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Assari S, Azad MA, Zare H. Race by Sex Intersectional Differences in the Association between Allostatic Load and Depression in US Adults: 2005-2018. GLOBAL JOURNAL OF EPIDEMIOLOGY AND INFECTIOUS DISEASE 2024; 4:20-33. [PMID: 39119133 PMCID: PMC11308993 DOI: 10.31586/gjeid.2024.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Objective Previous research has underscored the link between allostatic load-a comprehensive indicator of the cumulative physiological burden of chronic stress-and depression. However, there remains a significant gap in understanding how this relationship may differ across race and sex intersectional groups. This study aimed to investigate variations in the association between elevated allostatic load (AL>4) and depression among different race-sex intersectional groups within the general population. Methods This cross-sectional secondary analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018. The analysis included variables such as race, sex, age, socioeconomic status, depression (measured via the Patient Health Questionnaire - PHQ), and allostatic load. Linear regression analyses were conducted to examine the interactions between race and sex with allostatic load, focusing on the likelihood of high depression as the outcome. Results Across the pooled sample, an allostatic load greater than 4 was significantly associated with increased depression. Notably, an interaction effect was observed between race and AL>4 on depression among women, indicating that non-Hispanic Black women with a high allostatic load exhibited more pronounced depressive symptoms (Beta: 1.09, CI: 0.02-2.61). Conversely, among men, allostatic load greater than 4 neither correlated with nor interacted with race to influence depression levels. Conclusion The study highlights the critical need to consider allostatic load as a key intervention point for preventing or reducing depression, particularly among Black women. These findings underscore the necessity for customized intervention strategies that address the nuanced race-sex disparities in the impact of allostatic load on mental health across populations.
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Affiliation(s)
- Shervin Assari
- 1 Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, California, USA. 2 Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, California, USA. 3 Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, California, USA. 4 Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, California, USA
| | - Mahbube Askari Azad
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; University of Maryland Global Campus, Health Services Management, Adelphi, Maryland, USA
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Hsueh C, Esin G, Breen T, Gitto M, Katz M, Gulati M, Capers Iv Q, Reynolds HR, Volgman AS, Wenger N, Altin SE. Myocardial infarction with nonobstructive coronary arteries: a single-center retrospective study by sex and race. Coron Artery Dis 2024:00019501-990000000-00251. [PMID: 38989611 DOI: 10.1097/mca.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND In myocardial infarction with nonobstructive coronary arteries (MINOCA), there are limited patient-level data on outcomes by sex and race. OBJECTIVE The aim of this study was to assess baseline demographics and 3-year outcomes by sex and race for MINOCA patients. METHODS Patients admitted to a single center with acute myocardial infarction (MI) between 1 January 2012 and 31 December 2018, were identified by chart and angiographic review. The primary outcome was nonfatal MI with secondary outcomes including nonfatal cerebrovascular accident (CVA), chest pain readmission, and repeat coronary angiography. RESULTS During the study period, 304 patients were admitted with MINOCA. The cohort was predominantly female (66.4%), and women were significantly older (64.6 vs. 59.2). One-sixth of the total population were Black patients, and nearly half of Black patients (47.2%) were male. Prior CVA (19.7%) and comorbid anxiety, depression, or post-traumatic stress disorder (41.1%) were common. Rates of nonfatal MI were 6.3% without difference by sex or race. For secondary outcomes, rates of CVA were 1.7%, chest pain readmission was 22.4%, and repeat angiography was 8.9%. Men were significantly more likely to have repeat angiography (13.7 vs. 6.4%), and Black patients were more likely to be readmitted for angina (34.0 vs. 19.1%). Over one-quarter of patients underwent repeat stress testing, with 8.9% ultimately undergoing repeat angiograms and low numbers (0.7%) undergoing revascularization. Men were more likely to be referred for a repeat angiogram (13.7 vs. 6.4%, P = 0.035). In multivariate analysis, Black race [odds ratio (OR), 2.31; 95% confidence interval (CI), 1.06-5.03] was associated with an increased risk of readmission for angina, while female sex was associated with decreased odds of repeat angiography (OR, 0.36; 95% CI, 0.14-0.90) and current smoking was associated with increased odds of repeat angiography (OR, 4.07; 95% CI, 1.02-16.29)] along with hyperlipidemia (OR, 4.65; 95% CI, 1.22-17.7). CONCLUSION White women presented more frequently with MINOCA than White men, however, Black men are equally as affected as Black women. Rates of nonfatal MI were low without statistical differences by sex or race.
