1
|
Shippee TP, Parikh RR, Baker ZG, Bucy TI, Ng W, Jarosek S, Qin X, Woodhouse M, Nkimbeng M, McCarthy T. Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer's Disease and Related Dementias. J Aging Health 2024; 36:379-389. [PMID: 37493607 DOI: 10.1177/08982643231191164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ObjectivesAmong nursing home (NH) residents with Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012-2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0-100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.
Collapse
Affiliation(s)
- Tetyana Pylypiv Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Zachary G Baker
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA
| | - Taylor I Bucy
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Weiwen Ng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Jarosek
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Xuanzi Qin
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, USA
| | - Mark Woodhouse
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Manka Nkimbeng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Teresa McCarthy
- Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
2
|
Som MN, Chao NT, Karwoski A, Pitsenbarger LT, Dunlap E, Nagarsheth KH. Modified Frailty Index Helps Predict Mortality and Ambulation Differences Between Genders and Racial Differences Following Major Lower Extremity Amputation. Am Surg 2024; 90:1030-1036. [PMID: 38063164 DOI: 10.1177/00031348231220570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Major lower extremity amputation (LEA) is associated with significant morbidity and mortality. The modified frailty index (mFI-5) has been used to predict outcomes including ambulation and mortality after LEA. It remains unknown for which patient demographics the mFI-5 is a reliable predictor. METHODS This was a retrospective review of all patients who underwent a first-time major LEA at our institution from 2015 to 2022. Patients were stratified into 2 risk groups based on their mFI-5 score: non-frail (mFI<3) and frail (mFI≥3) and assessed on outcomes. RESULTS Our sample consisted of 687 patients of whom 134 (19.6%) were considered frail and 551 (80.4%) were considered non-frail. A higher mFI-5 is associated with decreased ambulation rates (OR: 0.565, P = .004), increased hospital readmission (OR: 1.657, P = .021), and increased mortality (OR: 2.101, P = .001) following major LEA. In African American patients, frail and non-frail patients differed on readmission at 90 days (P = .008), mortality at 1 year (P = .001), ambulatory status (P < .001), and prosthesis use (P = .023). In male patients, frail and non-frail patients differed on readmission at 90 days (P = .019), death at 1 year (P = .001), and ambulatory status (P = .002). In Caucasian patients and female patients, frail and non-frail patients did not differ significantly on outcomes. DISCUSSION The mFI-5 is a valuable predictor of outcomes following major LEA, specifically in males and African American patients. Moreover, surgeons should consider using frailty status to risk stratify patients and inform treatment plans.
Collapse
Affiliation(s)
- Maria N Som
- Department of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Natalie T Chao
- Department of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Allison Karwoski
- Department of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Luke T Pitsenbarger
- Department of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eleanor Dunlap
- Department of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Khanjan H Nagarsheth
- Department of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| |
Collapse
|
3
|
Evans K, Casper M, Schieb L, DeLara D, Vaughan AS. Stroke Mortality and Stroke Hospitalizations: Racial Differences and Similarities in the Geographic Patterns of High Burden Communities Among Older Adults. Prev Chronic Dis 2024; 21:E26. [PMID: 38635495 DOI: 10.5888/pcd21.230339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Affiliation(s)
- Kirsten Evans
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michele Casper
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda Schieb
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David DeLara
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341
| |
Collapse
|
4
|
Chambergo-Michilot D, Becerra-Gonzales VG, Kittipibul V, Colombo R, Bravo-Jaimes K. Racial Differences in Hospice Care Outcomes in Patients With Advanced Heart Failure: Systematic Review and Meta-analysis. Am J Cardiol 2024; 217:5-9. [PMID: 38382703 DOI: 10.1016/j.amjcard.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/08/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
There remains a paucity of investigational data about disparities in hospice services in people with non-cancer diagnoses, specifically in heart failure (HF). Black patients with advanced HF have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced HF who were enrolled in hospice services. We obtained the data from PubMed, Scopus, and Embase for all investigations published until January 11, 2023. All studies that reported race-specific outcomes after hospice enrollment in patients with advanced HF were included. Of the 1,151 articles identified, 5 studies (n = 24,899) were considered for analysis involving a sample size ranging from 179 to 11,754 patients. Black patients had an increased risk of readmission (odds ratio 1.55, 95% confidence interval [CI] 1.34 to 1.79, I2 0%) and discharge (odds ratio 1.75, 95% CI 1.53 to 1.99, I2 0%) compared with White patients. Moreover, Black patients have a nonsignificant lower risk of mortality compared with White patients (relative risk 0.67, 95% CI 0.43 to 1.05, I2 90%). In conclusion, this study showed that Black patients with advanced HF receiving hospice care have a higher risk of readmission and discharge compared with White patients.
Collapse
Affiliation(s)
| | - Victor G Becerra-Gonzales
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | | | - Rosario Colombo
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida.
| |
Collapse
|
5
|
Hua JT, Zell-Baran LM, Moore CM, Rose CS. Racial Differences in Respiratory Impairment, Pneumoconiosis, and Federal Compensation for Western U.S. Indigenous Coal Miners. Ann Am Thorac Soc 2024; 21:551-558. [PMID: 37916934 PMCID: PMC10995550 DOI: 10.1513/annalsats.202305-496oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
Rationale: Indigenous populations in the United States face numerous health disparities, but the health of Indigenous workers is less well understood. In a recent surveillance study of active Indigenous coal miners, 3% had coal workers' pneumoconiosis/black lung, and 9% had respiratory impairment. However, occupational lung disease prevalence among Indigenous coal miners has not been directly compared with that among other race/ethnicity groups. Coal miners who are totally disabled from black lung may qualify for U.S. Department of Labor (DOL) compensation benefits, but it is unclear how current federal spirometry criteria affect qualification for Indigenous coal miners.Objectives: To compare findings of pneumoconiosis and respiratory impairment in Indigenous and non-Indigenous coal miners in the western United States and assess federal compensation qualification for Indigenous miners using different spirometry standards.Methods: We used voluntary medical surveillance data from 2002 to 2023 to compare the adjusted odds of pneumoconiosis and respiratory impairment between Indigenous/non-Indigenous coal miners. We examined the proportion of Indigenous miners meeting DOL criteria for federal compensation using different spirometry standards.Results: We identified 691 western U.S. coal miners with at least one year of coal mining employment, 289 Indigenous and 402 non-Indigenous (96% White/Hispanic). Indigenous miners had a greater odds ratio for pneumoconiosis for each additional decade of life (2.47 [95% confidence interval (CI), 1.66-3.68]) compared with non-Indigenous coal miners (1.48 [95% CI, 1.19-1.85]). For each decade, Indigenous coal miners also had a greater adjusted odds ratio for respiratory impairment (1.67 [95% CI, 1.25-2.24]) than non-Indigenous miners (1.06 [95% CI, 0.90-1.25]). Indigenous miners had an additional decline of 71 ml (95% CI, 6-136 ml) in forced expiratory volume in 1 second for each decade of life compared with non-Indigenous coal miners. Using the DOL-mandated Knudson (1976) spirometry standard rather than an Indigenous-specific standard, 6 of 18 (33%) Indigenous miners would not qualify for federal compensation.Conclusions: Indigenous coal miners experience greater adjusted odds for pneumoconiosis and respiratory impairment per decade of life and greater decline in forced expiratory volume in 1 second despite lower smoking rates. Structural inequities exist in federal spirometry requirements for Indigenous miners seeking DOL black lung benefits. Regulatory reform is needed to address barriers to compensation for these underrepresented workers.
Collapse
Affiliation(s)
- Jeremy T. Hua
- Division of Environmental and Occupational Health Sciences and
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado; and
- Department of Environmental and Occupational Health
| | - Lauren M. Zell-Baran
- Division of Environmental and Occupational Health Sciences and
- Department of Epidemiology, and
| | - Camille M. Moore
- Division of Biostatistics and Bioinformatics, Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Cecile S. Rose
- Division of Environmental and Occupational Health Sciences and
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado; and
- Department of Environmental and Occupational Health
| |
Collapse
|
6
|
Shah P, Agbor-Enoh S, Lee S, Andargie TE, Sinha SS, Kong H, Henry L, Park W, McNair E, Tchoukina I, Shah KB, Najjar SS, Hsu S, Rodrigo ME, Jang MK, Marboe C, Berry GJ, Valantine HA. Racial Differences in Donor-Derived Cell-Free DNA and Mitochondrial DNA After Heart Transplantation, on Behalf of the GRAfT Investigators. Circ Heart Fail 2024; 17:e011160. [PMID: 38375637 PMCID: PMC11021168 DOI: 10.1161/circheartfailure.123.011160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Black heart transplant patients are at higher risk of acute rejection (AR) and death than White patients. We hypothesized that this risk may be associated with higher levels of donor-derived cell-free DNA (dd-cfDNA) and cell-free mitochondrial DNA. METHODS The Genomic Research Alliance for Transplantation is a multicenter, prospective, longitudinal cohort study. Sequencing was used to quantitate dd-cfDNA and polymerase chain reaction to quantitate cell-free mitochondrial DNA in plasma. AR was defined as ≥2R cellular rejection or ≥1 antibody-mediated rejection. The primary composite outcome was AR, graft dysfunction (left ventricular ejection fraction <50% and decrease by ≥10%), or death. RESULTS We included 148 patients (65 Black patients and 83 White patients), median age was 56 years and 30% female sex. The incidence of AR was higher in Black patients compared with White patients (43% versus 19%; P=0.002). Antibody-mediated rejection occurred predominantly in Black patients with a prevalence of 20% versus 2% (P<0.001). After transplant, Black patients had higher levels of dd-cfDNA, 0.09% (interquartile range, 0.001-0.30) compared with White patients, 0.05% (interquartile range, 0.001-0.23; P=0.003). Beyond 6 months, Black patients showed a persistent rise in dd-cfDNA with higher levels compared with White patients. Cell-free mitochondrial DNA was higher in Black patients (185 788 copies/mL; interquartile range, 101 252-422 133) compared with White patients (133 841 copies/mL; interquartile range, 75 346-337 990; P<0.001). The primary composite outcome occurred in 43% and 55% of Black patients at 1 and 2 years, compared with 23% and 27% in White patients, P<0.001. In a multivariable model, Black patient race (hazard ratio, 2.61 [95% CI, 1.35-5.04]; P=0.004) and %dd-cfDNA (hazard ratio, 1.15 [95% CI, 1.03-1.28]; P=0.010) were associated with the primary composite outcome. CONCLUSIONS Elevated dd-cfDNA and cell-free mitochondrial DNA after heart transplant may mechanistically be implicated in the higher incidence of AR and worse clinical outcomes in Black transplant recipients. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02423070.
