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Rebouças P, Paixão ES, Ramos D, Pescarini J, Pinto-Junior EP, Falcão IR, Ichihara MY, Sena S, Veiga R, Ribeiro R, Rodrigues LC, Barreto ML, Goes EF. Ethno-racial inequalities on adverse birth and neonatal outcomes: a nationwide, retrospective cohort study of 21 million Brazilian newborns. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100833. [PMID: 39070074 PMCID: PMC11269955 DOI: 10.1016/j.lana.2024.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/30/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024]
Abstract
Background Ethno-racial inequalities are critical determinants of health outcomes. We quantified ethnic-racial inequalities on adverse birth outcomes and early neonatal mortality in Brazil. Methods We conducted a cohort study in Brazil using administrative linked data between 2012 and 2019. Estimated the attributable fractions for the entire population (PAF) and specific groups (AF), as the proportion of each adverse outcome that would have been avoided if all women had the same baseline conditions as White women, both unadjusted and adjusted for socioeconomics and maternal risk factors. AF was also calculated by comparing women from each maternal race/skin colour group in different groups of mothers' schooling, with White women with 8 or more years of education as the reference group and by year. Findings 21,261,936 newborns were studied. If all women experienced the same rate as White women, 1.7% of preterm births, 7.2% of low birth weight (LBW), 10.8% of small for gestational age (SGA) and 11.8% of early neonatal deaths would have been prevented. Percentages preventable were higher among Indigenous (22.2% of preterm births, 17.9% of LBW, 20.5% of SGA and 19.6% of early neonatal deaths) and Black women (6% of preterm births, 21.4% of LBW, 22.8% of SGA births and 20.1% of early neonatal deaths). AF was higher in groups with fewer years of education among Indigenous, Black and Parda for all outcomes. AF increased over time, especially among Indigenous populations. Interpretation A considerable portion of adverse birth outcomes and neonatal deaths could be avoided if ethnic-racial inequalities were non-existent in Brazil. Acting on the causes of these inequalities must be central in maternal and child health policies. Funding Bill & Melinda Gates Foundation and Wellcome Trust.
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Affiliation(s)
- Poliana Rebouças
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Enny S. Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Elzo Pereira Pinto-Junior
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Ila R. Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Samila Sena
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael Veiga
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rita Ribeiro
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Faculdade de Nutrição, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Laura C. Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maurício L. Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Emanuelle F. Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
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Li J, Daida YG, Bacong AM, Rosales AG, Frankland TB, Varga A, Chung S, Fortmann SP, Waitzfelder B, Palaniappan L. Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations. Am J Prev Cardiol 2024; 19:100688. [PMID: 39070025 PMCID: PMC11278113 DOI: 10.1016/j.ajpc.2024.100688] [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: 02/15/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/30/2024] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in the United States, and rates of CVD incidence vary widely by race and ethnicity. Cigarette smoking is associated with increased risk of CVD. The purpose of the study was: 1) to examine smoking prevalence over time across Asian and Pacific Islander (API) and multi-race API subgroups; 2) to determine whether the CVD risk associated with smoking differed among these subgroups. Methods We identified patients belonging to 7 single race/ethnicity groups, 4 multi-race/ethnicity groups, and a non-Hispanic White (NHW) comparison group at two large health systems in Hawaii and California. We estimated annual smoking prevalence from 2011 through 2018 by group and gender. We examined incidence of CVD events by smoking status and race/ethnicity, and computed hazard ratios for CVD events by age, gender, race/ethnicity, census block median household income, census block college degree, and study site using Cox regression. Results Of the 12 groups studied, the Asian Indian and Chinese American groups had the lowest smoking prevalence, and the Asian + Pacific Islander multiracial group had the highest smoking prevalence. The prevalence of smoking decreased from 2011 to 2018 for all groups. Multi-race/ethnicity groups had higher risk of CVD than the NHW group. There was no significant interaction between race/ethnicity and smoking in models predicting CVD, but the association between race/ethnicity and CVD incidence was attenuated after adjusting for smoking status. Conclusions There is considerable heterogeneity in smoking prevalence and the risk of CVD among API subgroups.
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Affiliation(s)
- Jiang Li
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, USA
| | | | | | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Sukyung Chung
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | - Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, USA
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Darvish S, Mahoney SA, Venkatasubramanian R, Rossman MJ, Clayton ZS, Murray KO. Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions. J Appl Physiol (1985) 2024; 137:194-222. [PMID: 38813611 DOI: 10.1152/japplphysiol.00188.2024] [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: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.
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Affiliation(s)
- Sanna Darvish
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kevin O Murray
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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LAM‐HINE TRACY, FORTHAL SARAH, JOHNSON CANDICEY, CHIN HELENB. Asking MultiCrit Questions: A Reflexive and Critical Framework to Promote Health Data Equity for the Multiracial Population. Milbank Q 2024; 102:398-428. [PMID: 38424372 PMCID: PMC11176410 DOI: 10.1111/1468-0009.12696] [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: 09/29/2023] [Revised: 01/05/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
Policy Points Health equity work primarily centers monoracial populations; however, the rapid growth of the Multiracial population and increasingly clear health disparities affecting the people in that population complicate our understanding of racial health equity. Limited resources exist for health researchers and professionals grappling with this complexity, likely contributing to the relative dearth of health literature describing the Multiracial population. We introduce a question-based framework built on core principles from Critical Multiracial Theory (MultiCrit) and Critical Race Public Health Praxis, designed for researchers, clinicians, and policymakers to encourage health data equity for the Multiracial population.
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Affiliation(s)
- TRACY LAM‐HINE
- School of MedicineStanford University
- Center for Population Health SciencesSchool of Medicine, Stanford University
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5
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Kuo A, Yazji I, Abbass N, Chong DD, Fane L, Örge FH. Lack of racial and ethnic diversity in pediatric ophthalmology clinical trials from 2000 to 2022. J AAPOS 2024; 28:103870. [PMID: 38460595 DOI: 10.1016/j.jaapos.2024.103870] [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: 09/10/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To examine the prevalence of and factors associated with racial and ethnic reporting and trends in such reporting and to assess whether categories of race and ethnicity have been under- or over-represented in pediatric ophthalmology randomized control trials (RCTs) in the United States. METHODS We systematically searched the literature on pediatric ophthalmology RCTs in high-impact factor ophthalmology journals published between 2000 and 2022. Logistic regression was used to assess parameters linked to race/ethnicity reporting; linear regression, to gauge the relationship between publication year and race/ethnicity reporting. The racial and ethnic composition of RCTs was contrasted with 2010 US census data by calculating percentage difference. RESULTS Of 170 eligible articles, 89 (52.4%) included race/ethnicity data. Multivariable analysis showed that academic (OR = 12.19; 95% CI, 3.34-44.44) and government (OR = 3.91; 95% CI, 1.20-12.72) funding was linked to data reporting. During the study period, publication year and race/ethnicity reporting had a nonstatistically significant 1.0% annual increase (r = 0.29, P = 0.18). White participants were over-represented, with a percentage difference of 16.7% (95% CI, 11.8%-21.7%), whereas Hispanic individuals were under-represented, with a percentage difference of -7.6% (95% CI, -11.2% to -4.1%) compared to the 2010 US census data. CONCLUSIONS Our results indicate a gradual rise in reported race and/or ethnicity in published pediatric ophthalmology RCTs, though not statistically significant, both in the United States and globally. Notably, under-representation of Hispanic, over-representation of White, and proportional representation of Black and Asian individuals were observed in US-based studies.
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Affiliation(s)
- Andy Kuo
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Isabella Yazji
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nadia Abbass
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David D Chong
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lauren Fane
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Faruk H Örge
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Machado S, Perez B, Papanicolas I. The role of race and ethnicity in health care crowdfunding: an exploratory analysis. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae027. [PMID: 38756917 PMCID: PMC10986198 DOI: 10.1093/haschl/qxae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 05/18/2024]
Abstract
Medical crowdfunding is a key source of financing for individuals facing high out-of-pocket costs, including organ-transplant candidates. However, little is known about racial disparities in campaigning activity and outcomes, or how these relate to access to care. In this exploratory, nationwide, cross-sectional study, we examined racial disparities in campaigning activity across states and the association between US campaigners' race and ethnicity and crowdfunding outcomes using a novel database of organ-transplant-related campaigns, and an algorithm to identify race and ethnicity based on name and geographic location. This analysis suggests that there are racial disparities in individuals' ability to successfully raise requested funds, with Black and Hispanic campaigners fundraising lower amounts and less likely to achieve their monetary goals. We also found that crowdfunding among White, Black, and Hispanic populations exhibits different patterns of activity at the state level, and in relation to race-specific uninsurance and waitlist additions, highlighting potential differences in fundraising need across the 3 groups. Policy efforts should consider not only how inequalities in fundraising ability for associated costs influence accessibility to care but also how to identify clinical need among minorities.
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Affiliation(s)
- Sara Machado
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02903, United States
- Department of Health Policy, London School of Economics, London WC2A 2AE, United Kingdom
| | - Beatrice Perez
- Department of Computer Science, University of Massachusetts, Boston, MA 02125, United States
| | - Irene Papanicolas
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02903, United States
- Department of Health Policy, London School of Economics, London WC2A 2AE, United Kingdom
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
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Prey Dawson J, Finn H, Chittalia AZ, Vawdrey DK. Analyzing Patient-Provided Responses to Improve Collection of Health Equity Data Elements. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:569-578. [PMID: 38222420 PMCID: PMC10785944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Self-report is purported to be the gold standard for collecting demographic information. Many entry forms include a free-text "write-in" option in addition to structured responses. Balancing the flexibility of free-text with the value of collecting data in a structured format is a challenge if the data are to be useful for measuring and mitigating health disparities. While much work has been done to improve collection of race and ethnicity information, how to best collect data related to sexual and gender minority status and military veteran status has been less commonly studied. We analyzed 3,381 patient-provided free-text responses collected via a patient portal for gender identity, sexual orientation, pronouns, and veteran experiences. We identified common responses to better understand our patient population and help improve future iterations of data collection tools.
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Affiliation(s)
| | - Heather Finn
- Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania
| | | | - David K Vawdrey
- Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania
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Katheria A, Szychowski J, Carlo WA, Subramaniam A, Reister F, Essers J, Vora F, Martin C, Schmölzer GM, Law B, Dempsey E, O'Donoghue K, Kaempf J, Tomlinson M, Fulford K, Folsom B, Karam S, Morris R, Yanowitz T, Beck S, Clark E, DuPont T, Biniwale M, Ramanathan R, Bhat S, Hoffman M, Chouthai N, Bany-Mohammed F, Mydam J, Narendran V, Wertheimer F, Gollin Y, Vaucher Y, Arnell K, Varner M, Cutter G, Wilson N, Rich W, Finer N. Umbilical Cord Milking Versus Delayed Cord Clamping in Infants 28 to 32 Weeks: A Randomized Trial. Pediatrics 2023; 152:e2023063113. [PMID: 37941523 DOI: 10.1542/peds.2023-063113] [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: 08/02/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES To determine whether rate of severe intraventricular hemorrhage (IVH) or death among preterm infants receiving placental transfusion with UCM is noninferior to delayed cord clamping (DCC). METHODS Noninferiority randomized controlled trial comparing UCM versus DCC in preterm infants born 28 to 32 weeks recruited between June 2017 through September 2022 from 19 university and private medical centers in 4 countries. The primary outcome was Grade III/IV IVH or death evaluated at a 1% noninferiority margin. RESULTS Among 1019 infants (UCM n = 511 and DCC n = 508), all completed the trial from birth through initial hospitalization (mean gestational age 31 weeks, 44% female). For the primary outcome, 7 of 511 (1.4%) infants randomized to UCM developed severe IVH or died compared to 7 of 508 (1.4%) infants randomized to DCC (rate difference 0.01%, 95% confidence interval: (-1.4% to 1.4%), P = .99). CONCLUSIONS In this randomized controlled trial of UCM versus DCC among preterm infants born between 28 and 32 weeks' gestation, there was no difference in the rates of severe IVH or death. UCM may be a safe alternative to DCC in premature infants born at 28 to 32 weeks who require resuscitation.
