 39 barriers to AI applications in breast cancer risk prediction and screening efforts were identified. The most common barriers in the application of innovative AI tools for breast cancer prediction and improved screening rates included lack of external validity and limited generalizability (n = 6), as AI was used in studies with either a small sample size or datasets with missing data. Many studies (n = 5) also encountered selection bias due to exclusion of certain populations based on characteristics such as race/ethnicity, family history, or past medical history. Several recommendations for future research should be considered. AI models need to include a broader spectrum and more complete predictive variables for risk assessment. Investigating long-term outcomes with improved follow-up periods is critical to assess the impacts of AI on clinical decisions beyond just the immediate outcomes. Utilizing AI to improve communication strategies at both a local and organizational level can assist in informed decision-making and compliance, especially in populations with limited literacy levels. Conclusions: The use of AI in patient education and as an adjunctive tool for providers is still early in its incorporation, and future research should explore the implementation of AI-driven resources to enhance understanding and decision-making regarding breast cancer screening, especially in vulnerable populations with limited literacy.

Racial Disparities in Selected Complications and Comorbidities among People with Type 2 Diabetes

Type 2 diabetes (T2D) is a growing public health concern, disproportionately impacting racial and ethnic minorities. Assessing disparities is the first step towards achieving the translation goal to reduce disparities in diabetes outcomes, according to the Centers for Disease Control and Prevention (CDC)'s Division of Diabetes. We analyzed the data of patients (18+ years) diagnosed with T2D between 1 January 2012 and 31 March 2017, using the electronic health records of the University of Texas Medical Branch at Galveston. We compared the crude rate and age-standardized rate (using direct method) of selected micro- and macrovascular complication rates, associated obesity, and insulin dependence among racial and ethnic groups. Our sample included 20,680 patients who made 394,106 visits (9922 non-Hispanic White patients, 4698 non-Hispanic Black patients, and 6060 Hispanic patients). Our results suggest a higher risk of acquiring macrovascular (hypertension, ischemic disease, and stroke) and microvascular (renal, ophthalmic, and neurological) complications in Black patients compared to non-Hispanic White and Hispanic patients. The rates of stage I or II obesity were higher in Black patients compared with White and Hispanic patients. The rates of insulin use rather than oral hypoglycemics were also higher in Black patients than White and Hispanic patients. The disparities in terms of the higher susceptibility to complications among Black patients are possibly linked to the socioeconomic disadvantages of this population, leading to poorer management. Prevention strategies are warranted to reduce the incidence of T2D complications in racial minorities.

Racial and ethnic differences in predictors of participation in an intergenerational social connectedness intervention for older adults

BACKGROUND

Social connectedness is a key determinant of health and interventions have been developed to prevent social isolation in older adults. However, these interventions have historically had a low participation rate amongst minority populations. Given the sustained isolation caused by the COVID-19 pandemic, it is even more important to understand what factors are associated with an individual's decision to participate in a social intervention. To achieve this, we used machine learning techniques to model the racial and ethnic differences in participation in social connectedness interventions.

METHODS

Data were obtained from a social connectedness intervention that paired college students with Houston-area community-dwelling older adults (> 65 yo) enrolled in Medicare Advantage plans. Eligible participants were contacted telephonically and asked to complete the 3-item UCLA Loneliness Scale. We used the following machine-learning methods to identify significant predictors of participation in the program: k-nearest neighbors, logistic regression, decision tree, gradient-boosted decision tree, and random forest.

RESULTS

The gradient-boosted decision tree models yielded the best parameters for all race/ethnicity groups (96.1% test accuracy, 0.739 AUROC). Among non-Hispanic White older adults, key features of the predictive model included Functional Comorbidity Index (FCI) score, Medicare prescription risk score, Medicare risk score, and depression and anxiety indicators within the FCI. Among non-Hispanic Black older adults, key features included disability, Medicare prescription risk score, FCI and Medicare risk scores. Among Hispanic older adults, key features included depression, FCI and Medicare risk scores.

CONCLUSIONS

These findings offer a substantial opportunity for the design of interventions that maximize engagement among minority groups at greater risk for adverse health outcomes.