Collapse
Affiliation(s)
- Palak Shah
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Seiyon Lee
- Volgenau School of Engineering, George Mason University, Fairfax VA
| | - Temesgen E. Andargie
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Shashank S. Sinha
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Hyesik Kong
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Lawrence Henry
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Woojin Park
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Erick McNair
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Inna Tchoukina
- The Pauley Heart Center, Virginia Commonwealth University, Richmond VA
| | - Keyur B. Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond VA
| | - Samer S. Najjar
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC
| | - Steven Hsu
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
| | - Maria E. Rodrigo
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC
| | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Charles Marboe
- Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia, New York, New York, USA
| | | | - Hannah A. Valantine
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
7
|
Edmonds MC, Bickell NA, Gallagher EJ, LeRoith D, Lin JJ. Racial differences in weight perception among Black and White women diagnosed with breast cancer. J Cancer Surviv 2024; 18:531-540. [PMID: 36169797 PMCID: PMC10166002 DOI: 10.1007/s11764-022-01255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Black women are more likely than White women to have obesity, and obesity is associated with worse breast cancer prognosis. Weight perception, however, has not been studied as a potential mediator of obesity disparities in women with breast cancer. In this study, we sought to describe racial differences and the association of lifestyle factors with weight perception. METHODS In this cross-sectional study design, Black and White women with a new primary breast cancer were surveyed about socio-demographics, weight perception, diet, and exercise habits. Height and weight were measured at enrollment. We classified women with a BMI ≥ 25 kg/m2 or waist circumference ≥ 88 cm who reported that they were "about the right weight" as under-perceivers. Chi-square and t tests were used to assess study variables (e.g., race, physical activity) associated with under-perception of weight. Logistic regression models were fit to evaluate for racial differences in under-perception while controlling for other covariates. RESULTS Of 1,197 women with newly diagnosed breast cancer, the average age was 58 years, and 909 (75.9%) were White. Nine hundred eighteen (77%) had stage I cancer, 1,035 (87%) had estrogen receptor positive cancer, and 795 (66%) were privately insured at time of diagnosis. Seven hundred eighty-nine (66%) women had abdominal obesity (waist circumference ≥ 88 cm), while 366 (31%) women had a BMI ≥ 25 kg/m2. Overall, 24% of women were under-perceivers. Compared to White women, Black women with WC ≥ 88 cm more frequently under-perceived their weight (24% vs. 14% p < 0.0001) were more obese with BMI > 30 kg/m2 (51% vs. 23%, p < 0.0001) and had lower physical activity (22% vs. 77%, p < 0.0001). After controlling for age, education, and stage, Black women remained more likely to under-perceive their weight relative to White women for those with BMI ≥ 25 kg/m2 (OR: 2.64; 95% CI: 1.4-4.6) or waist circumference ≥ 88 cm (OR: 2.89; 95% CI: 1.8-4.5). With respect to lifestyle factors, among women with BMI ≥ 25 kg/m2, those who met physical activity guidelines were less likely to under-perceive their weight compared to those who did not meet physical activity guidelines (OR: 0.37; 95% CI: 0.2-0.6), regardless of race. CONCLUSIONS We found racial differences in weight perception and identified social determinants and lifestyle factors such as lower education and physical inactivity that influenced under-perception of weight among newly diagnosed breast cancer patients. IMPLICATIONS FOR CANCER SURVIVORS Since obesity is associated with worse breast cancer outcomes, identifying optimal modifiable factors to intervene upon to support weight management among breast cancer survivors is clinically important. Breast cancer patients' perceptions about their weight provide insight that may inform lifestyle behavior interventions to reduce obesity during survivorship care.
Collapse
Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Nina A Bickell
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily J Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
8
|
Ashana DC, Welsh W, Preiss D, Sperling J, You H, Tu K, Carson SS, Hough C, White DB, Kerlin M, Docherty S, Johnson KS, Cox CE. Racial Differences in Shared Decision-Making About Critical Illness. JAMA Intern Med 2024; 184:424-432. [PMID: 38407845 PMCID: PMC10897823 DOI: 10.1001/jamainternmed.2023.8433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024]
Abstract
Importance Shared decision-making is the preferred method for evaluating complex tradeoffs in the care of patients with critical illness. However, it remains unknown whether critical care clinicians engage diverse patients and caregivers equitably in shared decision-making. Objective To compare critical care clinicians' approaches to shared decision-making in recorded conversations with Black and White caregivers of patients with critical illness. Design, Setting, and Participants This thematic analysis consisted of unstructured clinician-caregiver meetings audio-recorded during a randomized clinical trial of a decision aid about prolonged mechanical ventilation at 13 intensive care units in the US. Participants in meetings included critical care clinicians and Black or White caregivers of patients who underwent mechanical ventilation. The codebook included components of shared decision-making and known mechanisms of racial disparities in clinical communication. Analysts were blinded to caregiver race during coding. Patterns within and across racial groups were evaluated to identify themes. Data analysis was conducted between August 2021 and April 2023. Main Outcomes and Measures The main outcomes were themes describing clinician behaviors varying by self-reported race of the caregivers. Results The overall sample comprised 20 Black and 19 White caregivers for a total of 39 audio-recorded meetings with clinicians. The duration of meetings was similar for both Black and White caregivers (mean [SD], 23.9 [13.7] minutes vs 22.1 [11.2] minutes, respectively). Both Black and White caregivers were generally middle-aged (mean [SD] age, 47.6 [9.9] years vs 51.9 [8.8] years, respectively), female (15 [75.0%] vs 14 [73.7%], respectively), and possessed a high level of self-assessed health literacy, which was scored from 3 to 15 with lower scores indicating increasing health literacy (mean [SD], 5.8 [2.3] vs 5.3 [2.0], respectively). Clinicians conducting meetings with Black and White caregivers were generally young (mean [SD] age, 38.8 [6.6] years vs 37.9 [8.2] years, respectively), male (13 [72.2%] vs 12 [70.6%], respectively), and White (14 [77.8%] vs 17 [100%], respectively). Four variations in clinicians' shared decision-making behaviors by caregiver race were identified: (1) providing limited emotional support for Black caregivers, (2) failing to acknowledge trust and gratitude expressed by Black caregivers, (3) sharing limited medical information with Black caregivers, and (4) challenging Black caregivers' preferences for restorative care. These themes encompass both relational and informational aspects of shared decision-making. Conclusions and Relevance The results of this thematic analysis showed that critical care clinicians missed opportunities to acknowledge emotions and value the knowledge of Black caregivers compared with White caregivers. These findings may inform future clinician-level interventions aimed at promoting equitable shared decision-making.
Collapse
Affiliation(s)
- Deepshikha C. Ashana
- Department of Medicine, Duke University, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Whitney Welsh
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Doreet Preiss
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - HyunBin You
- School of Nursing, Duke University, Durham, North Carolina
| | - Karissa Tu
- School of Medicine, University of Washington, Seattle
| | | | - Catherine Hough
- Department of Medicine, Oregon Health and Science University, Portland
| | - Douglas B. White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Meeta Kerlin
- Department of Medicine, University of Pennsylvania, Philadelphia
| | | | - Kimberly S. Johnson
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatrics Research Education and Clinical Center (GRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | | |
Collapse
|
9
|
Jebrin R, El Nekidy WS, Abidi E, John TLS, Kesav P, Hussain SI, Abdelsalam M, Khaled L, Raj D, John S. Racial differences in P2Y12 inhibitor responsiveness in patients undergoing neuro-endovascular procedures: A cohort from the Middle East. Clin Neurol Neurosurg 2024; 239:108167. [PMID: 38402103 DOI: 10.1016/j.clineuro.2024.108167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Data on P2Y12 inhibitors responsiveness from the middle east is scarce. We sought to investigate patient responsiveness to P2Y12 inhibitors within a cohort of major races that characterize the UAE population. The secondary objective was to assess risk factors for hyper and hypo-responsiveness in this population. METHODS We conducted a cross-sectional study on adults who received either clopidogrel or ticagrelor treatments and had platelet responsiveness testing before undergoing neuro-endovascular interventions at our quaternary care hospital between March 2015 and April 2019. RESULTS During the study period, 249 subjects met the inclusion criteria. Overall, 17.3 % were hyper-responsive and 25.7 % were hypo-responsive to P2Y12 inhibitors. When comparing between the P2Y12 inhibitors, rates of hyper-responsiveness were significantly higher to ticagrelor when compared to clopidogrel (11 versus 6 %, p = 0.02 respectively). Contrarily, hypo-responsiveness rates were significantly higher in clopidogrel treated patients compared to their ticagrelor treated counterparts (23 versus 2 %, p < .001 respectively). Patients of Middle-Eastern origin showed a significantly higher rate of hypo-responsiveness to both clopidogrel and ticagrelor when compared to other races (41.1 % and 26.7 %, P < 0.001 respectively). Asians showed the highest rates of hyper-responsiveness for both agents. Multivariate logistic regression analysis showed that proton pump inhibitors and statin combination, (OR: 6.39, 95 %CI [1.60, 25.392]), and Middle East vs. Indian subcontinent patients (OR: 4.67, 95 %CI [1.79-12.14]) were independent predictors of hypo-responsiveness to both P2Y12 inhibitors. CONCLUSION This study demonstrated a high rate of hypo-responsiveness to P2Y12 inhibitors in a UAE cohort of patients undergoing neuro-endovascular procedures. In addition, therapeutic responsiveness to P2Y12 inhibitors varied markedly based on the racial background. Future larger studies are needed to evaluate genetic variations that may contribute to this rate of hypo-responsiveness in our population.
Collapse
Affiliation(s)
- Rita Jebrin
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | - Wasim S El Nekidy
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Emna Abidi
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | | | - Praveen Kesav
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Syed I Hussain
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | | | - Luna Khaled
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | - Divya Raj
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates
| | - Seby John
- Cleveland Clinic Abu Dhabi, Abu Dhabi, the United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States.
| |
Collapse
|
10
|
Jain S, Priya A, Pekow P, Spitzer K, Walkey AJ, Opara I, Krumholz HM, Lindenauer PK. Racial Differences in 1-Year Mortality after Hospitalization for Chronic Obstructive Pulmonary Disease in the United States. Ann Am Thorac Soc 2024; 21:585-594. [PMID: 37943953 PMCID: PMC10995557 DOI: 10.1513/annalsats.202304-359oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
Rationale: One quarter of Medicare beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD) die within 1 year. Although overall mortality rates are higher among White patients with COPD, racial and ethnic differences in the vulnerable period following hospitalization are unknown.Objectives: To determine the association between race and ethnicity and mortality following COPD hospitalization and to evaluate the extent to which differences are explained by clinical, geographic, socioeconomic, and post-acute care factors among Medicare beneficiaries in the United States.Methods: In this retrospective cohort study of Medicare beneficiaries hospitalized for COPD exacerbation, we constructed Cox regression models for 1-year mortality accounting for hospital-level clustering; sequentially adjusting for clinical, geographic, neighborhood socioeconomic, and post-acute care characteristics; and stratifying by sex and individual socioeconomic status.Results: Among 244,624 hospitalizations, Medicare beneficiaries of racial and ethnic minority groups had a lower risk of dying within 1 year of hospitalization than those of White race (hazard ratios, 0.78 [95% confidence interval, 0.75-0.80] for Black patients, 0.79 [0.76-0.82] for Hispanic patients, and 0.82 [0.77-0.86] for others). Differences in visits to physicians, attendance of pulmonary rehabilitation, and discharge disposition explained some of the mortality gap among dual-eligible beneficiaries but not among non-dual-eligible beneficiaries.Conclusions: Medicare beneficiaries of White race are at greater risk of mortality following COPD hospitalization compared with beneficiaries of minority race and ethnicity groups. Our findings should be interpreted in the context of the selection of a hospitalized population and a potentially incomplete assessment of illness severity in administrative data, and warrant further investigation.