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Affiliation(s)
- Anup Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | | | | | | | - Frank Reister
- Department of Pediatrics and Obstetrics, University of Ulm, Ulm, Germany
| | - Jochen Essers
- Department of Pediatrics and Obstetrics, University of Ulm, Ulm, Germany
| | - Farha Vora
- Department of Pediatrics and Obstetrics, Loma Linda University, Loma Linda, California
| | - Courtney Martin
- Department of Pediatrics and Obstetrics, Loma Linda University, Loma Linda, California
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Brenda Law
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Eugene Dempsey
- Department of Pediatrics and Obstetrics, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Pediatrics and Obstetrics, University College Cork, Cork, Ireland
| | - Joseph Kaempf
- Women and Children's Services, Providence St Vincent Medical Center, Portland, Oregon
| | - Mark Tomlinson
- Women and Children's Services, Providence St Vincent Medical Center, Portland, Oregon
| | - Kevin Fulford
- Department of Pediatrics and Obstetrics, Sharp Grossmont Hospital, La Mesa, California
| | - Bergen Folsom
- Department of Pediatrics and Obstetrics, Sharp Grossmont Hospital, La Mesa, California
| | - Simon Karam
- Department of Pediatrics and Obstetrics, University of Mississippi Medical CenterJackson, Mississippi
| | - Rachael Morris
- Department of Pediatrics and Obstetrics, University of Mississippi Medical CenterJackson, Mississippi
| | - Toby Yanowitz
- Department of Pediatrics and Obstetrics, Magee Women's Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Stacy Beck
- Department of Pediatrics and Obstetrics, Magee Women's Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Erin Clark
- University of Utah, Department of Pediatrics and Obstetrics, Salt Lake City, Utah
| | - Tara DuPont
- University of Utah, Department of Pediatrics and Obstetrics, Salt Lake City, Utah
| | - Manoj Biniwale
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shazia Bhat
- Department of Pediatrics and Obstetrics, Christiana Care Health System, Newark, Delaware
| | - Matthew Hoffman
- Department of Pediatrics and Obstetrics, Christiana Care Health System, Newark, Delaware
| | - Nitin Chouthai
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri
| | - Fayez Bany-Mohammed
- Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, California
| | - Janardhan Mydam
- Department of Pediatrics, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Vivek Narendran
- Department of Pediatrics and Obstetrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Fiona Wertheimer
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yvonne Gollin
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Yvonne Vaucher
- Department of Pediatrics, University of California at San Diego, San Diego, California
| | - Kathy Arnell
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Michael Varner
- University of Utah, Department of Pediatrics and Obstetrics, Salt Lake City, Utah
| | - Gary Cutter
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicole Wilson
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Neil Finer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
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Proumen R, Connolly H, Debick NA, Hopkins R. Assessing the accuracy of electronic health record gender identity and REaL data at an academic medical center. BMC Health Serv Res 2023; 23:884. [PMID: 37608282 PMCID: PMC10463428 DOI: 10.1186/s12913-023-09825-6] [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: 03/21/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Collection of accurate patient race, ethnicity, preferred language (REaL) and gender identity in the electronic health record (EHR) is essential for equitable and inclusive care. Misidentification of these factors limits quality measurement of health outcomes in at-risk populations. Therefore, the aim of our study was to assess the accuracy of REaL and gender identity data at our institution. METHODS A survey was administered to 117 random patients, selected from prior day admissions at a large academic medical center in urban central New York. Patients (or guardians) self-reported REaL and gender identity data, selecting from current EHR options. Variables were coded for the presence or absence of a difference from data recorded in the EHR. RESULTS Race was misreported in the EHR for 13% of patients and ethnicity for 6%. For most White and Black patients, race was concordant. However, self-identified data for all multiracial patients were discordant with the EHR. Most Non-Hispanic patients had ethnicity correctly documented. Some Hispanic patients were misidentified. There was a significant association between reporting both a race and an ethnicity which differed from the EHR on chi square analysis (P < 0.001). Of those who reported an alternative ethnicity, 71.4% also reported an alternative race. Gender identity was missing for most patients and 11% of the gender-identity entries present in the EHR were discordant with the patient's self-identity. Preferred language was 100% concordant with the EHR. CONCLUSIONS At an academic medical center, multiracial and Hispanic patients were more likely to have their demographics misreported in the EHR, and gender identity data were largely missing. Healthcare systems need strategies that support accurate collection of patients' self-reported ReAL and gender identity data to improve the future ability to identify and address healthcare disparities.
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Affiliation(s)
- Rachael Proumen
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, 750 E. Adams St, Syracuse, New York, USA.
- State University of New York (SUNY) Upstate Medical University Norton College of Medicine, Syracuse, New York, USA.
| | - Hannah Connolly
- State University of New York (SUNY) Upstate Medical University Norton College of Medicine, Syracuse, New York, USA
| | - Nadia Alexandra Debick
- State University of New York (SUNY) Upstate Medical University Norton College of Medicine, Syracuse, New York, USA
| | - Rachel Hopkins
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, 750 E. Adams St, Syracuse, New York, USA
- Department of Medicine, Division of Endocrinology, State University of New York (SUNY) Upstate Medical University, 750 E Adams St., Syracuse, NY, 13210, USA
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Lee W, Martins MS, George RB, Fernandez A. Racial and ethnic disparities in obstetric anesthesia: a scoping review. Can J Anaesth 2023; 70:1035-1046. [PMID: 37165125 PMCID: PMC10370345 DOI: 10.1007/s12630-023-02460-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 05/12/2023] Open
Abstract
PURPOSE Health disparities continue to affect racial and ethnic marginalized obstetric patients disproportionally with increased risk of Cesarean delivery and pregnancy-related death. Yet, the literature on what influences such disparities in obstetric anesthesia service and its clinical outcomes is less well known. We set out to describe racial and ethnic disparities in obstetric anesthesia during the peripartum period in the USA via a scoping review of the recent literature. SOURCE Using the Institute of Medicine's definition of disparities, we searched the National Library of Medicine's PubMed/Medline, Embase, Web of Science, APA PsycINFO, and Google Scholar for articles published between 1 January 2000 and 30 June 2022 to identify literature on racial and ethnic disparities in obstetric anesthesia. PRINCIPAL FINDINGS Out of 8,432 articles reviewed, 15 met our inclusion criteria. All but one study was observational. Seven studies were single-institutional while the remaining used multicentre data/databases. All studies compared two or more race and ethnicity classifications. Studies in this review described disparities in the use of labour epidural analgesia, labour epidural request timing, anesthesia for Cesarean deliveries, postpartum pain management, and epidural blood patch for postdural puncture headaches. Several studies reported disparities observed in the unadjusted models becoming no longer significant when adjusted for other covariates. CONCLUSION Based on the findings of the present scoping review on racial and ethnic disparities in obstetric anesthesia, we present an evidence map identifying knowledge gaps and propose a future research agenda.
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Affiliation(s)
- Won Lee
- University of California San Francisco, San Francisco, California
| | | | - Ronald B. George
- University of California San Francisco, San Francisco, California
| | - Alicia Fernandez
- University of California San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital, San Francisco, California
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Getaneh FW, Ackenbom MF, Carter-Brooks CM, Brown O. Race in Clinical Algorithms and Calculators in Urogynecology: What Is Glaring to Us. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00108. [PMID: 37211673 DOI: 10.1097/spv.0000000000001371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Feven W Getaneh
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Medstar Georgetown Washington Hospital Center, Washington, DC
| | - Mary F Ackenbom
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Charelle M Carter-Brooks
- Department of Obstetrics and Gynecology, George Washington School of Medicine, Washington, DC; and
| | - Oluwateniola Brown
- Division of Urogynecology, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL
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Waitzfelder B, Palaniappan L, Varga A, Frankland TB, Li J, Daida YG, Kaholokula JK, Bacong AM, Rawlings AM, Chung S, Howick C, Fortmann SP. Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California. BMC Public Health 2023; 23:885. [PMID: 37189145 PMCID: PMC10184427 DOI: 10.1186/s12889-023-15795-5] [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: 09/02/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations. METHODS The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups. RESULTS The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos). CONCLUSIONS Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.
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Affiliation(s)
- Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Timothy B Frankland
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Jiang Li
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | | | - Andreea M Rawlings
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | | | - Connor Howick
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
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Reid CN, Obure R, Salemi JL, Ilonzo C, Louis J, Rubio E, Sappenfield WM. Race and Ethnicity Misclassification in Hospital Discharge Data and the Impact on Differences in Severe Maternal Morbidity Rates in Florida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5689. [PMID: 37174207 PMCID: PMC10178402 DOI: 10.3390/ijerph20095689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/07/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Hospital discharge (HD) records contain important information that is used in public health and health care sectors. It is becoming increasingly common to rely mostly or exclusively on HD data to assess and monitor severe maternal morbidity (SMM) overall and by sociodemographic characteristics, including race and ethnicity. Limited studies have validated race and ethnicity in HD or provided estimates on the impact of assessing health differences in maternity populations. This study aims to determine the differences in race and ethnicity reporting between HD and birth certificate (BC) data for maternity hospitals in Florida and to estimate the impact of race and ethnicity misclassification on state- and hospital-specific SMM rates. We conducted a population-based retrospective study of live births using linked BC and HD records from 2016 to 2019 (n = 783,753). BC data were used as the gold standard. Race and ethnicity were categorized as non-Hispanic (NH)-White, NH-Black, Hispanic, NH-Asian Pacific Islander (API), and NH-American Indian or Alaskan Native (AIAN). Overall, race and ethnicity misclassification and its impact on SMM at the state- and hospital levels were estimated. At the state level, NH-AIAN women were the most misclassified (sensitivity: 28.2%; positive predictive value (PPV): 25.2%) and were commonly classified as NH-API (30.3%) in HD records. NH-API women were the next most misclassified (sensitivity: 57.3%; PPV: 85.4%) and were commonly classified as NH-White (5.8%) or NH-other (5.5%). At the hospital level, wide variation in sensitivity and PPV with negative skewing was identified, particularly for NH-White, Hispanic, and NH-API women. Misclassification did not result in large differences in SMM rates at the state level for all race and ethnicity categories except for NH-AIAN women (% difference 78.7). However, at the hospital level, Hispanic women had wide variability of a percent difference in SMM rates and were more likely to have underestimated SMM rates. Reducing race and ethnicity misclassification on HD records is key in assessing and addressing SMM differences and better informing surveillance, research, and quality improvement efforts.