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Affiliation(s)
- Christine Hsueh
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ghenekaro Esin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Thomas Breen
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mauro Gitto
- Department of Biomedical Sciences, Humanitas University
- Division of Cardiology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Miriam Katz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Martha Gulati
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Quinn Capers Iv
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Harmony R Reynolds
- Division of Cardiology, Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | | | - Nanette Wenger
- Emory University School of Medicine, Emory Heart and Vascular Center, Emory Women's Heart Center, Atlanta, Georgia and
| | - S Elissa Altin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Division of Cardiology, West Haven VA Medical Center, West Haven, Connecticut, USA
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Cuevas AG, McSorley AM, Lyngdoh A, Kaba-Diakité F, Harris A, Rhodes-Bratton B, Rouhani S. Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities. Am J Prev Med 2024; 67:97-104. [PMID: 38458268 DOI: 10.1016/j.amepre.2024.02.021] [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: 08/25/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. METHODS Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. RESULTS Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. CONCLUSIONS Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York.
| | - Anna-Michelle McSorley
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Adiammi Lyngdoh
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Fatoumata Kaba-Diakité
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Adrian Harris
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Brennan Rhodes-Bratton
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Saba Rouhani
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York; Department of Epidemiology, New York University School of Global Public Health, New York, New York
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Zare H, Gilmore DR, Assari S, Molina IB, Delarmente BA, Azadi M, Thorpe RJ. Income Inequality, Gender Disparities, and Ethnic Differences: Investigating Allostatic Load in American Adults. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02025-w. [PMID: 38743347 DOI: 10.1007/s40615-024-02025-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
AIM To estimate the association between income inequality and allostatic load score (AL) in adults ages 20 years and older, with a particular focus on the differential impacts across racial and gender groups. By examining this association, the study seeks to inform targeted policy interventions to mitigate health disparities exacerbated by economic inequality. METHODS Utilizing data from the 1999-2016 National Health and Nutrition Examination Survey (NHANES), we assessed AL through eight biomarkers: systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), pulse rate (beats/min), body mass index (kg/m2), glycohemoglobin (%), direct HDL cholesterol (mg/dL), total cholesterol (mg/dL), and serum albumin (g/dL). Employing negative binomial regression (NBRG), we estimated incidence rate ratios (IRR) for a sample comprising 7367 men and 7814 women, adjusting for age, race/ethnicity, marital status, education, health insurance, comorbidity, and mental health professional utilization. Gini coefficients (GC) were calculated to assess income inequality among men and women. RESULTS Findings revealed that men exhibited a higher poverty-to-income ratio (PIR) compared to women (3.12 vs. 2.86, p < 0.01). Yet, women experienced higher rates of elevated AL (AL > 4) (31.8% vs. 29.0%) and were more adversely affected by income inequality (GC: 0.280 vs. 0.333). NBRG results indicated that high PIR individuals had a lower IRR (0.96; CI:0.92-0.95) compared to their low PIR counterparts, a trend observed in women but not men. High PIR was notably protective among White non-Hispanic (WNH) men and women. Additionally, vigorous and moderate physical activity engagement was associated with lower AL (IRR: 0.89, CI: 0.85-0.93). CONCLUSION The study emphasizes the importance of implementing policies that target AL in low-income populations across all racial groups, with a specific focus on Black non-Hispanic (BNH) and Hispanic communities. By prioritizing these groups, policies can more effectively target the nexus of income inequality, health disparities, and allostatic load, contributing to the reduction of health inequities.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 337, Baltimore, MD, 21205, USA.
- The School of Business, University of Maryland Global Campus (UMGC), College Park, USA.
| | - Danielle R Gilmore
- Edward A. Bouchet Graduate Honor Society Scholar, George Washington University, Washington, D.C., USA
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Benjo A Delarmente
- UCLA Value-Based Care Research Consortium, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Mojgan Azadi
- Montgomery College, Montgomery County, Rockville, MD, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Evans E, Ellis C. Looking Upstream to Understand Race/Ethnicity as a Moderator for Poststroke Neuroinflammation and a Social Determinant for Poststroke Aphasia Outcomes. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:74-86. [PMID: 38085794 PMCID: PMC11000804 DOI: 10.1044/2023_ajslp-23-00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Over the past decade, the stroke literature has begun to acknowledge and explore explanations for longstanding racial/ethnic differences in stroke outcomes. Poststroke cognitive impairment (PSCI) and poststroke aphasia are two such negative poststroke outcomes where racial/ethnic differences exist. Physiological differences, such as stroke type and lesion size, have been used to partially explain the variation in PSCI and aphasia. However, there is some evidence, although limited, that suggests neuroinflammatory processes as part of allostatic load may be a key contributor to the observed disparities. METHOD In this tutorial, we explore the influence of race differences in inflammation on poststroke cognitive outcomes. We suggest lifetime stress and other external determinants of health such as neighborhood environment and discriminatory practices through "weathering" explain differences in inflammation. While using an allostatic load framework, we explore the literature focusing specifically on the role of neuroinflammation on poststroke outcomes. CONCLUSIONS Examination of the immune response poststroke provides a foundation for understanding the mechanisms of PSCI and poststroke aphasia and the potential contributions of neuroinflammatory processes on poststroke cognitive outcomes. Furthermore, understanding of racial differences in those processes may contribute to a better understanding of racial disparities in general stroke outcomes as well as poststroke aphasia.