Collapse
Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine and
| | - Aruna Priya
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Penelope Pekow
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Kerry Spitzer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Allan J. Walkey
- Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, Massachusetts; and
| | - Ijeoma Opara
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| |
Collapse
|
11
|
Parab AZ, Kong A, Lee TA, Kim K, Nutescu EA, Malecki KC, Hoskins KF, Calip GS. Socioecologic Factors and Racial Differences in Breast Cancer Multigene Prognostic Scores in US Women. JAMA Netw Open 2024; 7:e244862. [PMID: 38568689 PMCID: PMC10993076 DOI: 10.1001/jamanetworkopen.2024.4862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Abstract
Importance Disproportionately aggressive tumor biology among non-Hispanic Black women with early-stage, estrogen receptor (ER)-positive breast cancer contributes to racial disparities in breast cancer mortality. It is unclear whether socioecologic factors underlie racial differences in breast tumor biology. Objective To examine individual-level (insurance status) and contextual (area-level socioeconomic position and rural or urban residence) factors as possible mediators of racial and ethnic differences in the prevalence of ER-positive breast tumors with aggressive biology, as indicated by a high-risk gene expression profile. Design, Setting, and Participants This retrospective cohort study included women 18 years or older diagnosed with stage I to II, ER-positive breast cancer between January 1, 2007, and December 31, 2015. All data analyses were conducted between December 2022 and April 2023. Main Outcomes and Measures The primary outcome was the likelihood of a high-risk recurrence score (RS) (≥26) on the Oncotype DX 21-gene breast tumor prognostic genomic biomarker. Results Among 69 139 women (mean [SD] age, 57.7 [10.5] years; 6310 Hispanic [9.1%], 274 non-Hispanic American Indian and Alaskan Native [0.4%], 6017 non-Hispanic Asian and Pacific Islander [8.7%], 5380 non-Hispanic Black [7.8%], and 51 158 non-Hispanic White [74.0%]) included in our analysis, non-Hispanic Black (odds ratio [OR], 1.33; 95% CI, 1.23-1.43) and non-Hispanic American Indian and Alaska Native women (OR, 1.38; 95% CI, 1.01-1.86) had greater likelihood of a high-risk RS compared with non-Hispanic White women. There were no significant differences among other racial and ethnic groups. Compared with non-Hispanic White patients, there were greater odds of a high-risk RS for non-Hispanic Black women residing in urban areas (OR, 1.35; 95% CI, 1.24-1.46), but not among rural residents (OR, 1.05; 95% CI, 0.77-1.41). Mediation analysis demonstrated that lack of insurance, county-level disadvantage, and urban vs rural residence partially explained the greater odds of a high-risk RS among non-Hispanic Black women (proportion mediated, 17%; P < .001). Conclusions and Relevance The findings of this cohort study suggest that the consequences of structural racism extend beyond inequities in health care to drive disparities in breast cancer outcome. Additional research is needed with more comprehensive social and environmental measures to better understand the influence of social determinants on aggressive ER-positive tumor biology among racial and ethnic minoritized women from disadvantaged and historically marginalized communities.
Collapse
Affiliation(s)
- Ashwini Z. Parab
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago
| | - Kibum Kim
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago
| | - Edith A. Nutescu
- Department of Pharmacy Practice, University of Illinois, Chicago
- Center for Pharmacoepidemiology & Pharmacoeconomic Research, University of Illinois, Chicago
| | - Kristen C. Malecki
- School of Public Health, University of Illinois, Chicago
- University of Illinois Cancer Center, Chicago
| | - Kent F. Hoskins
- University of Illinois Cancer Center, Chicago
- Division of Hematology and Oncology, University of Illinois College of Medicine, Chicago
| | - Gregory S. Calip
- Titus Family Department of Clinical Pharmacy, University of Southern California, Los Angeles
| |
Collapse
|
12
|
Colen CG, Drotning KJ, Sayer LC, Link B. A Matter of Time: Racialized Time and the Production of Health Disparities. J Health Soc Behav 2024; 65:126-140. [PMID: 37377057 DOI: 10.1177/00221465231182377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
An expansive and methodologically varied literature designed to investigate racial disparities in health now exists. Empirical evidence points to an overlapping, complex web of social conditions that accelerate the pace of aging and erodes long-term health outcomes among people of color, especially Black Americans. However, a social exposure-or lack thereof-that is rarely mentioned is time use. The current paper was specifically designed to address this shortcoming. First, we draw on extant research to illustrate how and why time is a critical source of racial disparities in health. Second, we employ fundamental causes theory to explain the specific mechanisms through which the differential distribution of time across race is likely to give rise to unequal health outcomes. Finally, we introduce a novel conceptual framework that identifies and distinguishes between four distinct forms of time use likely to play an outsized role in contributing to racial disparities in health.
Collapse
Affiliation(s)
| | | | | | - Bruce Link
- University of California, Riverside, CA, USA
| |
Collapse
|
13
|
Marino A, Fisher JH, Johannson KA, Khalil N, Kolb M, Manganas H, Marcoux V, Ryerson CJ, Assayag D. Sex and Racial Differences in Lung Biopsies for Interstitial Lung Diseases in Canada. Ann Am Thorac Soc 2024; 21:516-519. [PMID: 38426827 DOI: 10.1513/annalsats.202308-703rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
| | | | | | - Nasreen Khalil
- University of British Columbia Vancouver, British Columbia, Canada
| | - Martin Kolb
- McMaster University Hamilton, Ontario, Canada
| | | | | | | | | |
Collapse
|
14
|
Ivezaj V, Dilip A, Duffy AJ, Grilo CM. Racial differences after bariatric surgery: 24-month follow-up of a randomized, controlled trial for postoperative loss-of-control eating. Surg Obes Relat Dis 2024; 20:261-266. [PMID: 37949690 PMCID: PMC10922356 DOI: 10.1016/j.soard.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND While some bariatric surgery outcomes vary by race/ethnicity, less is known about racial/ethnic differences in loss-of-control (LOC) eating and psychosocial outcomes post-surgery. OBJECTIVE This prospective study examined and extended initial short-term findings regarding racial differences in post-bariatric surgery LOC eating and weight loss to longer-term outcomes through 24-month follow-ups. SETTING Academic medical center in the United States. METHODS Participants were 140 patients (46.4% non-White) in a 3-month randomized, controlled trial for LOC eating performed about 6 months after bariatric surgery. Participants were reassessed at 6, 12, 18, and 24 months after treatment ended (about 33 mo after surgery). Doctoral assessors administered the Eating Disorder Examination-Bariatric Surgery Version interview to assess LOC eating and eating-disorder psychopathology at 12- and 24-month follow-ups. The Beck Depression Inventory II was repeated, and measured weight was obtained at all follow-ups. RESULTS White patients had significantly greater percent excess weight loss at all follow-ups than non-White patients (p < .03). White patients reported significantly more LOC eating at 12- (p = .004) and 24-month (p = .024) follow-ups and significantly greater eating disorder psychopathology at 12-month follow-up (p < .028). Racial groups did not differ significantly in eating disorder psychopathology at 24-month follow-ups or in Beck Depression Inventory II depression scores at any follow-ups. CONCLUSIONS Our findings suggest that among patients with LOC eating after bariatric surgery, non-White patients attain a lower percent excess weight loss than White patients but have comparable or better outcomes in LOC eating, associated eating disorder psychopathology, and depression over time.
Collapse
Affiliation(s)
- Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Abhaya Dilip
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Andrew J Duffy
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Psychology, Yale University, New Haven, Connecticut
| |
Collapse
|
15
|
Hinshaw TP, Fu Y, Irish WD, Parikh AA, Snyder RA. Racial Differences in Stage IV Colorectal Cancer Molecular Profiling and Mutation Rates. J Surg Res 2024; 295:763-769. [PMID: 38150868 DOI: 10.1016/j.jss.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Despite advances in colorectal cancer (CRC) treatment, racial disparities persist. The primary aims of the study were to: evaluate differences in molecular testing rates over time by race; and measure the incidence of tumor mutations by race in patients with metastatic CRC. METHODS A retrospective cohort study was performed of all adult patients with stage IV CRC (2008-2018) identified within the cancer registry of a large regional health system. Demographic/clinical characteristics were collected through primary data abstraction of the electronic health record. Molecular profiling results were obtained directly from Caris Molecular Intelligence and electronic health record. RESULTS Three hundred eighty-three patients were included: 40.5% (n = 155) were Black and 59.5% (n = 228) were White. Significant increases were observed in microsatellite instability (MSI), KRAS, and BRAF testing rates during the study period (P < 0.0001). The odds of testing over time increased more significantly in Black compared to White patients for MSI testing (White: odds ratio [OR] 1.26 [95% confidence interval [CI] 1.12-1.41], Black: OR 1.69 [95% CI 1.41-2.02], P = 0.005) and BRAF testing (White: OR 1.42 [95% CI 1.26-1.62], Black: OR 1.89 [95% CI 1.51-2.36], P = 0.027). An increase in KRAS testing over time was observed for both cohorts and was independent of race (P = 0.58). Mutation rates did not differ by race: KRAS (Black 55.8% versus White 45.6%, P = 0.13) and BRAF (Black 4.8% versus White 10.0%, P = 0.33). CONCLUSIONS Within a large regional health system, molecular testing rates in patients with metastatic CRC increased significantly following National Comprehensive Cancer Network guideline changes for both Black and White patients. Black and White patients who underwent molecular testing had similar rates of MSI, KRAS, and BRAF mutations.
Collapse
Affiliation(s)
- Tyler P Hinshaw
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Yuanyuan Fu
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - William D Irish
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina; Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Alexander A Parikh
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, The University of Texas Health San Antonio Mays Cancer Center, San Antonio, Texas
| | - Rebecca A Snyder
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina; Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, North Carolina; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
16
|
Gunasegaran G, Moghimi S, Nishida T, Walker E, Kamalipour A, Wu JH, Mahmoudinezhad G, Zangwill LM, Weinreb RN. Racial Differences in the Diagnostic Accuracy of OCT Angiography Macular Vessel Density for Glaucoma. Ophthalmol Glaucoma 2024; 7:197-205. [PMID: 37783272 DOI: 10.1016/j.ogla.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma. DESIGN Observational, cross sectional study. PARTICIPANTS A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study. METHODS Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6 × 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes. MAIN OUTCOME MEASURES Macular VD and wiGCC measurements. RESULTS Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], P = 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; P = 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; P = 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants. CONCLUSIONS Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Gopikasree Gunasegaran
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Evan Walker
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Jo-Hsuan Wu
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Golnoush Mahmoudinezhad
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California.
| |
Collapse
|
17
|
Andre KE, Hood RB, Gaskins AJ, Kawwass JF, Almquist RG, Kramer MR, Hipp HS. Neighborhood deprivation and racial differences in in vitro fertilization outcomes. Am J Obstet Gynecol 2024; 230:352.e1-352.e18. [PMID: 37939983 DOI: 10.1016/j.ajog.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND There are significant racial disparities in in vitro fertilization outcomes, which are poorly explained by individual-level characteristics. Environmental factors such as neighborhood-level socioeconomic factors may contribute to these disparities. However, few studies have directly addressed this research question in a large, racially diverse cohort. OBJECTIVE This study aimed to investigate whether neighborhood deprivation is associated with differences in in vitro fertilization outcomes. STUDY DESIGN Our retrospective cohort study included 1110 patients who underwent 2254 autologous in vitro fertilization cycles between 2014 and 2019 at an academic fertility center in the Southeastern United States. Neighborhood deprivation was estimated using the Neighborhood Deprivation Index, a composite variable measuring community levels of material capital based on poverty, occupation, housing, and education domains. Using multivariable log-binomial generalized estimating equations with cluster weighting, risk ratios and 95% confidence intervals were estimated for cycle cancellation, miscarriage (defined as spontaneous pregnancy loss before 20 weeks after a confirmed intrauterine gestation), and live birth according to patient Neighborhood Deprivation Index. RESULTS There were positive associations between increasing Neighborhood Deprivation Index (indicating worsening neighborhood deprivation) and body mass index, as well as increasing prevalence of tubal and uterine factor infertility diagnoses. The crude probability of live birth per cycle was lower among Black (24%) than among White patients (32%), and the crude probability of miscarriage per clinical pregnancy was higher among Black (22%) than among White patients (12%). After adjustment, the Neighborhood Deprivation Index was not significantly associated with risk of cycle cancellation or live birth. Results were consistent when analyses were stratified by race. CONCLUSION Our research demonstrates racial disparities between Black and White women in the incidence of miscarriage and live birth following in vitro fertilization. Although the level of neighborhood deprivation was closely related to race, it did not have strong associations with in vitro fertilization outcomes in our population as a whole or within strata of race.