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Affiliation(s)
- Chinyere N. Reid
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Renice Obure
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Jason L. Salemi
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Chinwendu Ilonzo
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Judette Louis
- Department of Obstetrics & Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Estefania Rubio
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - William M. Sappenfield
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
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14
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Menon K, Sorce LR, Argent A, Bennett TD, Carrol ED, Kissoon N, Sanchez-Pinto LN, Schlapbach LJ, de Souza DC, Watson RS, Wynn JL, Zimmerman JJ, Ranjit S. Reporting of Social Determinants of Health in Pediatric Sepsis Studies. Pediatr Crit Care Med 2023; 24:301-310. [PMID: 36696549 PMCID: PMC10332854 DOI: 10.1097/pcc.0000000000003184] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Standardized, consistent reporting of social determinants of health (SDOH) in studies on children with sepsis would allow for: 1) understanding the association of SDOH with illness severity and outcomes, 2) comparing populations and extrapolating study results, and 3) identification of potentially modifiable socioeconomic factors for policy makers. We, therefore, sought to determine how frequently data on SDOH were reported, which factors were collected and how these factors were defined in studies of sepsis in children. DATA SOURCES AND SELECTION We reviewed 106 articles (published between 2005 and 2020) utilized in a recent systematic review on physiologic criteria for pediatric sepsis. DATA EXTRACTION Data were extracted by two reviewers on variables that fell within the World Health Organization's SDOH categories. DATA SYNTHESIS SDOH were not the primary outcome in any of the included studies. Seventeen percent of articles (18/106) did not report on any SDOH, and a further 36.8% (39/106) only reported on gender/sex. Of the remaining 46.2% of articles, the most reported SDOH categories were preadmission nutritional status (35.8%, 38/106) and race/ethnicity (18.9%, 20/106). However, no two studies used the same definition of the variables reported within each of these categories. Six studies reported on socioeconomic status (3.8%, 6/106), including two from upper-middle-income and four from lower middle-income countries. Only three studies reported on parental education levels (2.8%, 3/106). No study reported on parental job security or structural conflict. CONCLUSIONS We found overall low reporting of SDOH and marked variability in categorizations and definitions of SDOH variables. Consistent and standardized reporting of SDOH in pediatric sepsis studies is needed to understand the role these factors play in the development and severity of sepsis, to compare and extrapolate study results between settings and to implement policies aimed at improving socioeconomic conditions related to sepsis.
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Affiliation(s)
- Kusum Menon
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Lauren R Sorce
- Ann & Robert H. Lurie Children's Hospital AND Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Tellen D Bennett
- Sections of Informatics and Data Science and Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | - Niranjan Kissoon
- British Columbia Children's Hospital and The University of British Columbia, Vancouver, BC, Canada
| | - L Nelson Sanchez-Pinto
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology, Children`s Research Center University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniela C de Souza
- Child Health Research Centre, The University of Queensland, St Lucia, QLD, Australia
| | - R Scott Watson
- Departments of Pediatrics, Hospital Sírio-Libanês and Hospital Universitário da Universidade de São Paulo, São Paolo, Brazil
| | - James L Wynn
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jerry J Zimmerman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Florida, Gainesville, FL
| | - Suchitra Ranjit
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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PONCE NINEZA, SHIMKHADA RITI, ADKINS‐JACKSON PARISB. Making Communities More Visible: Equity-Centered Data to Achieve Health Equity. Milbank Q 2023; 101:302-332. [PMID: 37096622 PMCID: PMC10126976 DOI: 10.1111/1468-0009.12605] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Despite decades of research exposing health disparities between populations and communities in the US, health equity goals remain largely unfulfilled. We argue these failures call for applying an equity lens in the way we approach data systems, from collection and analysis to interpretation and distribution. Hence, health equity requires data equity. There is notable federal interest in policy changes and federal investments to improve health equity. With this, we outline the opportunities to align these health equity goals with data equity by improving the way communities are engaged and how population data are collected, analyzed, interpreted, made accessible, and distributed. Policy priority areas for data equity include increasing the use of disaggregated data, increasing the use of currently underused federal data, building capacity for equity assessments, developing partnerships between government and community, and increasing data accountability to the public.
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Affiliation(s)
- NINEZ A. PONCE
- Center for Health Policy ResearchUniversity of CaliforniaLos Angeles
- Los Angeles Fielding School of Public HealthUniversity of California
| | - RITI SHIMKHADA
- Center for Health Policy ResearchUniversity of CaliforniaLos Angeles
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Robers MV, Hurtubise B, Roberts MH, Robinson R, Schmidt H, Amezcua L. Multiple sclerosis in indigenous peoples of the Americas: A systematic review of incidence, prevalence, and outcomes. Mult Scler Relat Disord 2023; 72:104612. [PMID: 36917888 DOI: 10.1016/j.msard.2023.104612] [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: 08/09/2022] [Revised: 01/25/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The incidence, prevalence and outcomes of multiple sclerosis (MS) are unclear in Indigenous Peoples (IP) who are more likely to be underrepresented in research. We completed a systematic review of MS in IP of the Americas. METHODS A systematic review was conducted using PubMed, Web of Science, and Cochrane databases as well as references of retrieved papers. Inclusion criteria were: peer-reviewed publications (January 1990- December 2021), incidence, prevalence, or clinical outcome measures of MS in self-identified IP in the Americas. Incidence, prevalence, morbidity and mortality data were summarized and stratified by location and year of publication. Study quality was evaluated by risk of bias or confounding. RESULTS Out of 416 titles, thirteen studies met inclusion criteria. Four studies evaluated incidence, seven prevalence, three clinical outcomes and one mortality. Most studies were completed in Canada or the United States (US). Incidence rates per 100,000 ranged from 0.48 (in US Indian Health Service records) to 8.15 (First Nations Manitoban Canadians). Prevalence ranged from 0 (Lacandonian Mexicans and Panamanians) to 188.5 (First Nations Manitoban Canadians). Incidence and prevalence are consistently lower in IP than comparator White populations. IP with MS were reported to have higher disability and faster disability progression than non-Indigenous comparators. MS-related mortality is low compared to White people. CONCLUSION There is an absence of high-quality studies evaluating MS in IP. Available evidence indicates low, but increasing incidence and prevalence of MS in IP of the Americas. IP with MS may have worse disability than non-Indigenous comparators. Future studies should evaluate the factors influencing the increases in incidence and prevalence as well as better characterize possible disparities in MS care among IP.
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Affiliation(s)
- Michael V Robers
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States of America.
| | - Brigitte Hurtubise
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Melissa H Roberts
- College of Pharmacy, University of New Mexico, Albuquerque, New Mexico
| | - Rheanna Robinson
- Department of First Nations Studies, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Hollie Schmidt
- Accelerated Cure Project, Waltham, MA, United States of America
| | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
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Cho MK, Duque Lasio ML, Amarillo I, Mintz KT, Bennett RL, Brothers KB. Words matter: The language of difference in human genetics. Genet Med 2023; 25:100343. [PMID: 36524987 PMCID: PMC9991958 DOI: 10.1016/j.gim.2022.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Diversity, equity, and inclusion efforts in academia are leading publishers and journals to re-examine their use of terminology for commonly used scientific variables. This reassessment of language is particularly important for human genetics, which is focused on identifying and explaining differences between individuals and populations. Recent guidance on the use of terms and symbols in clinical practice, research, and publications is beginning to acknowledge the ways that language and concepts of difference can be not only inaccurate but also harmful. To stop perpetuating historical wrongs, those of us who conduct and publish genetic research and provide genetic health care must understand the context of the terms we use and why some usages should be discontinued. In this article, we summarize critiques of terminology describing disability, sex, gender, race, ethnicity, and ancestry in research publications, laboratory reports, diagnostic codes, and pedigrees. We also highlight recommendations for alternative language that aims to make genetics more inclusive, rigorous, and ethically sound. Even though norms of acceptable language use are ever changing, it is the responsibility of genetics professionals to uncover biases ingrained in professional practice and training and to continually reassess the words we use to describe human difference because they cause harm to patients.
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Affiliation(s)
- Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA; Departments of Medicine and Pediatrics, Stanford University, Stanford, CA.
| | - Maria Laura Duque Lasio
- Division of Genetics & Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO; Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ina Amarillo
- Department of Pathology and Laboratory Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Kevin Todd Mintz
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA
| | - Robin L Bennett
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Kyle B Brothers
- Norton Children's Research Institute Affiliated with the University of Louisville, Louisville, KY
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Martinez RAM, Andrabi N, Goodwin AN, Wilbur RE, Smith NR, Zivich PN. Conceptualization, Operationalization, and Utilization of Race and Ethnicity in Major Epidemiology Journals, 1995-2018: A Systematic Review. Am J Epidemiol 2023; 192:483-496. [PMID: 35938872 PMCID: PMC9985111 DOI: 10.1093/aje/kwac146] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/27/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Despite repeated calls by scholars to critically engage with the concepts of race and ethnicity in US epidemiologic research, the incorporation of these social constructs in scholarship may be suboptimal. This study characterizes the conceptualization, operationalization, and utilization of race and ethnicity in US research published in leading journals whose publications shape discourse and norms around race, ethnicity, and health within the field of epidemiology. We systematically reviewed randomly selected articles from prominent epidemiology journals across 5 periods: 1995-1999, 2000-2004, 2005-2009, 2010-2014, and 2015-2018. All original human-subjects research conducted in the United States was eligible for review. Information on definitions, measurement, coding, and use in analysis was extracted. We reviewed 1,050 articles, including 414 (39%) in our analyses. Four studies explicitly defined race and/or ethnicity. Authors rarely made clear delineations between race and ethnicity, often adopting an ethnoracial construct. In the majority of studies across time periods, authors did not state how race and/or ethnicity was measured. Top coding schemes included "Black, White" (race), "Hispanic, non-Hispanic" (ethnicity), and "Black, White, Hispanic" (ethnoracial). Most often, race and ethnicity were deemed "not of interest" in analyses (e.g., control variables). Broadly, disciplinary practices have remained largely the same between 1995 and 2018 and are in need of improvement.
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Affiliation(s)
- Rae Anne M Martinez
- Correspondence to Rae Anne M. Martinez, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7340 (e-mail: )
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von Ash T, Huynh R, Deng C, White MA. Associations between mukbang viewing and disordered eating behaviors. Int J Eat Disord 2023. [PMID: 36807921 DOI: 10.1002/eat.23915] [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: 03/10/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE Mukbang videos are a popular cultural phenomenon that often feature a host consuming large amounts of food to entertain an audience. We aim to examine the relationship between mukbang viewing characteristics and eating disorders symptoms. METHODS Eating disorder symptoms were evaluated using the eating disorders examination-questionnaire. Frequency of mukbang viewing, average watch time per occasion, tendency to eat while watching mukbang, and problematic mukbang viewing (using the Mukbang Addiction Scale) were assessed. We used multivariable regressions to estimate associations between mukbang viewing characteristics and eating disorder symptoms, adjusting for gender, race/ethnicity, age, education, and BMI. We used social media to recruit adults who watched mukbang at least once during the past year (n = 264). RESULTS A total of 34% of participants reported watching mukbang daily or almost daily, with mean watch time per viewing session being 29.94 min (SD = 1.00). Eating disorder symptoms, especially binge eating and purging, were associated with greater problematic mukbang viewing and a tendency to not consume food while viewing mukbang. Participants with greater body dissatisfaction watched mukbang more frequently and were more likely to eat while watching mukbang, yet they scored lower on the Mukbang Addiction Scale and watched fewer average minutes of mukbang per viewing occasion. DISCUSSION In a world increasingly penetrated by online media, our findings linking mukbang viewing and disordered eating may inform clinical diagnoses and treatments of eating disorders. Future studies establishing directionality of the relationship between mukbang viewing behaviors and eating disorder pathology are warranted. PUBLIC SIGNIFICANCE Mukbang videos often feature a host consuming large amounts of food. Using a questionnaire assessing mukbang viewing behaviors and disordered eating pathology, we found associations between certain viewing habits and disordered eating symptoms. Given the health consequences of eating disorders and potentially problematic consequences of certain online media, this study can inform clinical understanding of individuals with disordered eating who engage in certain online media, like mukbang.