Depression, Sleep Health & Sociodemographic Correlates in a Nationwide Survey: Implications for Depression Treatment During the COVID-19

Purpose

The COVID-19 pandemic has had a profound impact on mental health worldwide, with depression and sleep problems among the most common issues experienced by many individuals. Depression can lead to sleep problems, which can increase the risk of developing depressive symptoms. However, it is unclear which United States (US) sub-population was most affected by depression and sleep problems during the pandemic.

Methods

We conducted a secondary analysis using self-reported data from the 2021 National Health Interview Survey (NHIS), focusing on adults aged 18 years and above (n=29,763). We utilized self-reported responses to questions about prescription medication and frequency of depressive feelings to determine participants' depression status. Appropriate weights were applied to account for the sampling design of the surveys. Our analysis involved descriptive statistics and chi-squared tests to compare sociodemographic, clinical, behavioral, and sleep-related characteristics between US adults with and without depression. Additionally, logistic regression was used to examine the associations between sleep duration, sleep quality and depression.

Results

The overall prevalence of depression in our sample was 44.4%. It were higher in certain demographic groups, including younger adults (18-39 years, 47.7%), non-Hispanic whites (47.9%), females (50.1%), those at the lower income bracket (52.2%), those with no college or degree (48.7%) uninsured individuals (45.2%), and those reporting poor general health (71.9%). Individuals with depression had a 12% increased odds of experiencing short sleep (aOR: 1.12, 95% CI:1.04-1.20, p<0.001), 34% increased odds of experiencing long sleep (aOR: 1.34, 95% CI: 1.20-1.50, p < 0.001) and more than 2.5 fold increased odds of reporting poor sleep quality (aOR:2.57, 95% CI: 2.40-2.78; p<0.0001). In the multivariate analysis, all variables (sex, race/ethnicity, education, health insurance coverage, marital status, general health status and use of sleep medications, smoking and alcohol use status) were significantly predictors of poor sleep quality, with the exceptions of age and family income.

Conclusion

The findings emphasize the need to address sleep health in treating depression, especially during times of public health crises.

Factors associated with poor health literacy in older adults: A systematic review

OBJECTIVES

To identify factors associated with poor health literacy in older adults.

METHODS

A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy".

PROSPERO - CRD

42022350140.

RESULTS

Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others).

CONCLUSIONS

The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

Human Papillomavirus Awareness by Educational Level and by Race and Ethnicity

Importance

Understanding disparities in human papillomavirus (HPV) awareness is crucial, given its association with vaccine uptake.

Objective

To investigate differences in HPV awareness by educational attainment, race, ethnicity, and their intersectionality.

Design, Setting, and Participants

This cross-sectional study used the Health Information National Trends Survey (HINTS) 5 cycles 1 to 4 data (January 26, 2017, to June 15, 2020). The data were analyzed from December 12, 2022, to June 20, 2023. A sample of the noninstitutionalized civilian US population 18 years or older was included in the analysis.

Main Outcomes and Measures

Weighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cancer, stratified by educational attainment and by race and ethnicity. Interaction between educational attainment and race and ethnicity was assessed using a Wald test.

Results

A total of 15 637 participants had educational attainment data available; of these, 51.2% were women, and the median age was 58 (IQR, 44-69) years. A total of 14 444 participants had race and ethnicity information available; of these, 4.6% were Asian, 13.9% were Black, 15.3% were Hispanic, 62.6% were White, and 3.6% were of other race or ethnicity (including American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and more than 1 race or ethnicity). Awareness of HPV by educational attainment ranged from 40.4% for less than high school to 78.2% for college or higher; awareness by race and ethnicity ranged from 46.9% among Asian individuals to 70.2% among White individuals. Awareness of HPV vaccines across educational attainment ranged from 34.7% among those with less than high school to 74.7% among those with a college degree or higher and by race and ethnicity from 48.4% among Asian individuals to 68.2% among White individuals. Among adults who were aware of HPV, knowledge that HPV causes cervical cancer differed by educational attainment, ranging from 51.7% among those with less than high school to 84.7% among those with a college degree or higher, and by race and ethnicity, ranging from 66.0% among Black individuals to 77.9% among Asian individuals. The interaction between educational attainment and race and ethnicity on HPV awareness and HPV vaccine awareness was not significant; however, within each educational attainment level, awareness differed by race and ethnicity, with the lowest awareness consistently among Asian individuals regardless of educational attainment. Within each racial and ethnic group, HPV awareness and HPV vaccine awareness significantly decreased with decreasing educational attainment.

