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Warner DF, Fein HL, Schiltz NK, Vu L, Szaflarski M, Bensken WP, Sajatovic M, Ghearing G, Koroukian S. Incident Epilepsy Among US Medicare Beneficiaries, 2019: Differences by Age, Sex, and Race/Ethnicity. Neurology 2024; 103:e209804. [PMID: 39250748 PMCID: PMC11385955 DOI: 10.1212/wnl.0000000000209804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is common among older adults, but previous incident studies have had limited ability to make comparisons across key subgroups. We aimed to provide updated epilepsy incidence estimates among older adults, comparing across age, sex, and race/ethnicity. METHODS Using a random sample of 4,999,999 US Medicare beneficiaries older than 65 years, we conducted a retrospective cohort study of epilepsy incidence using administrative claims for 2016-2019. Sampled beneficiaries were enrolled in the Fee-for-Service (FFS) program in each of 2016-2018 and had no epilepsy claims in those years. Non-Hispanic Black and Hispanic beneficiaries were oversampled to ensure adequate cases for detailed comparisons. Incidence in 2019 was identified in the Master Beneficiary Summary File as ≥1 inpatient claim or ≥2 outpatient nondrug claims occurring at least 1 day apart (ICD-10 G40.x). Incidence models were estimated by age, sex, race/ethnicity, and combinations thereof, with adjustment for the racial/ethnic oversampling. RESULTS We identified 20,545 incident epilepsy cases. The overall epilepsy incidence rate (IR) was 393 per 100,000 (99% CI 385-400). Incidence peaked at ages 85-89 (504 [481-529]) and was higher for men (396 [385-407]) than women (376 [366-385]). The sex difference in IRs was constant with age. Incidence was higher for non-Hispanic Black (678 [653-702]) and Hispanic (405 [384-426]), and lower for non-Hispanic Asian/Pacific Islander (272 [239-305]) beneficiaries, compared with non-Hispanic White beneficiaries (354 [299-408]). The age-specific IRs significantly differed by race/ethnicity and sex, but only among non-Hispanic Black beneficiaries-where men had higher rates at younger ages and women at older ages. DISCUSSION We found higher epilepsy IRs among those enrolled in the Medicare FFS system 2016-2019 than previous studies using Medicare claims data from at least a decade ago. The risk of epilepsy onset is higher for those in their late 80s, men, and non-Hispanic Black and Hispanic older adults. There is also evidence that these age-graded risks operate differently for Black men and Black women. Efforts to provide care and services that improve quality of life for older adults living with epilepsy should consider differences by multiple social characteristics simultaneously: age, sex, and race/ethnicity.
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Affiliation(s)
- David F Warner
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Hannah L Fein
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Nicholas K Schiltz
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Long Vu
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Magdalena Szaflarski
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Wyatt P Bensken
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Martha Sajatovic
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Gena Ghearing
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
| | - Siran Koroukian
- From the Department of Sociology (D.F.W., M. Szaflarski), University of Alabama at Birmingham; Center for Family & Demographic Research (D.F.W.), Bowling Green State University; Department of Population and Quantitative Health Sciences (H.L.F., L.V., W.P.B., S.K.), Frances Payne Bolton School of Nursing (N.K.S.), and Departments of Psychiatry and Neurology (M. Sajatovic), Case Western Reserve University, Cleveland, OH; and Department of Neurology (G.G.), University of Iowa Health Center, Iowa City
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DeAngelis RT. Racial Capitalism and Black-White Health Inequities in the United States: The Case of the 2008 Financial Crisis. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241260103. [PMID: 39077803 DOI: 10.1177/00221465241260103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Scholars cite racist political-economic systems as drivers of health inequities in the United States (i.e., racial capitalism). But how does racial capitalism generate health inequities? I address this open question within the historical context of predatory lending during the 2008 financial crisis. Relevant hypotheses are tested with multiple waves of data from Black and White participants of the National Longitudinal Study of Adolescent to Adult Health (N = 8,877). Across socioeconomic strata, I find that Black participants report higher rates of foreclosure, eviction, repossession, delinquent bills, lost income, and new debts in the wake of the financial crisis. Using structural equation and quasi-experimental models, I then show that Black participants also self-report rapid health declines and increases in prescription drug abuse throughout this period, much of which is explained by chronic financial stress. I conclude that racial capitalism can generate health inequities by ensnaring Black Americans in a toxic web of financial exploitation and stress proliferation.