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Affiliation(s)
- Tayla von Ash
- Department of Behavioral & Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA.,Center for Health Promotion & Health Equity, Brown School of Public Health, Providence, Rhode Island, USA
| | | | - Carrie Deng
- Brown University, Providence, Rhode Island, USA
| | - Marney A White
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Johnston ER. An analysis of KwaZulu-Natal clinical psychologists’ multicultural experience. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2023. [DOI: 10.1177/00812463221148552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this article, perspectives of South African clinical psychologists (based in KwaZulu-Natal) regarding multicultural issues in clinical practice and training are presented. The discussion focuses on emergent themes from 13 qualitative semi-structured interviews. Themes from interviews were analysed using thematic analysis and techniques from a grounded theory approach. While the study focused on a number of contextual multicultural issues both in service delivery and in training, this article documents the experiences of clinical psychologists regarding multicultural challenges and concerns, as well as approaches and capacities used to improve service delivery in this area. These perspectives are important in the multicultural and multilingual South African context, where there is limited literature in this area as well as related aspects such as cultural competency. There are many different belief systems as well as historical and sociopolitical factors that may influence how clinicians and individuals presenting for treatment may understand their experience and symptoms. This article seeks to document some of the challenges this may present in terms of service delivery in this context. Understandings of the term cultural competence as well as suggestions (primarily as noted by participants) to address the gap between training, competencies, and the realities of service delivery are also presented. Questions and considerations for future research are also raised.
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Affiliation(s)
- Emma R Johnston
- Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa
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21
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Matson TE, Lapham GT, Bobb JF, Oliver M, Hallgren KA, Williams EC, Bradley KA. Validity of the Single-Item Screen-Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care. JAMA Netw Open 2022; 5:e2239772. [PMID: 36318205 PMCID: PMC9627408 DOI: 10.1001/jamanetworkopen.2022.39772] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Importance Cannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition. Objective To evaluate the Single-Item Screen-Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD. Design, Setting, and Participants This diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022. Exposures The SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients' medical records. Main Outcomes and Measures The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population. Results Of 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%. Conclusions and Relevance In this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.
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Affiliation(s)
- Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research & Development Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Kevin A. Hallgren
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Emily C. Williams
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research & Development Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Department of Medicine, University of Washington School of Medicine, Seattle
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22
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Abstract
To determine if racial disparities exist in the management of febrile seizures in a large pediatric emergency department (ED), We performed a retrospective cross-sectional analysis of children 6 months to 6 years-old who presented to the ED with a febrile seizure over a 4-year period. Multivariate logistic regression models were built to examine the association between race and the primary outcome of neuroimaging, and secondary outcomes of hospital admission and abortive anticonvulsant prescription at ED discharge. There were 980 ED visits during the study period. Overall, 4.0% of children underwent neuroimaging and 11.1% were admitted. Of the 871 children discharged from the ED, 9.4% were prescribed an abortive anticonvulsant. There were no differences by race in neuroimaging or hospital admission. However, black children were less likely to be prescribed abortive anticonvulsants (adjusted odds ratio [aOR] 0.47; 95% confidence interval [CI]: 0.23-0.96) compared to non-black peers, when adjusting for demographic and clinical confounders. Stratification by insurance revealed that this disparity existed in Medicaid-insured patients (aOR 0.33, 95% CI: 0.14-0.78) but not in privately-insured patients. We found no racial disparities in neuroimaging or hospital admission among ED patients with febrile seizures. We did find racial disparities in our secondary outcome of abortive anticonvulsant prescription, driven primarily by individuals on Medicaid insurance. This pattern of findings may reflect the lack of standardized recommendations regarding anticonvulsant prescription, in contrast to the guidelines issued for other ED management decisions. Further investigation into the potential for treatment guidelines to reduce racial disparities is needed.
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Affiliation(s)
- Gina Chang
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- * Correspondence: Gina Chang, Division of Neurology at The Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, USA (e-mail: )
| | - Mercedes Blackstone
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer L McGuire
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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23
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Loor JM, Judd NS, Rice CM, Perea DD, Croswell E, Singh PP, Unruh M, Zhu Y, Sehgal AR, Goff SL, Bryce CL, Myaskovsky L. Protocol for the AKT-MP trial: Access to Kidney Transplantation in Minority Populations. Contemp Clin Trials Commun 2022; 30:101015. [PMID: 36246997 PMCID: PMC9562954 DOI: 10.1016/j.conctc.2022.101015] [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: 05/23/2022] [Revised: 09/02/2022] [Accepted: 10/01/2022] [Indexed: 11/01/2022] Open
Abstract
Background Kidney transplant (KT) is the optimal treatment for kidney failure (KF), and although completion of KT evaluation is an essential step in gaining access to transplantation, the process is lengthy, time consuming, and burdensome. Furthermore, despite similar referral rates to non-Hispanic Whites, both Hispanic/Latinos and American Indians are less likely to be wait-listed or to undergo KT. Methods The Access to Kidney Transplantation in Minority Populations (AKT-MP) Trial compares two patient-centered methods to facilitate KT evaluation: kidney transplant fast track (KTFT), a streamlined KT evaluation process; and peer navigators (PN), a peer-assisted evaluation program that incorporates motivational interviewing. This pragmatic randomized trial will use a comparative effectiveness approach to assess whether KTFT or PN can help patients overcome barriers to transplant listing. We will randomly assign patients to the two conditions. We will track participants' medical records and conduct surveys prior to their initial evaluation clinic visit and again after they complete or discontinue evaluation. Conclusion Our aims are to (1) compare KTFT and PN to assess improvements in kidney transplant (KT) related outcomes and cost effectiveness; (2) examine how each approach effects changes in cultural/contextual factors, KT concerns, KT knowledge, and KT ambivalence; and (3) develop a framework for widespread implementation of either approach. The results of this trial will provide key information for facilitating the evaluation process, improving patient care, and decreasing disparities in KT.
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Affiliation(s)
- Jamie M. Loor
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Nila S. Judd
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Claudia M. Rice
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Diana D. Perea
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, United States
| | - Pooja P. Singh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Yiliang Zhu
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Ashwini R. Sehgal
- Department of Medicine, Case Western Reserve University, United States
| | - Sarah L. Goff
- Department of Health Policy and Management, University of Massachusetts, Amherst, United States
| | - Cindy L. Bryce
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, United States
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States,Department of Internal Medicine, University of New Mexico, School of Medicine, United States,Corresponding author. Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States.
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24
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Singh S, Morshed S, Motamedi D, Kidane J, Paul A, Hsiao EC, Wentworth KL. Identification of Risk Factors in the Development of Heterotopic Ossification After Primary Total Hip Arthroplasty. J Clin Endocrinol Metab 2022; 107:e3944-e3952. [PMID: 35451005 PMCID: PMC9387692 DOI: 10.1210/clinem/dgac249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Heterotopic ossification (HO) is a process by which bone forms abnormally in soft tissues. Known risk factors for developing HO include male sex, spinal cord injury, trauma, and surgery. We investigated additional risk factors in the development of HO after hip arthroplasty. METHODS We performed a retrospective review of electronic medical records of 4070 individuals who underwent hip arthroplasty from September 2010 to October 2019 at the University of California, San Francisco Hospital. Demographics, anthropometrics, medications, and comorbid conditions were used in logistic regression analysis to identify factors associated with the development of HO. RESULTS A total of 2541 patients underwent primary hip arthroplasty in the analyzed timeframe (46.04% men, mean age at procedure: 62.13 ± 13.29 years). The incidence of postsurgical HO was 3% (n = 80). A larger proportion of individuals who developed HO had underlying osteoporosis (P < 0.001), vitamin D deficiency (P < 0.001), spine disease (P < 0.001), type 1 or 2 diabetes (P < 0.001), amenorrhea (P = 0.037), postmenopausal status (P < 0.001), parathyroid disorders (P = 0.011), and history of pathologic fracture (P = 0.005). Significant predictors for HO development were Black/African American race [odds ratio (OR) 2.97, P = 0.005], preexisting osteoporosis (OR 2.72, P = 0.001), spine disease (OR 2.04, P = 0.036), and low estrogen states (OR 1.99, P = 0.025). In the overall group, 75.64% received perioperative nonsteroidal anti-inflammatory drugs (NSAIDs), which negatively correlated with HO formation (OR 0.39, P = 0.001). CONCLUSIONS We identified new factors potentially associated with an increased risk of developing HO after primary hip arthroplasty, including African American race, osteoporosis, and low estrogen states. These patients may benefit from HO prophylaxis, such as perioperative NSAIDs.
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Affiliation(s)
- Sukhmani Singh
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Saam Morshed
- Departments of Orthopedic Surgery, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Kidane
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra Paul
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- The Institute for Human Genetics, The Program in Craniofacial Biology, and the Robert L. Kroc Chair in Rheumatic and Connective Tissue Diseases III, University of California-San Francisco, San Francisco, CA, USA
| | - Kelly L Wentworth
- Correspondence: Kelly Wentworth, MD, University of California, San Francisco, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Room 3501A, UCSF Box 0874, San Francisco, CA 94110, USA.
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25
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Aliseda-Alonso A, Lis SBD, Lee A, Pond EN, Blauer B, Rutkow L, Nuzzo JB. The Missing COVID-19 Demographic Data: A Statewide Analysis of COVID-19-Related Demographic Data From Local Government Sources and a Comparison With Federal Public Surveillance Data. Am J Public Health 2022; 112:1161-1169. [PMID: 35830674 PMCID: PMC9342811 DOI: 10.2105/ajph.2022.306892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To collect and standardize COVID-19 demographic data published by local public-facing Web sites and analyze how this information differs from Centers for Disease Control and Prevention (CDC) public surveillance data. Methods. We aggregated and standardized COVID-19 data on cases and deaths by age, gender, race, and ethnicity from US state and territorial governmental sources between May 24 and June 4, 2021. We describe the standardization process and compare it with the CDC's process for public surveillance data. Results. As of June 2021, the CDC's public demographic data set included 80.9% of total cases and 46.7% of total deaths reported by states, with significant variation across jurisdictions. Relative to state and territorial data sources, the CDC consistently underreports cases and deaths among African American and Hispanic or Latino individuals and overreports deaths among people older than 65 years and White individuals. Conclusions. Differences exist in amounts of data included and demographic composition between the CDC's public surveillance data and state and territory reporting, with large heterogeneity across jurisdictions. A lack of standardization and reporting mechanisms limits the production of complete real-time demographic data.