Collapse
Affiliation(s)
- Kerri E Andre
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
| | - Robert B Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Audrey J Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - R Garland Almquist
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Heather S Hipp
- Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
18
|
Hammarlund N, Holt SK, Basu A, Etzioni R, Morehead D, Lee JR, Wolff EM, Gore JL, Nyame YA. Isolating the Drivers of Racial Inequities in Prostate Cancer Treatment. Cancer Epidemiol Biomarkers Prev 2024; 33:435-441. [PMID: 38214587 PMCID: PMC10922444 DOI: 10.1158/1055-9965.epi-23-0892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Black individuals in the United States are less likely than White individuals to receive curative therapies despite a 2-fold higher risk of prostate cancer death. While research has described treatment inequities, few studies have investigated underlying causes. METHODS We analyzed a cohort of 40,137 Medicare beneficiaries (66 and older) linked to the Surveillance Epidemiology and End Results (SEER) cancer registry who had clinically significant, non-metastatic (cT1-4N0M0, grade group 2-5) prostate cancer (diagnosed 2010-2015). Using the Kitagawa-Oaxaca-Blinder decomposition, we assessed the contributions of patient health and health care delivery on the racial difference in localized prostate cancer treatments (radical prostatectomy or radiation). Patient health consisted of comorbid diagnoses, tumor characteristics, SEER site, diagnosis year, and age. Health care delivery was captured as a prediction model with these health variables as predictors of treatment, reflecting current treatment patterns. RESULTS A total of 72.1% and 78.6% of Black and White patients received definitive treatment, respectively, a difference of 6.5 percentage points. An estimated 15% [95% confidence interval (CI): 6-24] of this treatment difference was explained by measured differences in patient health, leaving the remaining estimated 85% (95% CI: 74-94) attributable to a potentially broad range of health care delivery factors. Limitations included insufficient data to explore how specific health care delivery factors, including structural racism and social determinants, impact differential treatment. CONCLUSIONS Our results show the inadequacy of patient health differences as an explanation of the treatment inequity. IMPACT Investing in studies and interventions that support equitable health care delivery for Black individuals with prostate cancer will contribute to improved outcomes.
Collapse
Affiliation(s)
- Noah Hammarlund
- Department of Health Services Research Management & Policy, University of Florida, Gainesville, FL, USA
- Department of Urology, University of Washington Medical Center, Seattle WA, USA
| | - Sarah K. Holt
- Department of Urology, University of Washington Medical Center, Seattle WA, USA
| | - Anirban Basu
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Danté Morehead
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jenney R Lee
- Department of Urology, University of Washington Medical Center, Seattle WA, USA
| | - Erika M. Wolff
- Department of Urology, University of Washington Medical Center, Seattle WA, USA
| | - John L. Gore
- Department of Urology, University of Washington Medical Center, Seattle WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yaw A. Nyame
- Department of Urology, University of Washington Medical Center, Seattle WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
19
|
Palermo BJ, Wilkinson KS, Plante TB, Nicoli CD, Judd SE, Kamin Mukaz D, Long DL, Olson NC, Cushman M. Interleukin-6, Diabetes, and Metabolic Syndrome in a Biracial Cohort: The Reasons for Geographic and Racial Differences in Stroke Cohort. Diabetes Care 2024; 47:491-500. [PMID: 38237104 PMCID: PMC10909684 DOI: 10.2337/dc23-0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/26/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Black Americans have a greater risk of type 2 diabetes than White Americans. The proinflammatory cytokine interleukin-6 (IL-6) is implicated in diabetes pathogenesis, and IL-6 levels are higher in Black individuals. This study investigated associations of IL-6 with incident diabetes and metabolic syndrome in a biracial cohort. RESEARCH DESIGN AND METHODS The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled 30,239 Black and White adults age ≥45 years in 2003-2007, with a follow-up ∼9.5 years later. Baseline plasma IL-6 was measured in 3,399 participants at risk of incident diabetes and 1,871 at risk of metabolic syndrome. Relative risk (RR) by IL-6 was estimated with modified Poisson regression for both groups. RESULTS Incident diabetes occurred in 14% and metabolic syndrome in 20%; both rates rose across IL-6 quartiles. There was a three-way interaction of IL-6, race, and central adiposity for incident diabetes (P = 8 × 10-5). In Black participants with and without central adiposity, RRs were 2.02 (95% CI 1.00-4.07) and 1.66 (1.00-2.75) for the fourth compared with first IL-6 quartile, respectively. The corresponding RRs were 1.73 (0.92-3.26) and 2.34 (1.17-4.66) in White participants. The pattern was similar for IL-6 and metabolic syndrome. CONCLUSIONS Although IL-6 was higher in Black than in White participants and those with central adiposity, the association of IL-6 with diabetes risk was statistically significant only among White participants without central adiposity. The association with metabolic syndrome risk was similarly stronger in low-risk groups. The results support the concept of interventions to lower inflammation in diabetes prevention, but to reduce race disparities, better biomarkers are needed.
Collapse
Affiliation(s)
| | - Katherine S. Wilkinson
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Timothy B. Plante
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Charles D. Nicoli
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Nels C. Olson
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| |
Collapse
|
20
|
Fernandez JM, Plampton K, Behbahani S, Sutton AV, Whitley MJ, Wysong A. Racial Differences in Anatomic Sites of Distant Metastatic Melanoma: A Retrospective Cohort Study of 10,120 Cases. J Cutan Med Surg 2024; 28:190-191. [PMID: 38263788 DOI: 10.1177/12034754231223457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Katherine Plampton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sara Behbahani
- Department of Dermatology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam V Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melodi J Whitley
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
21
|
Pagadala MS, Ryan S, Carter H, Javier-DesLoges J. Comparison of Genomic Inflation Estimates in Genome-Wide Association Studies Using Genetically Identified Ancestry vs Self-Identified Race/Ethnicity in Prostate Cancer Patients in ELLIPSE Cohort. J Urol 2024; 211:465-468. [PMID: 38010907 DOI: 10.1097/ju.0000000000003794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Meghana S Pagadala
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, La Jolla, California
| | - Stephen Ryan
- Division of Urology, Maine Medical Center, Portland, Maine
| | - Hannah Carter
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, La Jolla, California
| | - Juan Javier-DesLoges
- Department of Urology, University of California, San Diego, La Jolla, California
- Online Content Assistant Editor
| |
Collapse
|
22
|
Xu C, Xiao D, Su BB, Saveron JM, Gamez D, Navia RO, Wang N, Roy U, Adjeroh DA, Wang K. Association of APOE gene with longitudinal changes of CSF amyloid beta and tau levels in Alzheimer's disease: racial differences. Neurol Sci 2024; 45:1041-1050. [PMID: 37759100 DOI: 10.1007/s10072-023-07076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The Apolipoprotein E (APOE) ε4 allele is a risk factor for late-onset Alzheimer's disease (AD). However, no investigation has focused on racial differences in the longitudinal effect of APOE genotypes on CSF amyloid beta (Aβ42) and tau levels in AD. METHODS This study used data from the Alzheimer's Disease Neuroimaging Initiative (ADNI): 222 participants with AD, 264 with cognitive normal (CN), and 692 with mild cognitive impairment (MCI) at baseline and two years follow-up. We used a linear mixed model to investigate the effect of APOE-ε4-genotypes on longitudinal changes in the amyloid beta and tau levels. RESULTS Individuals with 1 or 2 APOE ε4 alleles revealed significantly higher t-Tau and p-Tau, but lower amyloid beta Aβ42 compared with individuals without APOE ε4 alleles. Significantly higher levels of log-t-Tau, log-p-Tau, and low levels of log-Aβ42 were observed in the subjects with older age, being female, and the two diagnostic groups (AD and MCI). The higher p-Tau and Aβ42 values are associated with poor Mini-Mental State Examination (MMSE) performance. Non-Hispanic Africa American (AA) and Hispanic participants were associated with decreased log-t-Tau levels (β = - 0.154, p = 0.0112; β = - 0.207, and p = 0.0016, respectively) as compared to those observed in Whites. Furthermore, Hispanic participants were associated with a decreased log-p-Tau level (β = - 0.224, p = 0.0023) compared to those observed in Whites. There were no differences in Aβ42 level for non-Hispanic AA and Hispanic participants compared with White participants. CONCLUSION Our study, for the first time, showed that the APOE ε4 allele was associated with these biomarkers, however with differing degrees among racial groups.
Collapse
Affiliation(s)
- Chun Xu
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, TX, 78520, USA
| | - Danqing Xiao
- Department of STEM, School of Arts and Sciences, Regis College, Weston, MA, 02493, USA
| | - Brenda Bin Su
- Department of Pediatrics - Allergy and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jaime Miguel Saveron
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, TX, 78520, USA
| | - Daniela Gamez
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, TX, 78520, USA
| | - R Osvaldo Navia
- Department of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
| | - Nianyang Wang
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Upal Roy
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, TX, 78520, USA
| | - Donald A Adjeroh
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV, 26506, USA
| | - Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, 26506, USA.
| |
Collapse
|
23
|
Newton RL, Zhang D, Johnson WD, Martin CK, Apolzan JW, Denstel KD, Brantley PJ, Davis TC, Arnold C, Sarpong DF, Price-Haywood EG, Lavie CJ, Thethi TK, Katzmarzyk PT. Predictors of racial differences in weight loss: the PROPEL trial. Obesity (Silver Spring) 2024; 32:476-485. [PMID: 38058232 PMCID: PMC10922207 DOI: 10.1002/oby.23936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Studies have consistently shown that African American individuals lose less weight in response to behavioral interventions, but the mechanisms leading to this result have been understudied. METHODS Data were derived from the PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) study, which was a cluster-randomized, two-arm trial conducted in primary care clinics. In the PROPEL trial, African American individuals lost less weight compared with patients who belonged to other racial groups after 24 months. In the current study, counterfactual mediation analyses among 445 patients in the intervention arm of PROPEL were used to determine which variables mediated the relationship between race and weight loss. The mediators included treatment engagement, psychosocial, and lifestyle factors. RESULTS At 6 months, daily weighing mediated 33% (p = 0.008) of the racial differences in weight loss. At 24 months, session attendance and daily weighing mediated 35% (p = 0.027) and 66% (p = 0.005) of the racial differences in weight loss, respectively. None of the psychosocial or lifestyle variables mediated the race-weight loss association. CONCLUSIONS Strategies specifically targeting engagement, such as improving session attendance and self-weighing behaviors, among African American individuals are needed to support more equitable weight losses over extended time periods.
Collapse
Affiliation(s)
| | - Dachaun Zhang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | | | | | | | | | - Terry C. Davis
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Connie Arnold
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Daniel F. Sarpong
- Office of Health Equity Research, Yale University School of Medicine, New Haven, CT, USA
| | | | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School- the UQ School of Medicine, New Orleans, LA, USA
| | - Tina K. Thethi
- AdventHealth Translational Research Institute, Orlando, FL, USA
| | | |
Collapse
|
24
|
Malla G, Long DL, Cherrington A, Goyal P, Guo B, Safford MM, Khodneva Y, Cummings DM, McAlexander TP, DeSilva S, Judd SE, Hidalgo B, Levitan EB, Carson AP. Neighborhood Disadvantage and Risk of Heart Failure: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circ Cardiovasc Qual Outcomes 2024; 17:e009867. [PMID: 38328917 PMCID: PMC10950536 DOI: 10.1161/circoutcomes.123.009867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status. METHODS We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term. RESULTS The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes. CONCLUSIONS In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.