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Affiliation(s)
- Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
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Baxter SLK, Zare H, Thorpe RJ. Race Disparities in Hypertension Prevalence Among Older Men. Int J Aging Hum Dev 2024; 98:10-26. [PMID: 37150878 DOI: 10.1177/00914150231172119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR = 1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities.
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Affiliation(s)
- Samuel L K Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Business, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD, USA
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Zare H, Najand B, Fugal A, Assari S. Allostatic load in the US general population: Race and educational intersection. PUBLIC HEALTH IN PRACTICE 2023; 6:100425. [PMID: 37711501 PMCID: PMC10498186 DOI: 10.1016/j.puhip.2023.100425] [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: 04/12/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Objectives Educational attainment is a protective factor against poor health, but high educational attainment has a weaker effect on black people than on white people; this pattern has been called marginalization-related diminished returns (MDRs). Using a national sample of white people and black people 25 years and above, this study estimates the association between high educational attainment and allostatic load between black people and white people, and within each group. Study design This cross-sectional study uses data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016, including 2761 black people and 7058 white people. The outcome variable of interest was the Allostatic Load Scale (AL). We created the allostatic load scale by using 8 biomarkers, then created a binary variable (if ALS≥4 as 1 and ALS<4 as 0) to present elevated AL. Methods We used several weighted modified Poisson regression models controlling for educational attainment (a predictor) and race (a moderator variable), age, sex, and marital status. We also controlled the models for smoking and drinking status as health behavior variables. As a sensitivity analysis, we ran several sets of regression analysis using the AL scale as a continuous outcome variable. Results We found an inverse association between AL and educational attainment. The interaction between race and education has resulted in an inverse association between AL and educational attainment, with a weaker association in black people than in white people. We found similar findings by running regression models with AL as a continuous variable. Conclusions We observed a weaker association between educational attainment and AL in black people than in white people, suggesting that educational attainment has more robust protection against allostatic load for white people than black people.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD, 20774, USA
| | - Babak Najand
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Adriele Fugal
- Utah Valley University, 800 W University Pkwy, Orem, UT, 84058, USA
| | - Shervin Assari
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Ly DP, Blegen MB, Gibbons MM, Norris KC, Tsugawa Y. Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study. BMJ 2023; 380:e073290. [PMID: 36858422 PMCID: PMC9975928 DOI: 10.1136/bmj-2022-073290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To assess inequities in mortality by race and sex for eight common surgical procedures (elective and non-elective) across specialties in the United States. DESIGN Retrospective cohort study. SETTING US, 2016-18. PARTICIPANTS 1 868 036 Black and White Medicare beneficiaries aged 65-99 years undergoing one of eight common surgeries: repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection. MAIN OUTCOME MEASURE The main outcome measure was 30 day mortality, defined as death during hospital admission or within 30 days of the surgical procedure. RESULTS Postoperative mortality overall was higher in Black men (1698 deaths, adjusted mortality rate 3.05%, 95% confidence interval 2.85% to 3.24%) compared with White men (21 833 deaths, 2.69%, 2.65% to 2.73%), White women (21 847 deaths, 2.38%, 2.35% to 2.41%), and Black women (1631 deaths, 2.18%, 2.04% to 2.31%), after adjusting for potential confounders. A similar pattern was found for elective surgeries, with Black men showing a higher adjusted mortality (393 deaths, 1.30%, 1.14% to 1.46%) compared with White men (5650 deaths, 0.85%, 0.83% to 0.88%), White women (4615 deaths, 0.82%, 0.80% to 0.84%), and Black women (359 deaths, 0.79%, 0.70% to 0.88%). This 0.45 percentage point difference implies that mortality after elective procedures was 50% higher in Black men compared with White men. For non-elective surgeries, however, mortality did not differ between Black men and White men (1305 deaths, 6.69%, 6.26% to 7.11%; and 16 183 deaths, 7.03%, 6.92% to 7.14%, respectively), although mortality was lower for White women and Black women (17 232 deaths, 6.12%, 6.02% to 6.21%; and 1272 deaths, 5.29%, 4.93% to 5.64%, respectively). These differences in mortality appeared within seven days after surgery and persisted for up to 60 days after surgery. CONCLUSIONS Postoperative mortality overall was higher among Black men compared with White men, White women, and Black women. These findings highlight the need to understand better the unique challenges Black men who require surgery face.
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Affiliation(s)
- Dan P Ly
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mariah B Blegen
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- National Clinician Scholars Program, UCLA, Los Angeles, CA, USA
| | - Melinda M Gibbons
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90024, USA
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