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Affiliation(s)
- Angel Aliseda-Alonso
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Sara Bertran de Lis
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Adam Lee
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Emily N Pond
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Beth Blauer
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Lainie Rutkow
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Jennifer B Nuzzo
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
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26
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Caetano R, Vaeth PA, Gruenewald PJ, Ponicki WR, Kaplan ZB, Annechino R. Trends and correlates of spatially aggregated alcohol-involved crashes among Whites and Hispanics in California. Alcohol Clin Exp Res 2022; 46:1449-1459. [PMID: 35702933 PMCID: PMC9427699 DOI: 10.1111/acer.14884] [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: 01/25/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
AIMS This paper examines trends and correlates of alcohol-involved motor vehicle crashes (AMVCs) in California between 2005 and 2016 among Hispanic and non-Hispanic Whites (Whites hereafter). Together these two groups comprise 76% of the state population. The paper also examines whether alcohol outlet density, percentage of Hispanics in census tract populations, and distance to the U.S./Mexico border are related to greater risks for AMVCs. The border is of interest given the greater availability of alcohol in the area. METHODS Crash data come from Statewide Integrated Traffic Records System maintained by the California Highway Patrol. Sociodemographic and community characteristics data from the U.S. Census and alcohol outlet density were aggregated to census tracts. Total motor vehicle crashes and AMVCs were related to these characteristics using hierarchical Bayesian Poisson space-time models. RESULTS There were over two million injury and fatality crashes during the period of analysis, of which 11% were AMVCs. About 1.7% of these crashes had fatalities. The rate of AMVCs increased among both Whites and Hispanics until 2008. After 2008, the rate among Whites declined through 2016 while the rate among Hispanics declined for 2 years (2009 and 2010) and increased thereafter. Crash distance from the border (RR = 1.016, 95% CI = 1.010 to 1.022) and percent Hispanic population (RR = 1.006; 95% CI = 1.003 to 1.009) were well-supported results with 95% credible intervals that did not include 1. The percentages of the following: bars/pubs, males, individuals aged 18 to 29 and 40 to 49 years, U.S. born population, individuals below the 150% poverty level, unemployed, housing vacant, and housing owner-occupied were all positively associated with AMVCs and well supported. CONCLUSIONS Between 2005 and 2016 the rate of AMVCs in California declined among Whites but not among Hispanics. Population-level indicators of percent Hispanic population, distance to the U.S. Mexico border, gender, age distribution, and socioeconomic stability were positively associated with crash rates, indicating that important contextual characteristics help determine the level of AMVC rates in communities.
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Affiliation(s)
- Raul Caetano
- Prevention Research Center, 2150 Shattuck Avenue, Suite
601, Berkeley, California 94704, U.S.A
| | - Patrice A.C. Vaeth
- Prevention Research Center, 2150 Shattuck Avenue, Suite
601, Berkeley, California 94704, U.S.A
| | - Paul J. Gruenewald
- Prevention Research Center, 2150 Shattuck Avenue, Suite
601, Berkeley, California 94704, U.S.A
| | - William R. Ponicki
- Prevention Research Center, 2150 Shattuck Avenue, Suite
601, Berkeley, California 94704, U.S.A
| | - Zoe B. Kaplan
- Prevention Research Center, 2150 Shattuck Avenue, Suite
601, Berkeley, California 94704, U.S.A
| | - Rachelle Annechino
- Prevention Research Center, 2150 Shattuck Avenue, Suite
601, Berkeley, California 94704, U.S.A
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27
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Peltzman T, Rice K, Jones KT, Washington DL, Shiner B. Optimizing Data on Race and Ethnicity for Veterans Affairs Patients. Mil Med 2022; 187:e955-e962. [PMID: 35323934 DOI: 10.1093/milmed/usac066] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Maintaining accurate race and ethnicity data among patients of the Veterans Affairs (VA) healthcare system has historically been a challenge. This work expands on previous efforts to optimize race and ethnicity values by combining multiple VA data sources and exploring race- and ethnicity-specific collation algorithms. MATERIALS AND METHODS We linked VA patient data from 2000 to 2018 with race and ethnicity data from four administrative and electronic health record sources: VA Medical SAS files (MedSAS), Corporate Data Warehouse (CDW), VA Centers for Medicare extracts (CMS), and VA Defense Identity Repository Data (VADIR). To assess the accuracy of each data source, we compared race and ethnicity values to self-reported data from the Survey of Health Experiences of Patients (SHEP). We used Cohen's Kappa to assess overall (holistic) source agreement and positive predictive values (PPV) to determine the accuracy of sources for each race and ethnicity separately. RESULTS Holistic agreement with SHEP data was excellent (K > 0.80 for all sources), while race- and ethnicity-specific agreement varied. All sources were best at identifying White and Black users (average PPV = 0.94, 0.93, respectively). When applied to the full VA user population, both holistic and race-specific algorithms substantially reduced unknown values, as compared to single-source methods. CONCLUSIONS Combining multiple sources to generate race and ethnicity values improves data accuracy among VA patients. Based on the overall agreement with self-reported data, we recommend using non-missing values from sources in the following order to fill in race values-SHEP, CMS, CDW, MedSAS, and VADIR-and in the following order to fill in ethnicity values-SHEP, CDW, MedSAS, VADIR, and CMS.
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Affiliation(s)
- Talya Peltzman
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
| | - Korie Rice
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
| | | | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Brian Shiner
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
- Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA
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28
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Díaz Rios LK, Stage VC, Leak TM, Taylor CA, Reicks M. Collecting, Using, and Reporting Race and Ethnicity Information: Implications for Research in Nutrition Education, Practice, and Policy to Promote Health Equity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:582-593. [PMID: 35351358 DOI: 10.1016/j.jneb.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
This report will describe approaches for collecting, analyzing, and reporting race and ethnicity information in nutrition education and behavior research, practice, and policy to advance health equity. Race and ethnicity information is used to describe study participants and compare nutrition and health-related outcomes. Depending on the study design, race and ethnicity categories are often defined by the research question or other standardized approaches. Participant self-reported data are more acceptable than researcher adjudicated identification data, which can add bias and/or error. Valid methods to collect, use, and report race and ethnicity information are foundational to publication quality, findings of value, contribution to the knowledge base, and health equity.
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Affiliation(s)
- L Karina Díaz Rios
- Division of Agriculture and Natural Resources, University of California Merced, Merced, CA
| | - Virginia C Stage
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Tashara M Leak
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St Paul, MN.
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29
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Sasa SM, Yellow Horse AJ. Just data representation for Native Hawaiians and Pacific Islanders: A critical review of systemic Indigenous erasure in census and recommendations for psychologists. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 69:343-354. [PMID: 34878178 DOI: 10.1002/ajcp.12569] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/27/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
The decennial Census survey marks the emergence of federal classifications of race and ethnicity by which the U.S. government has historically conflated Native Hawaiians and Pacific Islanders (NHPI, hereafter) as "Asian or Pacific Islander." This conflation amplifies health injustices and inequities of NHPIs through multiple mechanisms because it masks the complex and heterogeneous experiences of NHPIs, whose positions and relations with the settler state are qualitatively and substantially distinct from Asian Americans. This critical review examines federal documents and research to examine how the panethnic categorizations are often sustained through scientific inquiry and methodologies. We found that self-determination and self-identification for NHPIs are impeded by settler-colonial relations between U.S. colonization of parts of Oceania (e.g., Hawai'i, Sāmoa, Fiji, and Guam) and the forcefully imposed categorization that continues to be in use to legitimize the domination of Indigenous Peoples through race misclassification. Specifically, Census data collection fails to capture accurate and reliable data due to serious methodological limitations. These implications for psychological research compel us to make several recommendations for psychologists: (1) engage with NHPI community partners in all research processes; (2) critically examine Census research design and consider oversampling NHPI households to ensure just data representation; (3) meaningfully engage when, whether and how to aggregate Asian Americans with NHPIs; and (4) use Indigeneity as a critical framework.
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Affiliation(s)
- Steven M Sasa
- Department of Counseling and Counseling Psychology, Arizona State University, Tempe, Arizona, USA
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30
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Brown O, Mou T, Tate M, Miller E, Debbink M. Considerations for the Use of Race in Research in Obstetrics and Gynecology. Clin Obstet Gynecol 2022; 65:236-243. [PMID: 35348530 DOI: 10.1097/grf.0000000000000705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The race variable in research has been the topic of debate in both research and clinical realms. The tension surrounding the discourse of the use of race in research stem from the difficulties in defining race, the limitations of the variable, and the implications for health and racial equity. In this review, we dissect the challenges faced when incorporating race into research and offer a guide for incorporating race in research in a manner that promotes racial and health equity.
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Affiliation(s)
- Oluwateniola Brown
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Tsung Mou
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Mary Tate
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Edward Miller
- Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michelle Debbink
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
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Yellow Horse AJ, Patterson SE. Greater Inclusion of Asian Americans in Aging Research on Family Caregiving for Better Understanding of Racial Health Inequities. THE GERONTOLOGIST 2022; 62:704-710. [PMID: 34698339 PMCID: PMC9154291 DOI: 10.1093/geront/gnab156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 11/12/2022] Open
Abstract
With the substantial demographic changes in racial composition in the United States since 1965, research on racial health inequities must build upon the Black-White binary to assess the complex ways "race" affects health and aging. Considering variation in the prevalence and meanings of aging across racialized groups requires concerted efforts to expand and disaggregate samples. Aligned with the goals of the intersectionality framework, we argue that greater inclusion of Asian Americans is critical to advance both theoretical and methodological considerations that enable us to investigate the lived experiences of Asian Americans. Using caregiving as an example, we discuss how systemic, cultural, and interpersonal marginalization from racism and other oppressive systems intertwine with "race" to produce the race effects. Greater inclusion of Asian Americans helps further provide the opportunity to conceptualize culture as dynamic and interacting with structure to produce different racial patterns. Meaningful inclusion of Asian Americans in research requires more systemic effort to collect accurate, reliable, and quality data for Asian Americans that can be disaggregated by other important axes of stratification.
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Affiliation(s)
| | - Sarah E Patterson
- Population Studies Center, University of Michigan, Ann Arbor, Michigan, USA
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Cook L, Espinoza J, Weiskopf NG, Mathews N, Dorr DA, Gonzales KL, Wilcox A, Madlock-Brown C. Issues with Variability in EHR Data About Race and Ethnicity: A Descriptive Analysis of the National COVID Cohort Collaborative Data Enclave (Preprint). JMIR Med Inform 2022; 10:e39235. [PMID: 35917481 PMCID: PMC9490543 DOI: 10.2196/39235] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/21/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The adverse impact of COVID-19 on marginalized and under-resourced communities of color has highlighted the need for accurate, comprehensive race and ethnicity data. However, a significant technical challenge related to integrating race and ethnicity data in large, consolidated databases is the lack of consistency in how data about race and ethnicity are collected and structured by health care organizations. Objective This study aims to evaluate and describe variations in how health care systems collect and report information about the race and ethnicity of their patients and to assess how well these data are integrated when aggregated into a large clinical database. Methods At the time of our analysis, the National COVID Cohort Collaborative (N3C) Data Enclave contained records from 6.5 million patients contributed by 56 health care institutions. We quantified the variability in the harmonized race and ethnicity data in the N3C Data Enclave by analyzing the conformance to health care standards for such data. We conducted a descriptive analysis by comparing the harmonized data available for research purposes in the database to the original source data contributed by health care institutions. To make the comparison, we tabulated the original source codes, enumerating how many patients had been reported with each encoded value and how many distinct ways each category was reported. The nonconforming data were also cross tabulated by 3 factors: patient ethnicity, the number of data partners using each code, and which data models utilized those particular encodings. For the nonconforming data, we used an inductive approach to sort the source encodings into categories. For example, values such as “Declined” were grouped with “Refused,” and “Multiple Race” was grouped with “Two or more races” and “Multiracial.” Results “No matching concept” was the second largest harmonized concept used by the N3C to describe the race of patients in their database. In addition, 20.7% of the race data did not conform to the standard; the largest category was data that were missing. Hispanic or Latino patients were overrepresented in the nonconforming racial data, and data from American Indian or Alaska Native patients were obscured. Although only a small proportion of the source data had not been mapped to the correct concepts (0.6%), Black or African American and Hispanic/Latino patients were overrepresented in this category. Conclusions Differences in how race and ethnicity data are conceptualized and encoded by health care institutions can affect the quality of the data in aggregated clinical databases. The impact of data quality issues in the N3C Data Enclave was not equal across all races and ethnicities, which has the potential to introduce bias in analyses and conclusions drawn from these data. Transparency about how data have been transformed can help users make accurate analyses and inferences and eventually better guide clinical care and public policy.