Collapse
Affiliation(s)
- Gargya Malla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Boyi Guo
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Monika M. Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Yulia Khodneva
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Doyle M. Cummings
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Tara P. McAlexander
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shanika DeSilva
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bertha Hidalgo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
25
|
Kuehn BM. Citing Harms, Momentum Grows to Remove Race From Clinical Algorithms. JAMA 2024; 331:463-465. [PMID: 38231518 DOI: 10.1001/jama.2023.25530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This Medical News article discusses efforts to evaluate the inclusion of race as a factor in widely used clinical decision-making algorithms.
Collapse
|
26
|
LeBlanc ES, Pittas AG, Nelson J, Chatterjee R, Rasouli N, Rhee MK, Pratley RE, Desouza CV, Neff LM, Peters AM, Dagogo-Jack S, Hsia DS. Racial differences in measures of glycemia in the Vitamin D and Type 2 Diabetes (D2d) Study: a secondary analysis of a randomized trial. BMJ Open Diabetes Res Care 2024; 12:e003613. [PMID: 38350671 PMCID: PMC10862329 DOI: 10.1136/bmjdrc-2023-003613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Understanding how race may influence the association between A1c and glycemia can improve diabetes screening. We sought to determine whether, for a given A1c level, glucose levels during an oral glucose tolerance test (OGTT) differed by race. RESEARCH DESIGN AND METHODS From data collected at 22 US clinical sites, we conducted a cross-sectional study of concurrently measured A1c and OGTT and observational longitudinal follow-up of the subset with high-risk pre-diabetes. Numerical integration methods were used to calculate area under the glycemic curve (AUCglu) during OGTT and least squares regression model to estimate A1c for a given AUCglu by race, controlling for potential confounders. RESULTS 1016 black, 2658 white, and 193 Asian persons at risk of diabetes were included in cross-sectional analysis. Of these, 2154 with high-risk pre-diabetes were followed for 2.5 years. For a given A1c level, AUCglu was lower in black versus white participants. After adjustment for potential confounders, A1c levels for a given AUCglu quintile were 0.15-0.20 and 0.02-0.19 percentage points higher in black and Asian compared with white participants, respectively (p<0.05). In longitudinal analyses, black participants were more likely to be diagnosed with diabetes by A1c than white participants (28% vs 10%, respectively; p<0.01). Black and Asian participants were less likely to be diagnosed by fasting glucose than white participants (16% vs 15% vs 37%, respectively; p<0.05). Black participants with A1c levels in the lower-level quintiles had greater increase in A1c over time compared with white participants. CONCLUSIONS Use of additional testing beyond A1c to screen for diabetes may better stratify diabetes risk in the diverse US population.
Collapse
Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jason Nelson
- Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Neda Rasouli
- Endocrinology, Metabolism and Diabetes, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- Endocrinology, VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Mary K Rhee
- Medicine/Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Richard E Pratley
- Translational Research Institute, AdventHealth Research Institute, Orlando, Florida, USA
| | | | - Lisa M Neff
- Northwestern Medicine, Chicago, Illinois, USA
| | - Anne M Peters
- Endocrinology, USC, Manhattan Beach, California, USA
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism General Clinical Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| |
Collapse
|
27
|
Lee NS, Keddem S, Sorrentino AE, Jenkins KA, Long JA. Health Equity in the Veterans Health Administration From Veterans' Perspectives by Race and Sex. JAMA Netw Open 2024; 7:e2356600. [PMID: 38373000 PMCID: PMC10877456 DOI: 10.1001/jamanetworkopen.2023.56600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Importance Advancing equitable patient-centered care in the Veterans Health Administration (VHA) requires understanding the differential experiences of unique patient groups. Objective To inform a comprehensive strategy for improving VHA health equity through the comparative qualitative analysis of care experiences at the VHA among veterans of Black and White race and male and female sex. Design, Setting, and Participants This qualitative study used a technique termed freelisting, an anthropologic technique eliciting responses in list form, at an urban academic VHA medical center from August 2, 2021, to February 9, 2022. Participants included veterans with chronic hypertension. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item, allowing comparison of salient words and topics within and across different groups. Participants were asked about current perceptions of VHA care, challenges in the past year, virtual care, suggestions for change, and experiences of racism. Data were analyzed from February 10 through September 30, 2022. Main Outcomes and Measures The Smith salience index, which measures the frequency and rank of each word or phrase, was calculated for each group. Results Responses from 49 veterans (12 Black men, 12 Black women, 12 White men, and 13 White women) were compared by race (24 Black and 25 White) and sex (24 men and 25 women). The mean (SD) age was 64.5 (9.2) years. Some positive items were salient across race and sex, including "good medical care" and telehealth as a "comfortable/great option," as were some negative items, including "long waits/delays in getting care," "transportation/traffic challenges," and "anxiety/stress/fear." Reporting "no impact" of racism on experiences of VHA health care was salient across race and sex; however, reports of race-related unprofessional treatment and active avoidance of race-related conflict differed by race (present among Black and not White participants). Experiences of interpersonal interactions also diverged. "Impersonal/cursory" telehealth experiences and the need for "more personal/attentive" care were salient among women and Black participants, but not men or White participants, who associated VHA care with courtesy and respect. Conclusions and Relevance In this qualitative freelist study of veteran experiences, divergent experiences of interpersonal care by race and sex provided insights for improving equitable, patient-centered VHA care. Future research and interventions could focus on identifying differences across broader categories both within and beyond race and sex and bolstering efforts to improve respect and personalized care to diverse veteran populations.
Collapse
Affiliation(s)
- Natalie S. Lee
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Anneliese E. Sorrentino
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Kevin Ahmaad Jenkins
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A. Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| |
Collapse
|
28
|
Burton WM, Mumba MN. Race as a Structural Determinant of Mental Health. J Psychosoc Nurs Ment Health Serv 2024; 62:3-5. [PMID: 38315974 DOI: 10.3928/02793695-20240109-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
| | - Mercy Ngosa Mumba
- Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama
| |
Collapse
|
29
|
Magod B, Chokshi AK, Martin KA, Schimmel DR, Khan SS, Shah NS. Rural-urban differences in pulmonary embolism mortality by race-ethnicity and sex in the United States, 1999-2020. J Thromb Thrombolysis 2024; 57:337-340. [PMID: 37945938 DOI: 10.1007/s11239-023-02915-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Racial and ethnic differences in pulmonary embolism (PE) mortality within rural and urban regions in the U.S. have not previously been described. PE mortality may vary across regions and urbanization given disparities in social and structural determinants and comorbid disease. METHODS Using surveillance data from the Centers for Disease Control and Prevention, age-adjusted mortality rates (AAMR) related to PE were calculated for rural and urban regions in the U.S., in non-Hispanic Black and White women and men, between 1999 and 2020. RESULTS Among 137,946 deaths in urban regions and 41,333 deaths in rural regions due to PE during this period, AAMR decreased 1.8% per year in urban regions from 3.1 to 100,000 in 1999 to 2.2 per 100,000 in 2020, and decreased 1% per year in rural regions from 4.3 to 100,000 in 1999 to 3.3 per 100,000 in 2020. Since 2008, AAMR from PE increased in non-Hispanic White males in rural and urban regions, decreased in non-Hispanic Black females in rural regions, and otherwise remained stagnant in all other race-sex groups. CONCLUSIONS AAMR from PE was higher in rural compared with urban individuals, with differences by race and sex. Mortality rates remained stagnant over the last decade in non-Hispanic Black adults and non-Hispanic White females and increased in non-Hispanic White males.
Collapse
Affiliation(s)
- Benjamin Magod
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Anuj K Chokshi
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Karlyn A Martin
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Daniel R Schimmel
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Nilay S Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA.
| |
Collapse
|
30
|
Vina ER, Patel P, Grest CV, Kwoh CK, Jakiela JT, Bye T, White DK. Does Physical Activity Confound Race Differences in Osteoarthritis-Related Functional Limitation? Arthritis Care Res (Hoboken) 2024; 76:200-207. [PMID: 37518677 DOI: 10.1002/acr.25209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE This study sought to determine the extent to which physical activity confounds the relation between race and the incidence of osteoarthritis (OA)-related functional limitation. METHODS OA Initiative study participants with or at increased risk of knee OA who wore an accelerometer were included. Race was self-reported. Average time spent in moderate to vigorous physical activity (minutes per day) based on ActiGraph uniaxial accelerometer data was assessed. Functional limitation was based on the following: (1) inability to achieve a community walking speed (1.2 m/s) standard, (2) slow walking speed (<1.0 m/s), and (3) low physical functioning based on a Western Ontario and McMaster Universities OA Index (WOMAC) physical function score greater than 28 of 68. RESULTS African American (AA) participants (n = 226), compared with White participants (n = 1348), had a higher likelihood of developing functional limitation based on various measures. When adjusted for time in moderate to vigorous physical activity, the association between AA race and inability to walk a community walking speed slightly decreased (from relative risk [RR] 2.15, 95% confidence interval [95% CI] 1.64-2.81, to RR 1.99, 95% CI 1.51-2.61). Association between AA race and other measures of functional limitation mildly decreased (slow walking speed: from RR 2.06, 95% CI 1.40-3.01, to RR 1.82, 95% CI 1.25-2.63; low physical functioning: from RR 3.44, 95% CI 1.96-6.03, to RR 3.10, 95% CI 1.79-5.39). When further adjusted for demographic and other clinical variables, only the association between race and low physical functioning (WOMAC) significantly decreased and no longer met statistical significance. CONCLUSION Greater physical activity is unlikely to completely make up for race differences in OA-related functional limitation, and other barriers to health equity need to be addressed.
Collapse
Affiliation(s)
- Ernest R Vina
- Temple University, Philadelphia, Pennsylvania, and University of Arizona, Tucson
| | - Puja Patel
- Temple University, Philadelphia, Pennsylvania
| | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | | | | |
Collapse
|
31
|
Zheng X, Yang M, Li W, Lin HC. The mediating roles of mental health problems and racial differences in the linkage between social media use and E-cigarette use among American youth. Prev Med 2024; 179:107842. [PMID: 38169240 DOI: 10.1016/j.ypmed.2023.107842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Social media use is shown to be linked to youth's e-cigarette use. However, less is known about the underlying mechanisms. This study examined the mediating roles of internalizing and externalizing problems in the association between youth's social media use and e-cigarette use, and the racial differences in the mediation association. METHODS The study sample included 4913 U.S. youth from the Population Assessment of Tobacco and Health Study Waves 3-5 (2015-2019). Two weighted generalized structural equation models were conducted to examine the mediation pathways between youth's social media use (Wave 3) and past-30-day e-cigarette use (Wave 5) through internalizing and externalizing problems (Wave 4), respectively. Invariance tests were conducted to examine racial group differences. RESULTS Youth with high social media use frequency were more likely to use e-cigarettes (total effect: OR = 1.20, p < 0.001 in both internalizing and externalizing models). Internalizing and externalizing problems mediated the aforementioned associations (mediation proportions: 5.05% and 5.66%, respectively). The invariance tests indicated a significant difference between White and non-White groups (both ps < 0.001), where a larger proportion of mediation was found in the non-White group (12.22% for internalizing and 11.99% for externalizing) compared to their White counterparts (2.46% for internalizing and 3.17% for externalizing). CONCLUSIONS Mental health problems following social media use served as a risk factor for e-cigarette use among youth. Interventions aiming to improve youth's mental health could in turn temper e-cigarette use among youth social media users, and implementing tailored interventions in response to racial differences is warranted.