Conclusions and Relevance

Disparities in HPV awareness were evident across social factors, with the lowest awareness among Asian individuals and individuals with lower educational attainment. These results emphasize the importance of considering social factors in HPV awareness campaigns to increase HPV vaccination.

Investigating Racial and Ethnic Differences in Diabetes Self-Management Education Among Adults With Diabetes

PURPOSE

The purpose of this study was to examine racial and ethnic differences in diabetes self-management education (DSME) participation among adults with diabetes.

METHODS

Population-based, cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System diabetes module were analyzed. Study cohort included 9881 adults age 18 years or older with self-reported diabetes living in 11 US states, Washington, DC, and Puerto Rico. The outcome variable was participation in DSME. Weighted descriptive statistics and multivariable logistic regression were computed to investigate the association between race and ethnicity and participation in DSME, adjusting for self-reported social determinants of health factors (eg, sex, education, employment, health insurance).

RESULTS

Overall, 19.3% self-identified as non-Hispanic Black, 16.5% as Hispanic, and 59.9% as non-Hispanic White. Of participants, 44.3% were between 66 and 80 years old, and 50.4% were women. Half (50.1%) reported participating in DSME, and 78.5% had seen clinicians for diabetes-related care 1 to 5 times in the past year. Hispanic participants were less likely to report participation in DSME (28.5%) compared to non-Hispanic Black (60.3%) and non-Hispanic White (53.4%) participants (P < .001). Adults with diabetes who were less likely to participate in DSME tend to be unmarried, have high school or lower-level education, and not exercise regularly.

CONCLUSIONS

Racial and ethnic differences exist in DSME participation. Because DSME has been shown to improve diabetes outcomes, there is a need to develop strategies promoting equity in DSME participation, particularly among Hispanic populations, to reduce health disparities in diabetes care.

Racial and Ethnic Disparities in Health Insurance Coverage in the USA: Findings from the 2018 National Health Interview Survey

Under the broad context of health care reforms, I explored racial and ethnic disparities in health insurance coverage as well as potential mechanisms that might contribute to these disparities for an extensive list of groups. The study used the 2018 National Health Interview Survey to analyze the effects of race/ethnicity on uninsurance, with adjustment for other predisposing characteristics (age, gender, marital status, and immigration status), enabling resources (education, income, language proficiency, and region), and need (self-reported health status). Results from the study documented an average uninsured rate of 13%, with substantial variations across different racial and ethnic groups, ranging from over 30% among Native Americans and Mexicans to less than 10% among whites and Asian subgroups. Enabling resources significantly reduced uninsurance among African Americans, Puerto Ricans, and Cubans compared to whites. On the other hand, these confounding factors only partially contributed to uninsurance among Native Americans, Mexicans, Mexican Americans, Dominicans, and other Central and South Americans. This study revealed substantial racial/ethnic disparities in uninsured rates, with Native Americans and a few Hispanic subgroups (Mexicans, Mexican Americans, and Dominicans) having higher and Asian Indians having lower rates than whites in uninsurance. Pathways leading to coverage varied by race/ethnicity. The main findings yielded empirical, theoretical, and policy implications that contributed to health care disparity research.

Psychosocial Difficulties Experienced by MS Patients in their Quality of Life: A Comparative Study of Two Countries

BACKGROUND

MS is deeply impacted by social factors, such as access to health services, support from official and unofficial sources, and social welfare, which are also thought to contribute to the quality of life of MS patients. The purpose of this study is to examine the quality of life and to analyse the psychosocial challenges of MS patients in North Cyprus and Germany.

METHODS

This study was designed with a cross-sectional and comparative research method. The personal information form and the WHO Quality of Life Scale Short Form were used. A total sixty-eight participants joined the study: 35 German patients and 33 Turkish Cypriot patients. Researchers collected the data by face-to-face interviews between December 2021 and March 2022. The majority of MS patients were females average age was 49.48 years old.

RESULTS

In general, the two populations had comparable total sub-dimension scores of quality of life. However, only environment sub-dimension score has significant difference between Germany (x̄ =70.04) and North Cyprus (x̄ =55.87). Perceived opportunities for accessing medication, physiotherapy, and psychological support, as well as the opportunity to receive psychological support after the time of diagnosis were considered greater in the German group compared to the Turkish Cypriot one.