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Affiliation(s)
- Lily Cook
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Juan Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Nicole G Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Nisha Mathews
- College of Human Sciences and Humanities, University of Houston, Clear Lake-Pearland, TX, United States
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Kelly L Gonzales
- Citizen of the Cherokee Nation, Portland, OR, United States
- Joint School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States
- Founding Indigenous Member, BIPOC Decolonizing Data Council, Portland, OR, United States
- Indigenous Equity Institute, Portland, OR, United States
| | - Adam Wilcox
- Department of Medicine, Institute for Informatics, Washington University in St. Louis, St. Louis, MO, United States
| | - Charisse Madlock-Brown
- Tennessee Clinical and Translational Science Institute, University of Tennessee Health Science Center, Memphis, TN, United States
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Atatoa Carr P, Langridge F, Neumann D, Paine SJ, Liang R, Taufa S, Fa’alili Fidow J, Fenaughty J, Kingi TK. ‘Seeing’ our tamariki in longitudinal studies: exploring the complexity of ethnic identification trajectories within Growing Up in New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2064518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Polly Atatoa Carr
- Te Ngira: Institute for Population Research, The University of Waikato, Hamilton, New Zealand
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
| | - Fiona Langridge
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
| | - Denise Neumann
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
| | - Sarah-Jane Paine
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
| | - Renee Liang
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
| | - Seini Taufa
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | - Jacinta Fa’alili Fidow
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | - John Fenaughty
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | - Te Kani Kingi
- Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand
- Research and Innovation, Te Whare Wānanga o Awanuiārangi, Whakatane, New Zealand
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Tarr GAM, Morris KJ, Harding AB, Jacobs S, Smith MK, Church TR, Berman JD, Rau A, Ashida S, Ramirez MR. Cognitive factors influenced physical distancing adherence during the COVID-19 pandemic in a population-specific way. PLoS One 2022; 17:e0267261. [PMID: 35503754 PMCID: PMC9064111 DOI: 10.1371/journal.pone.0267261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/05/2022] [Indexed: 01/25/2023] Open
Abstract
Even early in the COVID-19 pandemic, adherence to physical distancing measures was variable, exposing some communities to elevated risk. While cognitive factors from the Health Belief Model (HBM) and resilience correlate with compliance with physical distancing, external conditions may preclude full compliance with physical distancing guidelines. Our objective was to identify HBM and resilience constructs that could be used to improve adherence to physical distancing even when full compliance is not possible. We examined adherence as expressed through 7-day non-work, non-household contact rates in two cohorts: 1) adults in households with children from Minnesota and Iowa; and 2) adults ≥50 years-old from Minnesota, one-third of whom had Parkinson's disease. We identified multiple cognitive factors associated with physical distancing adherence, specifically perceived severity, benefits, self-efficacy, and barriers. However, the magnitude, and occasionally the direction, of these associations was population-dependent. In Cohort 1, perceived self-efficacy for remaining 6-feet from others was associated with a 29% lower contact rate (RR 0.71; 95% CI 0.65, 0.77). This finding was consistent across all race/ethnicity and income groups we examined. The barriers to adherence of having a child in childcare and having financial concerns had the largest effects among individuals from marginalized racial and ethnic groups and high-income households. In Cohort 2, self-efficacy to quarantine/isolate was associated with a 23% decrease in contacts (RR 0.77; 95% CI 0.66, 0.89), but upon stratification by education level, the association was only present for those with at least a Bachelor's degree. Education also modified the effect of the barrier to adherence leaving home for work, increasing contacts among those with a Bachelor's degree and reducing contacts among those without. Our findings suggest that public health messaging tailored to the identified cognitive factors has the potential to improve physical distancing adherence, but population-specific needs must be considered to maximize effectiveness.
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Affiliation(s)
- Gillian A. M. Tarr
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Keeley J. Morris
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Alyson B. Harding
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Samuel Jacobs
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - M. Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Timothy R. Church
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Jesse D. Berman
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Austin Rau
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Marizen R. Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
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Yao ES, Bullen P, Meissel K, Tiatia J, Fleming T, Clark TC. Effects of Ethnic Classification on Substantive Findings in Adolescent Mental Health Outcomes. J Youth Adolesc 2022; 51:1581-1596. [PMID: 35438431 PMCID: PMC9232462 DOI: 10.1007/s10964-022-01612-6] [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: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Although most adolescents are healthy, epidemiological studies show that a significant number experience mental health challenges, and that Indigenous and ethnic minority youth tend to have poorer mental health outcomes. However, ethnic classification in adolescence is complex due to increasing multi-ethnic identification, and little is known about how different classification methods affect research conclusions. This study used a nationally representative adolescent sample from Aotearoa New Zealand (N = 8275; ages 12–18; 55% female; 32% multi-ethnic) to investigate the effects that five ethnic classification methods have on substantive findings in three mental health outcomes: overall psychosocial difficulties, deliberate self-harm, and suicide attempts. The results showed that, depending on the classification method used, reported outcomes within the same nominal ethnic group varied by an effect size (d) of up to 0.12, and the reported magnitude of difference between nominal ethnic groups varied by an effect size (d) of up to 0.25. These effects are substantial given that they are solely due to a change in method. The impact that ethnic classification method has on substantive findings highlights the importance of criticality and transparency in research involving ethnicity data.
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Affiliation(s)
- Esther S Yao
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand.
| | - Pat Bullen
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | - Kane Meissel
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | - Jemaima Tiatia
- School of Māori Studies and Pacific Studies, The University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Terryann C Clark
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Weinberger AH, Steinberg ML, Mills SD, Dermody SS, Heffner JL, Kong AY, Pang RD, Rosen RL. Assessing Sex, Gender Identity, Sexual Orientation, Race, Ethnicity, Socioeconomic Status, and Mental Health Concerns in Tobacco Use Disorder Treatment Research: Measurement Challenges and Recommendations From a Society for Research on Nicotine and Tobacco Pre-conference Workshop. Nicotine Tob Res 2022; 24:643-653. [PMID: 34622932 PMCID: PMC8962699 DOI: 10.1093/ntr/ntab201] [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: 05/24/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022]
Abstract
This paper reports on topics discussed at a Society for Research on Nicotine and Tobacco pre-conference workshop at the 2019 annual Society for Research on Nicotine and Tobacco meeting. The goal of the pre-conference workshop was to help develop a shared understanding of the importance of several tobacco-related priority groups in tobacco use disorder (TUD) treatment research and to highlight challenges in measurement related to these groups. The workshop focused on persons with minoritized sex, gender identity, and sexual orientation identities; persons with minoritized racial and ethnic backgrounds; persons with lower socioeconomic status (SES); and persons with mental health concerns. In addition to experiencing commercial tobacco-related health disparities, these groups are also underrepresented in tobacco research, including TUD treatment studies. Importantly, there is wide variation in how and whether researchers are identifying variation within these priority groups. Best practices for measuring and reporting sex, gender identity, sexual orientation, race, ethnicity, SES, and mental health concerns in TUD treatment research are needed. This paper provides information about measurement challenges when including these groups in TUD treatment research and specific recommendations about how to measure these groups and assess potential disparities in outcomes. The goal of this paper is to encourage TUD treatment researchers to use measurement best practices in these priority groups in an effort to conduct meaningful and equity-promoting research. Increasing the inclusion and visibility of these groups in TUD treatment research will help to move the field forward in decreasing tobacco-related health disparities. Implications: Tobacco-related disparities exist for a number of priority groups including, among others, women, individuals with minoritized sexual and gender identities, individuals with minoritized racial and ethnic backgrounds, individuals with lower SES, and individuals with mental health concerns. Research on TUD treatments for many of these subgroups is lacking. Accurate assessment and consideration of these subgroups will provide needed information about efficacious and effective TUD treatments, about potential mediators and moderators, and for accurately describing study samples, all critical elements for reducing tobacco-related disparities, and improving diversity, equity, and inclusion in TUD treatment research.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sarah D Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah S Dermody
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA,USA
| | - Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raina D Pang
- Department of Preventive Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Rachel L Rosen
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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Adkins-Jackson PB, Chantarat T, Bailey ZD, Ponce NA. Measuring Structural Racism: A Guide for Epidemiologists and Other Health Researchers. Am J Epidemiol 2022; 191:539-547. [PMID: 34564723 DOI: 10.1093/aje/kwab239] [Citation(s) in RCA: 173] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
There have been over 100 years of literature discussing the deleterious influence of racism on health. Much of the literature describes racism as a driver of social determinants of health, such as housing, employment, income, and education. More recently, increased attention has been given to measuring the structural nature of a system that advantages one racialized group over others rather than solely relying on individual acknowledgement of racism. Despite these advances, there is still a need for methodological and analytical approaches to complement the aforementioned. This commentary calls on epidemiologists and other health researchers at large to engage the discourse on measuring structural racism. First, we address the conflation between race and racism in epidemiologic research. Next, we offer methodological recommendations (linking of interdisciplinary variables and data sets and leveraging mixed-method and life-course approaches) and analytical recommendations (integration of mixed data, use of multidimensional models) that epidemiologists and other health researchers may consider in health equity research. The goal of this commentary is to inspire the use of up-to-date and theoretically driven approaches to increase discourse among public health researchers on capturing racism as well as to improve evidence of its role as the fundamental cause of racial health inequities.
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Roubal AM, Pollock EA, Gennuso KP, Blomme CK, Givens ML. Comparative Methodologic and Practical Considerations for Life Expectancy as a Public Health Mortality Measure. Public Health Rep 2022; 137:255-262. [PMID: 33706596 PMCID: PMC8900236 DOI: 10.1177/0033354921999407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Life expectancy is a public health metric used to assess mortality. We describe life expectancy calculations for US counties and present methodologic considerations compared with years of potential life lost before age 75 (YPLL-75) and premature age-adjusted mortality (PAAM), 2 commonly used length-of-life metrics. METHODS We used death data from the National Center for Health Statistics for 2015-2017 and other health measures from the 2019 County Health Rankings & Roadmaps. We calculated life expectancy from birth at the county level using an abridged life table and the Chiang method of variance. Studentized residuals identified counties with discordant life expectancy and YPLL-75 or PAAM values. Correlations tested associations of life expectancy with key health measures (eg, smoking, child poverty, uninsured). RESULTS Among 3073 US counties, life expectancy ranged from 62.4 to 98.0 years, with a mean of 77.4 years. Life expectancy was strongly and negatively correlated with YPLL-75 (r = -0.91) and PAAM (r = -0.95) at the county level. Life expectancy was also associated with other key health metrics, such as smoking, employment, and education rates, where an improvement in the health factor indicated improvement in the respective length-of-life measure. Counties with discordant life expectancy and YPLL-75 or PAAM values had differing age structures. PRACTICE IMPLICATIONS Commonly used length-of-life metrics in population health settings are differentiated by methodological matters, such as computation complexity, data availability, and differential risk among age groups, especially among the very old or very young. The choice of metric should consider these factors, in addition to practical concerns, such as the communication needs of the audience.