Collapse
Affiliation(s)
- Xia Zheng
- School of Communication and Journalism, Stony Brook University, NY, United States of America
| | - Meng Yang
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States of America
| | - Wenbo Li
- School of Communication and Journalism, Stony Brook University, NY, United States of America
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States of America.
| |
Collapse
|
32
|
Ma B, Lu Y. Racial Disparities in the Clinical Prognosis of Gastrointestinal Cancer Patients with COVID-19: a Retrospective Study in UC CORDS. J Racial Ethn Health Disparities 2024; 11:216-225. [PMID: 36637614 PMCID: PMC9838534 DOI: 10.1007/s40615-023-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cancer patients are highly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Few studies have examined racial disparities of clinical prognosis among gastrointestinal (GI) cancer patients with COVID-19, especially after the approval of COVID-19 vaccines. METHODS We conducted a retrospective study based on the University of California COVID Research Data Set (UC CORDS). Patients aged ≥ 18 with GI cancer as well as SARS-CoV-2 infection between March 10, 2020, and May 8, 2022, were included. We examined racial disparities using multivariable logistic regression. RESULTS Among the 1054 GI cancer cases included, 117 (11.1%) patients were Asian and Pacific Islander, 51 (4.8%) were Black patients, 377 (35.8%) were Hispanic patients, 403 (38.2%) were White patients, and 106 (10.1%) belonged to other or unknown races. Fully adjusted logistic models revealed a significantly increased risk of COVID-19-related hospitalization or emergency room visits among the Black (OR = 2.26, 95% CI = 1.08-4.70), the Hispanic (OR = 2.24, 95% CI = 1.48-3.39), and the patients of other or unknown races (OR = 1.80, 95% CI = 1.00-3.26) compared with the White patients. No significant racial disparities in 30-day all-cause mortality and mechanical ventilation rate were found. Vaccination, age, cancer type, recent cancer diagnoses in UC CORDS, metastatic cancer or secondary malignant neoplasm, and Charlson comorbidity index score were associated with the prognosis of GI cancer patients with COVID-19. CONCLUSIONS GI cancer patients belonging to racial minorities experience worse COVID-19 outcomes. Vaccination status is a crucial factor associated with GI cancer patients' prognosis among different race/ethnicity groups. Targeted communication in the context of cancer is needed to encourage vaccination uptake in this vulnerable population.
Collapse
Affiliation(s)
- Bingya Ma
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Yunxia Lu
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA.
| |
Collapse
|
33
|
Supples MW, Snavely AC, O'Neill JC, Ashburn NP, Allen BR, Christenson RH, Nowak R, Wilkerson RG, Mumma BE, Madsen T, Stopyra JP, Mahler SA. Sex and race differences in the performance of the European Society of Cardiology 0/1-h algorithm with high-sensitivity troponin T. Clin Cardiol 2024; 47:e24199. [PMID: 38088463 PMCID: PMC10823440 DOI: 10.1002/clc.24199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 02/01/2024] Open
Abstract
The diagnostic performance of the high-sensitivity troponin T (hs-cTnT) European Society of Cardiology (ESC) 0/1-h algorithm in sex and race subgroups of US Emergency Department (ED) patients is unclear. A pre-planned subgroup analysis of the STOP-CP cohort study was conducted. Participants with 0- and 1-h hs-cTnT measures from eight US EDs (1/2017 to 9/2018) were stratified into rule-out, observation, and rule-in zones using the hs-cTnT ESC 0/1 algorithm. The primary outcome was adjudicated 30-day cardiac death or MI. The proportion with the primary outcome in each zone was compared between subgroups with Fisher's exact tests. The negative predictive value (NPV) of the ESC 0/1 rule-out zone for 30-day CDMI was calculated and compared between subgroups using Fisher's exact tests. Of the 1422 patients enrolled, 54.2% (770/1422) were male and 58.1% (826/1422) white with a mean age of 57.6 ± 12.8 years. At 30 days, cardiac death or myocardial infarction (MI) occurred in 12.9% (183/1422) of participants. Among patients stratified to the rule-out zone, 30-day cardiac death or MI occurred in 1.1% (5/436) of women versus 2.1% (8/436) of men (p = .40) and 1.2% (4/331) of non-white patients versus 1.8% (9/490) of white patients (p = .58). The NPV for 30-day cardiac death or MI was similar among women versus men (98.9% [95% confidence interval, CI: 97.3-99.6] vs. 97.9% [95% CI: 95.9-99.1]; p = .40) and among white versus non-white patients (98.8% [95% CI: 96.9-99.7] vs. 98.2% [95% CI: 96.5-99.2]; p = .39). NPVs <99% in each subgroup suggest the hs-cTnT ESC 0/1-h algorithm may not be safe for use in US EDs. Trial Registration: High-Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP-CP; ClinicalTrials.gov: NCT02984436; https://clinicaltrials.gov/ct2/show/NCT02984436).
Collapse
Affiliation(s)
- Michael W. Supples
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Anna C. Snavely
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - James C. O'Neill
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Nicklaus P. Ashburn
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Section on Cardiovascular Medicine, Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Brandon R. Allen
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Robert H. Christenson
- Department of PathologyUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Richard Nowak
- Department of Emergency MedicineHenry Ford Health SystemDetroitMichiganUSA
| | - R. Gentry Wilkerson
- Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Bryn E. Mumma
- Department of Emergency MedicineUniversity of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Troy Madsen
- Division of Emergency MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Jason P. Stopyra
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Simon A. Mahler
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Implementation ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| |
Collapse
|
34
|
Green DA, Evans AM, Litam SDA, Hornsby T, Boulden R, Shannon J, Ford DJ, Landrum D. Racial Identity Attitudes and Vicarious Traumatization from Undue Police Violence on Anticipatory Traumatic Reaction Among Black Americans. J Interpers Violence 2024; 39:848-868. [PMID: 37705463 DOI: 10.1177/08862605231198484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Although the viral nature of videos that capture violent and racialized policing of Black Americans in the United States can increase awareness, exposure to race-based violence can result in vicarious traumatization, particularly among Black Americans. The relationship between anticipatory traumatic reactions (ATRs) and racial identity attitudes is not clearly addressed in the extant body of literature. The current study addresses this research disparity by first analyzing group mean differences among Black Americans (N = 138) who were assigned to audiovisual, written, and imaginal exposure groups. The current study also used a cluster analysis of Black Americans to examine the differences between racial identity attitudes and ATRs following media exposure to undue police violence. Results from the study indicated that no differences in ATRs existed based on types of media exposure. Significant differences across three racial identity clusters existed between ATR in association with attitudes of assimilation, miseducation, self-hatred, anti-dominance, and ethnic-racial salience. Findings from the study suggest that mental health professionals should attend to racial identity attitudes as a relevant factor in how Black American clients experience the psychological impact of media exposure to undue police violence.
Collapse
Affiliation(s)
- Darius A Green
- Department of Counseling and Human Services, University of Colorado Colorado Springs, USA
| | - Amanda M Evans
- Department of Graduate Psychology, James Madison University, Harrisonburg, VA, USA
| | - Stacey D A Litam
- Department of Counseling, Administration, Supervision, and Adult Learning, Cleveland State University, OH, USA
| | - Tiffany Hornsby
- Department of Graduate Psychology, James Madison University, Harrisonburg, VA, USA
| | - Rawn Boulden
- Department of Counseling and Learning Sciences, West Virginia University, Morgantown, USA
| | | | - David J Ford
- Department of Professional Counseling, Monmouth University, West Long Branch, NJ, USA
| | | |
Collapse
|
35
|
Singer J, Cummings C, Coccaro EF. Parental separation and death during childhood as predictors of adult psychopathology: An examination of racial differences. Psychol Trauma 2024; 16:184-192. [PMID: 35737525 PMCID: PMC10262299 DOI: 10.1037/tra0001291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Parental separation and parental death during childhood are common but understudied forms of adverse childhood events (ACEs), thus little is known about the impact on psychological functioning in adulthood. We examined whether parental death and parental separation during childhood was associated with risk of diagnostic criteria for depressive disorders, anxiety disorders, posttraumatic stress disorder (PTSD), or personality disorders during adulthood. Second, we compared parental separation and parental death and psychopathology across African Americans (N = 499) and Whites (N = 782). METHOD The sample consists of 1,211 participants (n = 669 females). Diagnostic interviews were administered by master's or doctorate-level degree holders in Clinical Psychology or Social Work. There was good to excellent interrater reliabilities (mean kappa of .84 ± .05; range: .79-.93) spanning anxiety, mood, anxiety, trauma, and personality disorders. RESULTS White participants reporting parental separation during childhood were more likely to report depressive disorders (OR = 2.151, p < .001), PTSD (OR = 2.218, p < .01) and personality disorders (OR = 1.764, p < .001) during adulthood. African American endorsement of parental separation during childhood did not predict depressive disorders (OR = 1.21, p = .357), anxiety disorders (OR = 1.107, p = .659), PTSD (OR = 1.351, p = .425) or personality disorders (OR = 1.432, p = .098) during adulthood. Overall, participants who reported parental death did not have significantly higher rates of depressive disorders (OR = 1.100, p = .668), anxiety disorders (OR = 1.357, p = .207), PTSD (OR = 1.351, p = .425), and personality disorders (OR = 1.432, p = .098). CONCLUSIONS Parental separation was a significant risk factor for adult psychopathology, but only for White participants. Parental death was not a risk factor for adult psychopathology no matter the person's race. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center
| |
Collapse
|
36
|
Skolarus LE, Lin CC, Bi R, Bailey S, Corches CL, Sales AE, Springer MV, Burke JF. Reduction in Racial Differences in Stroke Thrombolytics in Flint, Michigan. Stroke 2024; 55:e24-e26. [PMID: 38152959 PMCID: PMC10872391 DOI: 10.1161/strokeaha.123.044663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Lesli E. Skolarus
- Northwestern University, Davee Department of Neurology, Chicago IL
- University of Michigan, Department of Neurology, Ann Arbor, MI
| | - Chun Chieh Lin
- Ohio State University, Department of Neurology, Columbus, OH
| | - Ran Bi
- Ohio State University, Department of Neurology, Columbus, OH
| | | | | | - Anne E. Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - James F. Burke
- Ohio State University, Department of Neurology, Columbus, OH
| |
Collapse
|
37
|
Hu Y, Lin D, Song M, Wu D, Zhang Y, Li G, Luo H. Sex and race differences in the association of albumin with cognitive function in older adults. Brain Behav 2024; 14:e3435. [PMID: 38409895 PMCID: PMC10897360 DOI: 10.1002/brb3.3435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND With the increasing aging population, dementia has become a significant socioeconomic burden. However, the effects of albumin on delayed recall (DR) impairment remain unclear, and there are limited reports on sex and race differences in this relationship. This study aimed to investigate the association between albumin levels and DR impairment in older adults. METHODS A total of 1507 normal cognitive function and 553 DR impairment from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were included in this cross-sectional analysis. Participants aged 60 years and above were assessed using the Consortium to Establish a Registry for Alzheimer's Disease DR (CERAD-DR) test to evaluate cognitive function. Participants were categorized into DR impairment and normal cognitive function groups according to their CERAD-DR scores. Logistic regression analyses, generalized additive models, and fitted smoothing curves were utilized for data analysis. RESULTS After adjusting for potential confounders, a negative association was found between albumin levels and cognitive function (odds ratio [OR] = 0.60, 95% confidence interval [CI] 0.41-0.87). Subgroup analysis stratified by sex, race/ethnicity, and age revealed that the negative association remained significant in men (OR = 0.53, 95%CI 032-0.87), Blacks (OR = 0.35, 95%CI 0.17-0.74), and the age group of 60-70 years (OR = 0.48, 95%CI 0.28-0.81). However, no significant association was observed in women (OR = 0.72, 95%CI 0.41-1.28), whites (OR = 0.58, 95%CI 0.31-1.07), or Mexican Americans (OR = 1.11, 95%CI 0.35-3.46), as well as the age group of 71-80 years (OR = 0.62, 95%CI 0.37-1.03). CONCLUSIONS Our study suggests that elevated albumin levels are associated with a decreased incidence of cognitive function impairment, particularly in older men and Blacks. This finding indicates that maintaining high levels of albumin may be beneficial for cognitive function in older adults.