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Lui E, Gill J, Hamid M, Wen C, Singh N, Okoh P, Xu X, Boakye P, James CE, Waterman AD, Edwards B, Mucsi I. Racialized and Immigrant Status and the Pursuit of Living Donor Kidney Transplant - a Canadian Cohort Study. Kidney Int Rep 2024; 9:960-972. [PMID: 38765593 PMCID: PMC11101831 DOI: 10.1016/j.ekir.2024.01.044] [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: 03/08/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Both immigrant and racialized status may be associated with the pursuit of living donor kidney transplant (LDKT). Methods This study was a secondary analysis of a convenience cross-sectional sample of patients with kidney failure in Toronto, obtained from our "Comprehensive Psychosocial Research Data System" research database. The exposures included racialized, immigrant, and combined immigrant and racialized status (White nonimmigrant, racialized nonimmigrant, White immigrant and racialized immigrant). Outcomes include the following: (i) having spoken about LDKT with others, (ii) having a potential living donor (LD) identified, (iii) having allowed others to share the need for LDKT, (iv) having directly asked a potential donor to be tested, and (v) accept a hypothetical LDKT offer. We assessed the association between exposure and outcomes using univariable, and multivariable binary or multinominal logistic regression (reference: White or White nonimmigrant participants). Results Of the 498 participants, 281 (56%) were immigrants; 142 (28%) were African, Caribbean, and Black (ACB); 123 (25%) were Asian; and 233 (47%) were White. Compared to White nonimmigrants, racialized immigrants (relative risk ratio [RRR]: 2.98; 95% confidence interval [CI]: 1.76-5.03) and racialized nonimmigrants (RRR: 2.84; 95% CI: 1.22-6.65) were more likely not to have spoken about LDKT with others (vs. having spoken or planning to do so). Both racialized immigrant (odds ratio [OR]: 4.07; 95% CI: 2.50-6.34), racialized nonimmigrants (OR: 2.68; 95% CI: 1.31-5.51) and White immigrants (OR: 2.68; 95% CI: 1.43-5.05) were more likely not to have a potential LD identified. Conclusion Both racialized and immigrant status are associated with less readiness to pursue LDKT. Supporting patients to communicate their need for LDKT may improve equitable access to LDKT.