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Affiliation(s)
- Anne M. Roubal
- County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, University of Wisconsin–Madison, Madison, WI, USA
| | - Elizabeth A. Pollock
- County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, University of Wisconsin–Madison, Madison, WI, USA
| | - Keith P. Gennuso
- County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, University of Wisconsin–Madison, Madison, WI, USA
| | - Courtney K. Blomme
- County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, University of Wisconsin–Madison, Madison, WI, USA
| | - Marjory L. Givens
- County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, University of Wisconsin–Madison, Madison, WI, USA
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Yao ES, Meissel K, Bullen P, Clark TC, Atatoa Carr P, Tiatia-Seath J, Peiris-John R, Morton SMB. Demographic discrepancies between administrative-prioritisation and self-prioritisation of multiple ethnic identifications. SOCIAL SCIENCE RESEARCH 2022; 103:102648. [PMID: 35183304 DOI: 10.1016/j.ssresearch.2021.102648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/22/2021] [Accepted: 09/19/2021] [Indexed: 06/14/2023]
Abstract
Ethnic classification is an inherently subjective process, especially when multiple ethnic identifications are involved. There are two methods commonly used to classify multiple ethnicities into single categories: administrative-prioritisation (assignment via a predetermined hierarchy) and self-prioritisation (where individuals select their "main" ethnicity). Currently, little is known about whether the demographic composition of outputted ethnic groups differs by prioritisation method. This study utilised large-scale data of multi-ethnic children (N = 1,860), adolescents (N = 2,413), and adults (N = 1,056) from Aotearoa New Zealand to examine individual and contextual demographic characteristics associated with discrepancies between administratively-prioritised and self-prioritised ethnicity. Results showed that discrepancy rates, which exceeded 50%, were systematically associated with neighbourhood ethnic composition and socioeconomic deprivation, but largely not associated with gender, age, and birthplace. The contextual nature of self-prioritisation highlights the importance of researchers' choice of ethnic classification method. Implications are discussed in the context of increasing multi-ethnic prevalence.
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Affiliation(s)
- Esther S Yao
- Faculty of Education and Social Work, The University of Auckland, New Zealand.
| | - Kane Meissel
- Faculty of Education and Social Work, The University of Auckland, New Zealand
| | - Pat Bullen
- Faculty of Education and Social Work, The University of Auckland, New Zealand
| | | | - Polly Atatoa Carr
- National Institute of Demographic and Economic Analysis, The University of Waikato, New Zealand
| | - Jemaima Tiatia-Seath
- School of Māori Studies and Pacific Studies, The University of Auckland, New Zealand
| | | | - Susan M B Morton
- Centre for Longitudinal Research, The University of Auckland, New Zealand
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Automatic Ethnicity Classification from Middle Part of the Face Using Convolutional Neural Networks. INFORMATICS 2022. [DOI: 10.3390/informatics9010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the field of face biometrics, finding the identity of a person in an image is most researched, but there are other, soft biometric information that are equally as important, such as age, gender, ethnicity or emotion. Nowadays, ethnicity classification has a wide application area and is a prolific area of research. This paper gives an overview of recent advances in ethnicity classification with focus on convolutional neural networks (CNNs) and proposes a new ethnicity classification method using only the middle part of the face and CNN. The paper also compares the differences in results of CNN with and without plotted landmarks. The proposed model was tested using holdout testing method on UTKFace dataset and FairFace dataset. The accuracy of the model was 80.34% for classification into five classes and 61.74% for classification into seven classes, which is slightly better than state-of-the-art, but it is also important to note that results in this paper are obtained by using only the middle part of the face which reduces the time and resources necessary.
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Zhu C, Weiss M, Scribbick FW, Johnson DA, Kheirkhah A. Occurrence of Occult Neoplasia in Pterygium Specimens among Hispanic and Non-Hispanic Patients. Curr Eye Res 2022; 47:978-981. [PMID: 35180019 DOI: 10.1080/02713683.2022.2035403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the role of race and ethnicity in the prevalence of occult ocular surface squamous neoplasia (OSSN) in pterygium specimens. METHODS This retrospective study reviewed pathology reports and medical records of 504 patients who underwent pterygium surgery in South Texas. Those with clinical signs of OSSN were excluded. Clinical data including age, sex, and self-reported race and ethnicity were analyzed to determine risk factors for presence of occult OSSN in pterygium specimens. RESULTS There were 504 specimens; 95.8% were from patients identified as White, 1.8% from African Americans, and 2.4% from Asians. Ethnicity included Hispanic in 71% and non-Hispanic in 29%. Among all specimens, 18 (3.6%) were positive for occult OSSN. The prevalence of occult OSSN in pterygium specimens was higher in Hispanics compared to Non-Hispanics (4.8% versus 0.7%, respectively, P = 0.025). The prevalence of occult OSSN in different races included 8.3% for Asians, 3.5% for Whites, and 0% for African Americans. However, the racial difference did not reach statistical significance (P = 0.57). There were also no statistically significant differences between those with or without occult OSSN regarding age or sex. CONCLUSIONS A significant but low rate of occult OSSN was found in pterygium specimens. The percentage of those with OSSN in pterygium specimens was significantly greater in Hispanics compared to Non-Hispanics. As treatment and prognosis of pterygium and OSSN differ, histopathologic evaluation of all pterygium specimens is warranted.
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Affiliation(s)
- Christopher Zhu
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Menachem Weiss
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Frank W Scribbick
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Daniel A Johnson
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
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Rice CM, Singh PP, Judd NS, Jimenez EY, Blair CK, Washburn A, Calvin C, Steiber A, Zhu Y, Argyropoulos C, Unruh M, Dew MA, Myaskovsky L. Protocol for the IMPACT Trial: Improving Healthcare Outcomes in American Transplant Recipients Using Culturally-Tailored Novel Technology. J Ren Nutr 2022; 32:e1-e12. [PMID: 35227873 PMCID: PMC9058226 DOI: 10.1053/j.jrn.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/11/2022] Open
Abstract
Kidney transplant (KT) recipients face post-transplant health issues. Immunosuppressive agents can cause hyperlipidemia, hypertension, post-transplant diabetes, and glomerulopathy. Post-transplant weight gain and decreased activity are associated with poor quality of life, sleep, and cardiometabolic outcomes. This study will test the feasibility and acceptability of a culturally tailored diet and exercise intervention for KT patients delivered immediately post-transplant using novel technology. A registered dietitian nutritionist (RDN) and physical rehabilitation therapist will examine participants' cultural background, preferences, and health-related obstacles (with consultation from the transplant team) to create an individualized exercise and meal plan. The RDN will provide medical nutrition therapy via the nutrition care process throughout the course of the intervention. The Twistle Patient Engagement Platform will be used to deliver and collect survey data, communicate with participants, and promote retention. Outcomes to be assessed include intervention feasibility and acceptability and intervention efficacy on patients' adherence, medical, quality of life, and occupational outcomes.
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Racial Disparities in 30-Day Outcomes After Colorectal Surgery in an Integrated Healthcare System. J Gastrointest Surg 2022; 26:433-443. [PMID: 34581979 DOI: 10.1007/s11605-021-05151-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Racial disparities in colorectal surgery outcomes have been studied extensively in the USA, and access to healthcare resources may contribute to these differences. The Veterans Health Administration (VHA) is the largest integrated healthcare network in the USA with the potential for equal access care to veterans. The objective of this study is to evaluate the VHA for the presence of racial disparities in 30-day outcomes of patients that underwent colorectal resection. METHODS Colon and rectal resections from 2008 to 2019 were reviewed retrospectively using the Veterans Affairs Surgical Quality Improvement Program database. Patients were categorized by race and ethnicity. Multivariable analysis was used to compare 30-day outcomes. Cases with "unknown/other/declined to answer" race/ethnicity were excluded. RESULTS Thirty-six-thousand-nine-hundred-sixty-nine cases met inclusion criteria: 27,907 (75.5%) Caucasian, 6718 (18.2%) African American, 2047 (5.5%) Hispanic, and 290 (0.8%) Native American patients. There were no statistically significant differences in overall complication incidence or mortality between all cohorts. Compared to Caucasian race, African American patients had longer mean length of stay (10.7 days vs. 9.7 days; p < 0.001). Compared to Caucasian race, Hispanic patients had higher odds of pulmonary-specific complications (adjusted odds ratio with 95% confidence interval = 1.39 [1.17-1.64]; p < 0.001). CONCLUSIONS The VHA provides the benefits of integrated healthcare and access, which may explain the improvements in racial disparities compared to existing literature. However, some racial disparities in clinical outcomes still persisted in this analysis. Further efforts beyond healthcare access are needed to mitigate disparities in colorectal surgery. CLASSIFICATIONS: [Outcomes]; [Database]; [Veterans]; [Colorectal Surgery]; [Morbidity]; [Mortality].
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von Ash T, Alikhani A, Lebron C, Risica PM. Racial/ethnic differences in maternal feeding practices and beliefs at 6 months postpartum. Public Health Nutr 2022; 25:1-10. [PMID: 35029142 PMCID: PMC9991812 DOI: 10.1017/s1368980021005073] [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: 03/01/2021] [Revised: 11/04/2021] [Accepted: 12/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine racial/ethnic differences in maternal feeding practices and beliefs in a sample of low-income smoke-exposed women. DESIGN Cross-sectional analysis using data collected during a randomised control trial. Maternal feeding practices and beliefs were assessed using the Infant Feeding Questionnaire (IFQ), which was administered at 6 months postpartum. ANOVA was used to examine differences in IFQ items by race/ethnicity, while multivariable linear regression models were used to examine differences in IFQ factor scores by race/ethnicity adjusting for potential confounders. SETTING Participants were recruited from prenatal clinics. PARTICIPANTS 343 women (39 % non-Hispanic White, 28 % Hispanic/Latina, 13 % Black, and 20 % other). RESULTS Racial/ethnic minority mothers were more likely than non-Hispanic White mothers to put cereal in their infant's bottle so that the infant would stay full longer (P = 0·032), state their infant wanted more than just formula or breast milk prior to 4 months (P = 0·019), allow their infant to eat whenever he/she wanted (P = 0·023) and only allow their infant to eat at set times (P < 0·001). Adjusting for potential confounders, racial/ethnic minority mothers had higher scores for factors 1 (concern about infant undereating or becoming underweight), 2 (concern about infant's hunger), 4 (concern about infant overeating or becoming overweight) and 5 (feeding infant on a schedule), and lower scores for factor 7 (social interaction with the infant during feeding) than White mothers. Racial/ethnic differences were not found for the other two factors. CONCLUSIONS Differences in maternal feeding practices and beliefs across race/ethnicity are present at 6 months postpartum.