CONCLUSION

Findings from this cross-sectional research demonstrate significant differences in services provided, particularly in the psychosocial domain, between those in Germany and those in Cyprus. Consequently, all parties in both countries (governments, families, health workers, social workers and people with MS) should cooperate to improve social support mechanisms. Moreover, it is needed better access to health services in Northern Cyprus.

Forgone Health Care for Non-COVID-19-Related Needs Among Medicare Beneficiaries During the COVID-19 Pandemic, Summer 2020-Winter 2021

INTRODUCTION

Forgone health care, defined as not using health care despite perceiving a need for it, is associated with poor health outcomes, especially among people with chronic conditions. The objective of our study was to examine how the pandemic affected forgone health care during 3 stages of the pandemic.

METHODS

We used the Medicare Current Beneficiary Survey COVID-19 Rapid Response Questionnaire administered in summer 2020, fall 2020, and winter 2021 to examine sociodemographic characteristics, chronic diseases, COVID-19 vaccination status, and telehealth availability in relation to beneficiary reports of forgone health care.

RESULTS

Of the 3 periods studied, the overall rate of forgone health care was highest in summer 2020 (20.8%), followed by fall 2020 (7.8%) and winter 2021 (6.5%). COVID-19 vaccination status, age, sex, race and ethnicity, US region, availability of primary care telehealth appointments, and chronic conditions (heart disease, arthritis, depression, osteoporosis or a broken hip, and diabetes or high blood glucose) were significantly related to forgone care.

CONCLUSION

High rates of forgone care among Medicare participants varied over time and were significantly related to beneficiary characteristics. Our findings highlight the need for health care reform and changes in policy to address the issue of access to care for people with chronic conditions during a pandemic or other public health emergency.

"The System Doesn't Let Us in"-A Call for Inclusive COVID-19 Vaccine Outreach Rooted in Los Angeles Latinos' Experience of Pandemic Hardships and Inequities

OBJECTIVE

Latino adults in Los Angeles have experienced disproportionate cases, deaths, and socioeconomic impacts from the COVID-19 pandemic. This qualitative study aimed to explore community perspectives on readiness for COVID-19 vaccination and to identify culturally tailored vaccine outreach strategies.

METHODS

We conducted virtual focus groups with Los Angeles County Latino/a residents via Zoom between December 2020 to January 2021, as the first COVID-19 vaccines were receiving Emergency Use Authorization (EUA). Focus groups were facilitated in Spanish and English by bilingual members of the research team. Discussions were analyzed via Atlas.ti software using reflexive thematic analysis.

RESULTS

Three focus groups (n = 15; four to six people each; two Spanish focus groups; one English) were conducted. Thematic findings centered on Latino COVID-19 vaccine equity: (1) Disproportionate infection risk due to essential worker status and socioeconomic burdens, misinformation, and familial or cultural tensions (2) Concerns for inequitable vaccine access due to immigration fears and limited healthcare access, and (3) A need for community-centered COVID-19 vaccine outreach and access.

CONCLUSIONS

Our study on early Latino adult reactions to vaccine roll-out suggests the need for outreach strategies centering on validating community hardships, combating dis-/misinformation through trusted sources, and addressing socio-economic needs impacted by the pandemic.

Geographic Disparity in Asthma Hospitalizations: The Role of Race/Ethnicity, Socioeconomic Status, and Other Factors

Background

In the United States, asthma is the most common chronic disease in children, and is associated with low sociodemographic, economic, and environmental factors. 

Objective

To investigate geographic disparities in asthma hospitalizations and the roles that race/ethnicity, health insurance, and other environmental factors played on these disparities in Lubbock County, Texas. 

Methods

Data were obtained from the Texas Inpatient Public Use Data File for the years 1999-2018. International classification of disease codes were used to identify primary diagnoses of asthma among all severe inpatient admissions. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). 