Collapse
Affiliation(s)
- Yang Hu
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Duo Lin
- Department of NeurologyZhongshan Hospital of Traditional Chinese MedicineGuangdongChina
| | - Min Song
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Dongmei Wu
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yuqing Zhang
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Gongbo Li
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Haiyan Luo
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| |
Collapse
|
38
|
Pinsino A, Wu J, Mohamed A, Cela A, Yu TC, Rednor SJ, Gong MN, Moskowitz A. Estimated glomerular filtration rate among intensive care unit survivors: From the removal of race coefficient to cystatin C-based equations. J Crit Care 2024; 79:154450. [PMID: 37918130 DOI: 10.1016/j.jcrc.2023.154450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Black race coefficient used in serum creatinine (sCr)-based estimated glomerular filtration rate (eGFR) calculation may perpetuate racial disparities. Among intensive care unit (ICU) survivors, sCr overestimates kidney function due to sarcopenia. Cystatin C (cysC) is a race- and muscle mass-independent eGFR marker. We investigated the impact of removing the race coefficient from sCr-based eGFR and compared cysC- and sCr-based eGFR in ICU survivors. MATERIALS AND METHODS Among 30,920 patients from 2 institutions in the Bronx and Boston, eGFR was calculated at hospital discharge using sCr-based equations with and without race coefficient (eGFRsCr2009 and eGFRsCr2021). In a subset with available cysC between ICU admission and 1-year follow-up, sCr- and cysC-based estimates were compared. RESULTS eGFRsCr2021 was higher than eGFRsCr2009 by a median of 4 ml/min/1.73 m2 among non-Black patients and lower by a median of 8 ml/min/1.73 m2 among Black patients. Removing race coefficient reclassified 12.9% of non-Black subjects and 16.1% of Black subjects to better and worse eGFR category, respectively, and differentially impacted the prevalence of kidney dysfunction between the institutions due to differences in racial composition. Among 51 patients with available cysC (108 measurements), cysC-based estimates were lower than sCr-based estimates (median difference 9 to 16 ml/min/1.73 m2), resulting in reclassification to worse eGFR category in 34% to 53.5% of measurements. CONCLUSIONS Among ICU survivors, removal of race coefficient leads to lower eGFR in Black patients and may contribute to overestimation of kidney function in non-Black patients. While cysC is rarely used, estimates based on this marker are significantly lower than those based on sCr.
Collapse
Affiliation(s)
- Alberto Pinsino
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA; Division of Cardiology, Columbia University Irving Medical Center, NY, USA.
| | - Jianwen Wu
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Amira Mohamed
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alban Cela
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Tsai-Chin Yu
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Samuel J Rednor
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Michelle Ng Gong
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Ari Moskowitz
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
39
|
Min SH, Schnall R, Lee C, Topaz M. Examining racial differences in the network structure and properties of specific cognitive domains among older adults. GeroScience 2024; 46:1395-1406. [PMID: 37594597 PMCID: PMC10828399 DOI: 10.1007/s11357-023-00912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023] Open
Abstract
Older adults oftentimes experience cognitive aging which leads to varying degrees of cognitive impairment. Previous studies have found that racial and ethnic disparities exist in the prevalence and severity of cognitive impairment among older adults. Yet, little is known on the relationship among specific cognitive domains and how this relationship differs between African American and White older adults. This is a secondary data analysis of Wave II (2010-2011) data from the National Social Life, Health, and Aging Project (NSHAP). A total of 2,471 older adults aged between 65 and 85 years old (African American n = 452, White n = 2019) were included. Network analysis was used to visualize and characterize the network structure and to examine network stability. Then, network comparison test was conducted to compare the network properties of the cognitive network structure between African American and White older adults. African American older adults had a lower cognitive function in all cognitive domains than White older adults. While there was no significant difference in global strength, there was a significant difference in the network structure and strength centrality measure between the two groups (p < 0.05). The invariance edge strength test found the language-visuospatial edge to be significantly stronger in African American older adults. Clinicians need to understand the different cognitive function across multiple cognitive domains between African American and White older adults and routinely offer targeted and timely cognitive assessment and management in this population.
Collapse
Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA.
| | - Rebecca Schnall
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA
| | - Chiyoung Lee
- School of Nursing & Health Studies, University of Washington Bothell, 18115 Campus Way NE, Bothell, WA, 98011, USA
| | - Maxim Topaz
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA
| |
Collapse
|
40
|
Padilla M, Luna-Gierke RE, Carree T, Gutierrez M, Yuan X, Dasgupta S. Racial Differences in Social Determinants of Health and Outcomes Among Hispanic/Latino Persons with HIV-United States, 2015-2020. J Racial Ethn Health Disparities 2024; 11:574-588. [PMID: 36826779 PMCID: PMC10447624 DOI: 10.1007/s40615-023-01542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Hispanic/Latino people with HIV (PWH) experience disparities in health outcomes compared with other racial and ethnic groups. Disaggregated data based on race for Hispanic/Latino PWH in the United States are rarely reported, potentially masking inequities. METHODS The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV. We used weighted interview and medical record data collected from June 2015-May 2021 to examine differences in social determinants of health (SDH) and health outcomes by self-reported race among Hispanic/Latino adults with diagnosed HIV. RESULTS Compared with White Hispanic/Latino PWH, Black Hispanic/Latino PWH were more likely to be unemployed (PR, 1.4; CI, 1.2-1.8), have a disability (PR, 1.3; CI, 1.2-1.5), have experienced homelessness (PR, 1.8; CI, 1.2-2.6), and have been incarcerated (PR, 2.6; CI, 1.5-4.5). American Indian/Alaska Native (AI/AN) (PR, 1.8; CI, 1.1-2.7) and multiracial (PR, 2.0; CI, 1.4-2.9) Hispanic/Latino PWH were more likely to have experienced homelessness than White Hispanic/Latino PWH. Black (PR, 1.3; CI, 1.2-1.5) and multiracial (PR, 1.2; CI, 1.1-1.5) Hispanic/Latino PWH were more likely to be virally unsuppressed than White Hispanic/Latino PWH. CONCLUSION Black, multiracial, and AI/AN Hispanic/Latino PWH experience disparities in SDH and HIV outcomes. Lumping Hispanic/Latino people into one racial and ethnic category obscures health disparities, which might limit our progress towards reaching national HIV goals. Future studies should consider disaggregating by other factors such as Hispanic origin, place of birth, immigration status, and primary language. Doing so recognizes the diversity of the Hispanic/Latino population.
Collapse
Affiliation(s)
- Mabel Padilla
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- DHAP/NCHHSTP/CDC, 1600 Clifton Road NE MS E-46, Atlanta, GA, 30333, USA.
| | - Ruth E Luna-Gierke
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mariana Gutierrez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Yuan
- DLH Corporation, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
41
|
James SH, Strauss GP. Racial differences in attenuated psychotic symptoms during the COVID-19 pandemic. Early Interv Psychiatry 2024; 18:165-169. [PMID: 37434396 PMCID: PMC10782813 DOI: 10.1111/eip.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/24/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
AIM Rates of attenuated psychotic symptoms (APS) have increased during the COVID-19 pandemic; however, it is unclear whether this is most evident among individuals from marginalized racial groups. METHODS The current study evaluated APS screening data across a six-year period in the state of Georgia in the United States, spanning several years prior to and during the COVID-19 pandemic to evaluate interactions between time and race. Participants included 435 clinical help-seeking individuals. RESULTS The rate of individuals scoring above the APS screening cut-off was higher during the pandemic compared to pre-pandemic (41% vs 23%). This pandemic-related increase in APS was significant for Black, but not White or Asian participants. CONCLUSIONS Findings indicate APS are increasing during the COVID-19 pandemic among clinical help-seeking populations. Black individuals may be at greater risk for developing a psychotic disorder during the pandemic, suggesting increased need for screening, mental health monitoring, and treatment.
Collapse
|
42
|
Case BC, Hill A. Editorial: Disparity persists: The continued need to address racial differences in TAVR and SAVR. Cardiovasc Revasc Med 2024; 59:91-92. [PMID: 37932201 DOI: 10.1016/j.carrev.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Andrew Hill
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
43
|
Ng AC, Chu W. Confirmatory factor analysis of the Race-Based Traumatic Stress Symptom Scale in a sample of Asian American adults. Psychol Trauma 2024; 16:250-253. [PMID: 36892917 DOI: 10.1037/tra0001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The present study examined the factor structure of the Race-Based Traumatic Stress Symptom Scale (RBTSSS) in a sample of Asian American adults. METHOD The sample (n = 403) comprised 78% women, ages 18-72 years, who were administered the RBTSSS in a survey. A first-order and second-order confirmatory factor analysis (CFA) were conducted. RESULTS The RBTSSS demonstrated good internal consistency in the present study, Cronbach's αs = .78-.94. The first-order CFA revealed mixed model fit indices, χ²(1,253) = 3,431.52, p < .001, root mean square error of approximation (RMSEA) = .066, comparative fit index (CFI) = .875, Tucker-Lewis index (TLI) = .868. The second-order CFA revealed similar mixed findings, χ²(1,267) = 3,559.93, p < .001, RMSEA = .067, CFI = .869, TLI = .863. CONCLUSIONS Findings demonstrated mixed support for the factor structure of the RBTSSS in a sample of Asian American adults. Future research may consider additional testing of the RBTSSS in Asian Americans and further exploring the construct of racial trauma in Asian Americans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Andrea C Ng
- Department of Psychology, University of Hawai'i Manoa
| | - Wendy Chu
- Department of Psychology, University of South Carolina
| |
Collapse
|
44
|
Brody DL. New Findings in Long-Neglected Areas of Traumatic Brain Injury Research: Intimate Partner Violence, Effects of Neighborhood Disadvantage, and Racial Differences in Pain Catastrophizing. J Neurotrauma 2024; 41:303-304. [PMID: 38301248 DOI: 10.1089/neu.2024.29142.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
|
45
|
Wang R, Neparidze N, Ma X, Colditz GA, Chang S, Wang S. Racial differences in treatment and survival among older patients with multiple myeloma. Cancer Med 2024; 13:e6915. [PMID: 38234237 PMCID: PMC10905251 DOI: 10.1002/cam4.6915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/24/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Treatments for multiple myeloma (MM) have evolved over time and improved MM survival. While racial differences in MM treatment and prognosis between non-Hispanic African American (NHAA) and non-Hispanic White (NHW) patients are well-established, it is unclear whether they have persisted after the introduction of novel agents. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare linked database, our study investigated racial difference in the receipt of treatment within 1 year following diagnosis and assessed survival outcomes among Medicare beneficiaries (≥66 years) diagnosed with MM from 2007 to 2017. We applied multivariable Cox proportional hazards models to estimate the association between race and survival and presented hazard ratios (HRs). RESULTS Of 2094 NHAA and 11,983 NHW older patients with MM, 59.5% and 64.8% received treatment during the first year, respectively. Discrepancy in the proportion of patients receiving treatment between the two groups increased from 2.9% in 2007 to 2009 to 6.9% in 2014-2017. After controlling for relevant factors, patients who received treatment within the first year had lower mortality than those who did not (HR = 0.90, 95% confidence interval [CI]: 0.86-0.94). NHAA patients had a lower probability to receive treatments during the first year than NHW patients (HR = 0.91, 95% CI: 0.85-0.97) but had lower mortality (HR = 0.94, 95% CI: 0.88-1.00). The lower mortality was only observed among patients who received no treatment (HR = 0.84, 95% CI: 0.77-0.93); NHAA and NHW patients who received treatment had similar survival (p = 0.63). CONCLUSIONS The increasing racial disparity in treatment utilization over time is concerning. Efforts are needed to eliminate the barriers of receiving treatment.