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Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
- Center for Health Promotion & Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Anna Alikhani
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
| | - Cynthia Lebron
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
- Center for Health Promotion & Health Equity, Brown School of Public Health, Providence, RI, USA
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Fletcher SA, Bivalacqua TJ, Brawley OW, Kates M. Race, ethnicity, and gender reporting in North American clinical trials for BCG-unresponsive non-muscle invasive bladder cancer. Urol Oncol 2021; 40:195.e13-195.e18. [PMID: 34949513 DOI: 10.1016/j.urolonc.2021.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The National Institutes of Health (NIH) Revitalization Act of 1993 established guidelines for the inclusion of racial/ethnic minorities and women in clinical research. However, the reporting rate of such patient demographic data in clinical trials for BCG-unresponsive non-muscle invasive bladder cancer is not well characterized. METHODS We identified published clinical trials of all phases (I -III) for BCG-unresponsive non-muscle invasive bladder cancer conducted in the US and/or Canada. We calculated the proportion of studies reporting patient gender and race/ethnicity, tabulating these data when present. We compared reported trial participant race, ethnicity and gender with the number of new bladder cancer cases and deaths using the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI) U.S. Cancer Statistics data from 2013 -2017. RESULTS We identified 27 trials published from 1998 -2021 enrolling a total of 1673 patients. While all trials included data on patient gender (22% women overall), only 40.7% included any data on patient race/ethnicity. Among those that did, trial participants were reported as white (94%), Black (2.1%), Hispanic (0.6%), Asian (0.9%), and Other (2.3%). Racial/ethnic minorities were underrepresented in clinical trials relative to their proportion of new bladder cancer cases and deaths. CONCLUSION Most clinical trials that have been conducted for BCG-unresponsive non-muscle invasive bladder cancer do not report data on patient race or ethnicity despite NIH guidelines advocating for inclusion of such data. Racial/ethnic minorities remain underrepresented in these trials relative to the burden of bladder cancer prevalence and mortality faced by these groups.
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Affiliation(s)
- Sean A Fletcher
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | - Otis W Brawley
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
| | - Max Kates
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
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Gore A, Truche P, Iskerskiy A, Ortega G, Peck G. Inaccurate Ethnicity and Race Classification of Hispanics Following Trauma Admission. J Surg Res 2021; 268:687-695. [PMID: 34482009 DOI: 10.1016/j.jss.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/25/2021] [Accepted: 08/04/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Race and ethnicity are associated with disparate trauma outcomes. This study seeks to characterize accuracy of trauma registry classification of patient race and ethnicity and to identify factors associated with misclassification. METHODS A prospective observational study of patients admitted to an urban Level 1 trauma center was conducted over a 6-mo period. Race and ethnicity data recorded in the trauma registry were compared to patients' self-identifying data obtained through in-person interviews. Logistic regression determined rates of discordant race and ethnicity between trauma registry and patient self-identification processes, and identified factors independently associated with misclassification. RESULTS A total of 444 patients were recruited. 98 (22%) self-identified as Hispanic/Latino. 45 patients self-identifying as Hispanic (45.9%) had inaccurately recorded ethnicity in the trauma registry. There was an increased odds of ethnicity misclassification in younger patients (OR 0.97, P < 0.01) and Spanish-only speakers (OR 11.80, P < 0.001). A decreased odds was found in males (OR 0.43, P < 0.05). No factors increased odds of racial misclassification, while dual English/Spanish speakers (OR 0.05, P < 0.01) wereas found to have decreased odds. Neither ethnicity nor race misclassification was associated with clinical variables. New racial self-identification was observed with 75% of patients who self-identified ethnically as Hispanic also self-identifying racially as Hispanic. CONCLUSIONS Hispanic trauma patients have racial and ethnic misclassifications regardless of clinical status. Racial and ethnic identification is not sufficiently captured by current standardized questionnaires. Accuracy of hospital level racial data is important for local and national policies to address trauma disparities.
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Affiliation(s)
- Ankita Gore
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Paul Truche
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Anton Iskerskiy
- Rutgers School of Graduate Studies, New Brunswick, New Jersey
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory Peck
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, New Brunswick, New Jersey.
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Johnston A, Tseung V, Dancey SR, Visintini SM, Coutinho T, Edwards JD. Use of Race, Ethnicity, and National Origin in Studies Assessing Cardiovascular Risk in Women With a History of Hypertensive Disorders of Pregnancy. CJC Open 2021; 3:S102-S117. [PMID: 34993440 PMCID: PMC8712581 DOI: 10.1016/j.cjco.2021.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Women with a history of hyperBtensive disorders of pregnancy (HDP) are at particularly high risk for cardiovascular disease (CVD) and CVD-related death, and certain racial and ethnic subpopulations are disproportionately affected by these conditions. We examined the use of race, ethnicity, and national origin in observational studies assessing CVD morbidity and mortality in women with a history of HDP. A total of 124 studies, published between 1976 and 2021, were reviewed. We found that white women were heavily overrepresented, encompassing 53% of all participants with HDP. There was limited and heterogeneous reporting of race and ethnicity information across studies and only 27 studies reported including race and/or ethnicity variables in at least 1 statistical analysis. Only 2 studies mentioned the use of these variables as a strength; several others (k = 18) reported a lack of diversity among participants as a study limitation. Just over half of included articles (k = 68) reported at least 1 sociodemographic variable other than race and ethnicity (eg, marital status and income); however, none investigated how they might have worked synergistically or antagonistically with race and/or ethnicity to influence participants' risk of CVD. These findings highlight significant areas for improvement in cardiovascular obstetrics research, including the need for more robust and standardized methods for collecting, reporting, and using sociodemographic information. Future studies of CVD risk in women with a history of HDP should explicitly examine racial and ethnic differences and use an intersectional approach.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Victrine Tseung
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sonia R. Dancey
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah M. Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jodi D. Edwards
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- IC/ES, Ottawa, Ontario, Canada
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Mannor KM, Malcoe LH. Uses of Theory in Racial Health Disparities Research: A Scoping Review and Application of Public Health Critical Race Praxis. Ann Epidemiol 2021; 66:56-64. [PMID: 34793963 DOI: 10.1016/j.annepidem.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022]
Abstract
Given the persistence of racial health disparities, scholars have called for investigations into structural origins of health inequity and deeper engagement with theory. We systematically assessed uses of theory-including theory-informed conceptualizations of race and ethnicity, social structure, and racial hierarchy-in epidemiology and other quantitative population health literature on racial health disparities. We conducted a scoping review of systematically identified original research articles (n=650) that sought to explain racial health disparities; articles were published in 17 high-impact epidemiology, public health, and social science journals. Trained coders abstracted data from each article. We applied Public Health Critical Race Praxis and an iterative data-charting method to identify key themes. Only 63 (9.7%) of 650 racial health disparities articles explicitly used theory. Among studies that engaged theory, one third (n=21/63) clearly conceptualized race and/or ethnicity, and a minority theorized social structure (n=19/63; 30%) and/or racial hierarchy as a structural relation (n=4/63; 6%). There is a pressing need for racial health disparities researchers to unambiguously use theory to conceptualize race and ethnicity in social and historical contexts and explain relational aspects of racial hierarchy. These approaches can better elucidate and inform action on structural determinants of both racial inequity and racial health inequity.
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Affiliation(s)
- Kara M Mannor
- University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, Milwaukee, WI, USA
| | - Lorraine Halinka Malcoe
- University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, Milwaukee, WI, USA.
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Levy JJ, Lebeaux RM, Hoen AG, Christensen BC, Vaickus LJ, MacKenzie TA. Using Satellite Images and Deep Learning to Identify Associations Between County-Level Mortality and Residential Neighborhood Features Proximal to Schools: A Cross-Sectional Study. Front Public Health 2021; 9:766707. [PMID: 34805078 PMCID: PMC8602058 DOI: 10.3389/fpubh.2021.766707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022] Open
Abstract
What is the relationship between mortality and satellite images as elucidated through the use of Convolutional Neural Networks? Background: Following a century of increase, life expectancy in the United States has stagnated and begun to decline in recent decades. Using satellite images and street view images, prior work has demonstrated associations of the built environment with income, education, access to care, and health factors such as obesity. However, assessment of learned image feature relationships with variation in crude mortality rate across the United States has been lacking. Objective: We sought to investigate if county-level mortality rates in the U.S. could be predicted from satellite images. Methods: Satellite images of neighborhoods surrounding schools were extracted with the Google Static Maps application programming interface for 430 counties representing ~68.9% of the US population. A convolutional neural network was trained using crude mortality rates for each county in 2015 to predict mortality. Learned image features were interpreted using Shapley Additive Feature Explanations, clustered, and compared to mortality and its associated covariate predictors. Results: Predicted mortality from satellite images in a held-out test set of counties was strongly correlated to the true crude mortality rate (Pearson r = 0.72). Direct prediction of mortality using a deep learning model across a cross-section of 430 U.S. counties identified key features in the environment (e.g., sidewalks, driveways, and hiking trails) associated with lower mortality. Learned image features were clustered, and we identified 10 clusters that were associated with education, income, geographical region, race, and age. Conclusions: The application of deep learning techniques to remotely-sensed features of the built environment can serve as a useful predictor of mortality in the United States. Although we identified features that were largely associated with demographic information, future modeling approaches that directly identify image features associated with health-related outcomes have the potential to inform targeted public health interventions.
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Affiliation(s)
- Joshua J. Levy
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Rebecca M. Lebeaux
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Anne G. Hoen
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Brock C. Christensen
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Louis J. Vaickus
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Todd A. MacKenzie
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Agarwal P, Nathan AS, Jaleel Z, Levi JR. Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic. Laryngoscope 2021; 132:895-900. [PMID: 34427327 DOI: 10.1002/lary.29841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To understand why pediatric otolaryngology patients do not attend scheduled clinic appointments and identify factors correlated with no-show status. STUDY DESIGN Retrospective cohort study. METHODS This is a retrospective cohort study that uses medical record data extraction of patients that was scheduled to attend new patient appointments at a pediatric otolaryngology clinic in 2018. RESULTS Factors associated with no-shows included complex psychiatric history (OR (95% CI) 0.789 (0.71-0.88), P < .001), increased appointment lead time (OR (95% CI) 0.981 (0.976-0.987), P < .001), afternoon appointments (OR (95% CI) 0.783 (0.64-0.99), P = .038), and complex maternal medical history (OR (95% CI) 0.987 (0.979-0.996), P < .005). In contrast, factors associated with attendance included complex patients' medical history (OR (95% CI) 1.058 (0.98-1.02), P < .001), primary care physician at the same hospital (OR (95% CI) 2.766 (2.25-3.39), P < .001), and primary language being Spanish (OR (95% CI) 2.536 (1.75-3.67) P < .001). The factors of distance from the hospital (OR (95% CI) 1.001 (0.99-1.01), P = .868), season of appointment (P = .997), race (P = .623), and ethnicity (P = .804) were not associated with attendance or no-shows. CONCLUSION Patient and maternal medical problems, mental health history, primary care location, appointment lead time, hour of appointment, and primary language, all contribute to appointment attendance, while appointment timing, race, and ethnicity are not associated with attendance. Further work must be performed to overcome these barriers to minimize healthcare risks and improve patient outcomes. QUALITY OF EVIDENCE Level 3 Laryngoscope, 2021.
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Affiliation(s)
- Pratima Agarwal
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Ajay S Nathan
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Zaroug Jaleel
- Department of Otolaryngology/Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Jessica R Levi
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
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