Results

Of the 248,768 patients admitted for severe conditions, 4,224 had a primary diagnosis of asthma. In multivariable-adjusted models, the odds of asthma hospitalizations varied across geographic regions of Lubbock with the Northeast having the highest age-adjusted prevalence (7.17 per 1,000) and ORs for asthma hospitalizations (OR: 1.25, CI: 1.12-1.40). Data suggested that non-Hispanic Blacks using federal insurance in the Northeast region had the highest odds for asthma hospitalizations (OR: 4.88, CI: 3.06-7.79; p-interaction = 0.001). Across all regions, a 1 μg/m³ increase in particulate matter 2.5 was associated with a 27% higher likelihood of asthma hospitalization (OR: 1.27, 95% CI: 1.23-1.31). 

Conclusion

In this study, geographic disparities in asthma hospitalizations were observed within Lubbock County and were significantly influenced by a disparate distribution of socioeconomic factors related to health insurance and race/ethnicity. The potential contributory role of particulate matter needs further investigation. 

The impact of race and socioeconomic factors on paediatric diabetes

There are over 29,000 children and young people (CYP) with Type 1 diabetes mellitus (T1DM) in England and Wales and another 726 with Type 2 diabetes mellitus (T2DM). There is little effect of deprivation on the prevalence of T1DM whereas the association of deprivation on the percentage of CYP with T2DM is striking with 45% of cases drawn from the most deprived backgrounds. A number that has not changed over the last 4 years. Data from the UK and USA as well as other countries demonstrate the impact of deprivation on outcomes in diabetes mellitus with clear effects on measures of long-term control and complications. In the UK black CYP had higher glycosylated haemoglobin (HbA1c) values compared to other groups. Within the black group, CYP from a Caribbean background had a higher mean HbA1c (77.0 mmol/mol (9.2%)) than those from Africa (70.4 mmol/mol (8.6%)). Treatment regimen (multiple daily injections or insulin pump therapy) explained the largest proportion of the variability in HbA1c followed by deprivation. Those in the least deprived areas had an average HbA1c 5.88 mmol/mol (0.5%) lower than those living in the most deprived areas. The picture is complex as UK data also show that deprivation and ethnicity is associated with less use of technology that is likely to improve diabetes control. Increased usage of pump therapy and continuous glucose monitoring was associated with a younger age of patient (less than 10 years of age), living in the least deprived areas and white ethnicity. This gap between pump usage amongst CYP with T1DM living in the most and least deprived areas has widened with time. In 2014/15 the gap was 7.9% and by 2018/19 had increased to 13.5%. To attain an equitable service for CYP with diabetes mellitus we need to consider interventions at the patient, health care professional, community, and health care system levels.

Impact of Race on the In-Hospital Quality of Care Among Young Adults With Acute Myocardial Infarction

Background The extent to which race influences in-hospital quality of care for young adults (≤55 years) with acute myocardial infarction (AMI) is largely unknown. We examined racial disparities in in-hospital quality of AMI care and their impact on 1-year cardiac readmission. Methods and Results We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study enrolling young Black and White US adults with AMI (2008-2012). An in-hospital quality of care score (QCS) was computed (standard AMI quality indicators divided by the total a patient is eligible for). Multivariable logistic regression was performed to identify factors associated with the lowest QCS tertile, including interactions between race and social determinants of health. Among 2846 young adults with AMI (median 48 years [interquartile range 44-52], 67.4% women, 18.8% Black race), Black individuals, especially women, exhibited a higher prevalence of cardiac risk factors and social determinants of health and were more likely to experience a non-ST-segment-elevation myocardial infarction than White individuals. Black individuals were more likely in the lowest QCS tertile than White individuals (40.8% versus 34.7%; P=0.003). The association between Black race and low QCS (odds ratio [OR], 1.25; 95% CI, 1.02-1.54) was attenuated by adjustment for confounders. Employment was independently associated with better QCS, especially among Black participants (OR, 0.76; 95% CI, 0.62-0.92; P-interaction=0.02). Black individuals experienced a higher rate of 1-year cardiac readmission (29.9% versus 20.0%; P<0.0001). Conclusions Black individuals with AMI received lower in-hospital quality of care and exhibited a higher rate of cardiac readmissions than White individuals. Black individuals had a lower quality of care if unemployed, highlighting the intersection of race and social determinants of health.