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Affiliation(s)
- Eric Lui
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jasleen Gill
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marzan Hamid
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Stanford University School of Medicine, Stanford, California, USA
| | - Cindy Wen
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Navneet Singh
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Princess Okoh
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Xihui Xu
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Boakye
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Carl E. James
- Faculty of Education, York University, Toronto, Ontario, Canada
| | - Amy D. Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Beth Edwards
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Assari S, Zare H, Sonnega A. Racial Disparities in Occupational Distribution Among Black and White Adults with Similar Educational Levels: Analysis of Middle-Aged and Older Individuals in the Health and Retirement Study. JOURNAL OF REHABILITATION THERAPY 2024; 6:1-11. [PMID: 38774764 PMCID: PMC11108055 DOI: 10.29245/2767-5122/2024/1.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Background Occupational classes play a significant role in influencing both individual and population health, serving as a vital conduit through which higher education can lead to better health outcomes. However, the pathway from education to corresponding occupational classes does not apply uniformly across different racial and ethnic groups, hindered by factors such as social stratification, labor market discrimination, and job segregation. Aims This study seeks to investigate the relationship between educational attainment and occupational classes among Black, Latino, and White middle-aged and older adults, with a focus on their transition into retirement. Methods Using cross-sectional data from the Health and Retirement Study (HRS), this research examines the impact of race/ethnicity, educational attainment, occupational classes, and timing of retirement among middle-aged and older adults. The analysis includes a sample of 7,096 individuals identified as White, Black, or Latino. Through logistic regression, we assess the additive and multiplicative effects of race/ethnicity and education on six defined occupational classes: 1. Managerial and specialty operations, 2. Professional Specialty, 3. Sales, 4. Clerical/administrative support, 5. Services, and 6. Manual labor. Results Participants were Black (n = 1,143) or White (n =5,953). This included Latino (N =459) or non-Latino (n = 6,634). Our analysis reveals a skewed distribution of Black and Latino adults in manual and service occupations, in stark contrast to White adults who were more commonly found in clerical/administrative and managerial positions. Educational attainment did not equate to similar occupational outcomes across racial groups. Key findings include: Firstly, Black individuals with a college degree or higher were less likely to occupy clerical and administrative positions compared to their White counterparts. Secondly, holding a General Educational Development (GED) credential or some college education was generally linked to reduced likelihood of being in managerial roles; however, this inverse relationship was less evident among Black middle-aged and older adults than White ones. Thirdly, having a GED reduced the chances of working in sales roles, while having a college degree increased such chances. An interaction between race and some college education revealed that the impact of some college education on sales roles was more significant for Black adults than for White ones. We did not observe any interaction between ethnicity (Latino) and educational attainment on occupational classes. Given the stability of occupational classes, these findings could also apply to the last occupation held prior to retirement. Conclusion This study highlights significant racial disparities in occupational classes among individuals with comparable levels of education, underscoring the profound implications for health and wellbeing disparities. Future research should explore strategies to alleviate labor market discrimination and job segregation as ways to close these occupational gaps. Additionally, the influence of social stratification, job segregation, and historical legacies, such as the repercussions of the Jim Crow era, on these disparities merits further investigation. Addressing these issues is crucial for enhancing the health and wellbeing of all populations.
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Affiliation(s)
- Shervin Assari
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Marginalization-Related-Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - 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
| | - Amanda Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Brown TH, Homan P. Structural Racism and Health Stratification: Connecting Theory to Measurement. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:141-160. [PMID: 38308499 PMCID: PMC11110275 DOI: 10.1177/00221465231222924] [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] [Indexed: 02/04/2024]
Abstract
Less than 1% of studies on racialized health inequities have empirically examined their root cause: structural racism. Moreover, there has been a disconnect between the conceptualization and measurement of structural racism. This study advances the field by (1) distilling central tenets of theories of structural racism to inform measurement approaches, (2) conceptualizing U.S. states as racializing institutional actors shaping health, (3) developing a novel latent measure of structural racism in states, (4) using multilevel models to quantify the association between structural racism and five individual-level health outcomes among respondents from the Health and Retirement Study (N = 9,020) and the Behavioral Risk Factor Surveillance System (N = 308,029), and (5) making our measure of structural racism publicly available to catalyze research. Results show that structural racism is consistently associated with worse health for Black people but not White people. We conclude by highlighting this study's contributions (theoretical, methodological, and substantive) and important avenues for future research on the topic.
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Boen CE, Yang YC, Aiello AE, Dennis AC, Harris KM, Kwon D, Belsky DW. Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis. Demography 2023; 60:1815-1841. [PMID: 37982570 PMCID: PMC10842850 DOI: 10.1215/00703370-11057546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27% to 55% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7% to 11%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.
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Affiliation(s)
- Courtney E Boen
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Claire Yang
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison E Aiello
- Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, USA
| | - Alexis C Dennis
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Kathleen Mullan Harris
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dayoon Kwon
- Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Daniel W Belsky
- Columbia Mailman School of Public Health and Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, USA
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