Collapse
Affiliation(s)
- Rong Wang
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale UniversityNew HavenConnecticutUSA
| | - Natalia Neparidze
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale UniversityNew HavenConnecticutUSA
- Department of Internal MedicineSection of Hematology, Yale School of MedicineNew HavenConnecticutUSA
| | - Xiaomei Ma
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale UniversityNew HavenConnecticutUSA
| | - Graham A. Colditz
- Department of Surgery, Division of Public Health SciencesWashington University School of MedicineSt. LouisMissouriUSA
| | - Su‐Hsin Chang
- Department of Surgery, Division of Public Health SciencesWashington University School of MedicineSt. LouisMissouriUSA
| | - Shi‐Yi Wang
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale UniversityNew HavenConnecticutUSA
| |
Collapse
|
46
|
Hantzmon SV, Davenport CA, Das Gupta MN, Adekunle TA, Gaither SE, Olsen MK, Pinheiro SO, Johnson KS, Mahoney H, Falls A, Lloyd L, Pollak KI. Race differences in patient trust and distrust from audio-recorded cardiology encounters. Patient Educ Couns 2024; 119:108083. [PMID: 37989068 PMCID: PMC10842896 DOI: 10.1016/j.pec.2023.108083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Many have reported racial disparities in self-reported trust in clinicians but have not directly assessed expressions of trust and distrust in physician-patient encounters. We created a codebook to examine racial differences in patient trust and distrust through audio-recorded cardiologist-patient interactions. METHODS We analyzed data from a randomized controlled trial of audio-recorded outpatient cardiology encounters (50 White and 51 Black patients). We created a codebook for trust and distrust that was applied to recordings between White cardiologists and White and Black patients. We assessed differences in trust, distrust, and guardedness while adjusting for patient age, sex, and first appointment with the cardiologist. RESULTS Compared to White patients, Black patients had significantly lower expressions of trust ([IRR] [95 % CI]: 0.59 [0.41, 0.84]) and a significantly lower mean guarded/open score ([β] [95 % CI] -0.38 [-0.71, -0.04]). There was no statistically significant association between race and odds of at least one distrustful expression (OR [95 % CI] 1.36 [0.37, 4.94]). CONCLUSION AND PRACTICE IMPLICATIONS We found that coders can reliably identify patient expressions of trust and distrust rather than relying on problematic self-reported measures. Results suggest that White clinicians can improve their communication with Black patients to increase expressions of trust.
Collapse
Affiliation(s)
- Sarah V Hantzmon
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | | | - Maya N Das Gupta
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | - Temi A Adekunle
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Sarah E Gaither
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA; Samuel DuBois Cook Center on Social Equity, Duke University, Durham, NC, USA
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sandro O Pinheiro
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, NC, USA
| | - Hannah Mahoney
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Allison Falls
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Lauren Lloyd
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Kathryn I Pollak
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA.
| |
Collapse
|
47
|
Sakhuja S, Jaeger BC, Yano Y, Shimbo D, Lewis CE, Clark Iii D, Tajeu GS, Hardy ST, Allen NB, Shikany JM, Schwartz JE, Viera AJ, Muntner P. Race differences in ambulatory blood pressure monitoring parameters. Blood Press Monit 2024; 29:23-30. [PMID: 37889596 DOI: 10.1097/mbp.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Mean systolic and diastolic blood pressure (SBP and DBP) on ambulatory blood pressure (BP) monitoring (ABPM) are higher among Black compared with White adults. With 48 to 72 BP measurements obtained over 24 h, ABPM can generate parameters other than mean BP that are associated with increased risk for cardiovascular events. There are few data on race differences in ABPM parameters other than mean BP. METHODS To estimate differences between White and Black participants in ABPM parameters, we used pooled data from five US-based studies in which participants completed ABPM (n = 2580). We calculated measures of SBP and DBP level, including mean, load, peak, and measures of SBP and DBP variability, including average real variability (ARV) and peak increase. RESULTS There were 1513 (58.6%) Black and 1067 (41.4%) White participants with mean ages of 56.1 and 49.0 years, respectively. After multivariable adjustment, asleep SBP and DBP load were 5.7% (95% CI: 3.5-7.9%) and 2.7% (95% CI: 1.1-4.3%) higher, respectively, among Black compared with White participants. Black compared with White participants also had higher awake DBP ARV (0.3 [95%CI: 0.0-0.6] mmHg) and peak increase in DBP (0.4 [95% CI: 0.0-0.8] mmHg). There was no evidence of Black:White differences in awake measures of SBP level, asleep peak SBP or DBP, awake and asleep measures of SBP variability or asleep measures of DBP variability after multivariable adjustment. CONCLUSION Asleep SBP load, awake DBP ARV and peak increase in awake DBP were higher in Black compared to White participants, independent of mean BP on ABPM.
Collapse
Affiliation(s)
- Swati Sakhuja
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Byron C Jaeger
- Wake Forest University School of Medicine, Winston-Salem
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | | | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Shakia T Hardy
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Joseph E Schwartz
- Columbia University, New York, New York
- Stony Brook University, Stony Brook, New York, USA
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
48
|
O’Laughlin KN, Klabbers RE, Ebna Mannan I, Gentile NL, Geyer RE, Zheng Z, Yu H, Li SX, Chan KCG, Spatz ES, Wang RC, L’Hommedieu M, Weinstein RA, Plumb ID, Gottlieb M, Huebinger RM, Hagen M, Elmore JG, Hill MJ, Kelly M, McDonald S, Rising KL, Rodriguez RM, Venkatesh A, Idris AH, Santangelo M, Koo K, Saydah S, Nichol G, Stephens KA. Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection. Front Public Health 2024; 11:1324636. [PMID: 38352132 PMCID: PMC10861779 DOI: 10.3389/fpubh.2023.1324636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection. Methods Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point. Results Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36-2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06-2.02; much less, OR: 2.23; 95%CI: 1.38-3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25-2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21-2.46; much less, OR: 2.08; 95%CI: 1.18-3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13-3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60-5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10-3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02-2.51; much less, OR: 2.49; 95%CI: 1.40-4.44), and more missed work (OR: 2.25; 95%CI: 1.27-3.98). Discussion Awareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.
Collapse
Affiliation(s)
- Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Robin E. Klabbers
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Imtiaz Ebna Mannan
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Nicole L. Gentile
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
- Post-COVID Rehabilitation and Recovery Clinic, University of Washington, Seattle, WA, United States
| | - Rachel E. Geyer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Zihan Zheng
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Kwun C. G. Chan
- Department of Biostatistics, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Erica S. Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Ralph C. Wang
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michelle L’Hommedieu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Robert A. Weinstein
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Medicine, Cook County Hospital, Chicago, IL, United States
| | - Ian D. Plumb
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Ryan M. Huebinger
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Melissa Hagen
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Joann G. Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Mandy J. Hill
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Morgan Kelly
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kristin L. Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
- Center for Connected Care, Thomas Jefferson University, Philadelphia, PA, United States
| | - Robert M. Rodriguez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Arjun Venkatesh
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Ahamed H. Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michelle Santangelo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Katherine Koo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Sharon Saydah
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | | |
Collapse
|
49
|
Baum MY, Jacob BA. Racial differences in parent response to COVID schooling policies. Proc Natl Acad Sci U S A 2024; 121:e2307308120. [PMID: 38190517 PMCID: PMC10801896 DOI: 10.1073/pnas.2307308120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/08/2023] [Indexed: 01/10/2024] Open
Abstract
This paper examines whether school COVID-19 policies influenced enrollment differently by student age and race/ethnicity. Unlike much prior research, we i) analyze enrollments for virtually the entire U.S. public school population for both the 2020-2021 and 2021-2022 school years, ii) compare enrollment trends within districts in order to isolate subgroup heterogeneity from district characteristics, and iii) account for district selection into preferred learning modes. Analyzing data on over 9,000 districts that serve more than 90% of public school students in the United States, we find enrollment responses to COVID policies differed notably. We find that White enrollments declined more than Black, Hispanic, and Asian enrollments in districts that started the 2020-2021 school year virtually, but in districts that started in-person the reverse was true: Non-White enrollments declined more than White enrollments. Moreover, Black, Hispanic, and Asian families responded more than White families to higher COVID-19 death rates in the months preceding the start of the 2021 school year. In 2021-2022, enrollment differences by the previous year's learning mode persisted. Racial/ethnic differences did not vary by whether the district required masking in classrooms. These findings are consistent with the greater risk faced by communities of color during the pandemic and demonstrate an additional source of disparate impact from COVID policies.
Collapse
Affiliation(s)
- Micah Y. Baum
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI48109
| | - Brian A. Jacob
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI48109
- National Bureau of Economic Research, Cambridge, MA02138
| |
Collapse
|
50
|
Bullen AL, Katz R, Poursadrolah S, Short SAP, Long DL, Cheung KL, Sharma S, Al-Rousan T, Fregoso A, Schulte J, Gutierrez OM, Shlipak MG, Cushman M, Ix JH, Rifkin DE. Plasma proenkephalin A and incident chronic kidney disease and albuminuria in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. BMC Nephrol 2024; 25:16. [PMID: 38200454 PMCID: PMC10782722 DOI: 10.1186/s12882-023-03432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Plasma proenkephalin A (PENK-A) is a precursor of active enkephalins. Higher blood concentrations have been associated with estimated glomerular filtration rate (eGFR) decline in European populations. Due to the significant disparity in incident chronic kidney disease (CKD) between White and Black people, we evaluated the association of PENK-A with incident CKD and other kidney outcomes among a biracial cohort in the U.S. METHODS In a nested cohort of 4,400 participants among the REasons for Geographic And Racial Differences in Stroke, we determined the association between baseline PENK-A concentration and incident CKD using the creatinine-cystatin C CKD-EPI 2021 equation without race coefficient, significant eGFR decline, and incident albuminuria between baseline and a follow-up visit 9.4 years later. We tested for race and sex interactions. We used inverse probability sampling weights to account for the sampling design. RESULTS At baseline, mean (SD) age was 64 (8) years, 49% were women, and 52% were Black participants. 8.5% developed CKD, 21% experienced ≥ 30% decline in eGFR and 18% developed albuminuria. There was no association between PENK-A and incident CKD and no difference by race or sex. However, higher PENK-A was associated with increased odds of progressive eGFR decline (OR: 1.12; 95% CI 1.00, 1.25). Higher PENK-A concentration was strongly associated with incident albuminuria among patients without diabetes mellitus (OR: 1.29; 95% CI 1.09, 1.53). CONCLUSION While PENK-A was not associated with incident CKD, its associations with progression of CKD and incident albuminuria, among patients without diabetes, suggest that it might be a useful tool in the evaluation of kidney disease among White and Black patients.
Collapse
Affiliation(s)
- Alexander L Bullen
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.
| | - Ronit Katz
- University of Washington, Seattle, WA, USA
| | - Sayna Poursadrolah
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katharine L Cheung
- Division of Nephrology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Shilpa Sharma
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Nephrology Section, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Tala Al-Rousan
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Alma Fregoso
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Orlando M Gutierrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Dena E Rifkin
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| |
Collapse
|