Promoviendo una Alimentación Saludable (PAS) results: Engaging Latino families in eating disorder treatment

Latinos/as are underrepresented in eating disorders clinical trials. This study compared results of a culturally adapted individual cognitive-behavioral treatment (CBT) for binge-spectrum eating disorders that included or excluded a family enhanced module (CBT + FE), in a proof-of-principle pilot study with a sample of Latina adults and one family member per patient. Twenty-five patients (M_age = 37 yrs) and 25 family members (M_age = 40 yrs) were randomized to CBT (n = 13) or CBT+ FE (n = 12). DSM-IV eating disorder diagnoses were: 48% (n = 12) bulimia nervosa, 28% (n = 7) binge-eating disorder, and 24% (n = 6) eating disorder not otherwise specified. Effect sizes favored CBT + FE on adherence and retention, and scores on treatment satisfaction and therapeutic alliance were high, indicating treatment acceptability. In spite of the hypothesis that family outcomes such as support, familism, cohesion, pride, family cultural conflict, burden, and marital satisfaction (in couples) would be superior in CBT + FE, the preliminary data were inconclusive and results were mixed. The hypothesis that eating disorder outcomes including global eating psychopathology, binge eating, and purging would improve in CBT + FE was not supported. There was some evidence that patients in CBT improved more particularly on binge eating, otherwise the groups had no differences. In conclusion, the results suggest that CBT + FE could enhance treatment adherence and retention, although this did not automatically translate to better family and symptom outcomes.

Limited-Variant Screening vs Comprehensive Genetic Testing for Familial Hypercholesterolemia Diagnosis

Question

How many clinically significant variants for familial hypercholesterolemia would be missed by limited-variant screening conducted on microarrays?

Findings

In this cross-sectional review of comprehensive genetic test results for individuals with indications for familial hypercholesterolemia, a limited-variant screen was found to have a significantly lower detection rate (8.4%) than the comprehensive diagnostic test (27%).

Meaning

The results of this study suggest that clinically significant findings for familial hypercholesterolemia would be missed for two-thirds of affected individuals if limited-variant screening was used.

Importance

Familial hypercholesterolemia (FH) is the most common inherited cardiovascular disease and carries significant morbidity and mortality risks. Genetic testing can identify affected individuals, but some array-based assays screen only a small subset of known pathogenic variants.

Objective

To identify the number of clinically significant variants associated with FH that would be missed by an array-based, limited-variant screen when compared with next-generation sequencing (NGS)–based comprehensive testing.

Design, Setting, and Participants

This cross-sectional study compared comprehensive genetic test results for clinically significant variants associated with FH with results for a subset of 24 variants screened by a limited-variant array. Data were deidentified next-generation sequencing results from indication-based or proactive gene panels. Individuals receiving next-generation sequencing–based genetic testing, either for an FH indication between November 2015 and June 2020 or as proactive health screening between February 2016 and June 2020 were included. Ancestry was reported by clinicians who could select from preset options or enter free text on the test requisition form.

Main Outcomes and Measures

Number of pathogenic or likely pathogenic (P/LP) variants identified.

Results

This study included 4563 individuals who were referred for FH diagnostic testing and 6482 individuals who received next-generation sequencing of FH-associated genes as part of a proactive genetic test. Among individuals in the indication cohort, the median (interquartile range) age at testing was 49 (32-61) years, 55.4% (2528 of 4563) were female, and 63.6% (2902 of 4563) were self-reported White/Caucasian. In the indication cohort, the positive detection rate would have been 8.4% (382 of 4563) for a limited-variant screen compared with the 27.0% (1230 of 4563) observed with the next-generation sequencing–based comprehensive test. As a result, 68.9% (848 of 1230) of individuals with a P/LP finding in an FH-associated gene would have been missed by the limited screen. The potential for missed findings in the indication cohort varied by ancestry; among individuals with a P/LP finding, 93.7% (59 of 63) of self-reported Black/African American individuals and 84.7% (122 of 144) of Hispanic individuals would have been missed by the limited-variant screen, compared with 33.3% (4 of 12) of Ashkenazi Jewish individuals. In the proactive cohort, the prevalence of clinically significant FH variants was approximately 1:191 per the comprehensive test, and 61.8% (21 of 34) of individuals with an FH-associated P/LP finding would have been missed by a limited-variant screen.

Conclusions and Relevance

Limited-variant screens may falsely reassure the majority of individuals at risk for FH that they do not carry a disease-causing variant, especially individuals of self-reported Black/African American and Hispanic ancestry.