Policy Brief.

Research suggests the social, physical, and socioeconomic contexts of residing in segregated neighborhoods may negatively affect mental health. To assess the association between racial residential segregation and prenatal mental health among Asian, Black, Hispanic, and White individuals. This population-based cross-sectional study was conducted in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system. Participants included self-identified Asian, Black, Hispanic, and White pregnant individuals who attended at least 1 prenatal care visit at KPNC between January 1, 2014, and December 31, 2019. Data were analyzed from January 14, 2023, to August 15, 2024. Racial residential segregation, defined by the local Getis-Ord Gi* statistic, was calculated in each racial and ethnic group and categorized as low (<0), medium (0-1.96), or high (>1.96). A positive Gi* statistic indicates overrepresentation (greater clustering or segregation) of the racial and ethnic group in an index census tract and neighboring tracts compared with the larger surrounding geographic area. Prenatal depression and anxiety defined by diagnoses codes documented in the electronic health record between the first day of the last menstrual period and the day prior to birth. Among the 201 115 participants included in the analysis (mean [SD] age, 30.8 [5.3] years; 26.8% Asian, 6.6% Black, 28.0% Hispanic, and 38.6% White), prenatal depression and anxiety were highest in Black individuals (18.3% and 18.4%, respectively), followed by White (16.0% and 18.2%, respectively), Hispanic (13.0% and 14.4%, respectively), and Asian (5.7% and 6.4%, respectively) individuals. Asian (40.8% vs 31.1%) and Black (43.3% vs 22.6%) individuals were more likely to live in neighborhoods with high vs low segregation, while Hispanic individuals were equally likely (34.3% vs 34.7%). High compared with low segregation was associated with greater odds of prenatal depression (adjusted odds ratio [AOR], 1.25 [95% CI, 1.10-1.42]) and anxiety (AOR, 1.14 [95% CI, 1.00-1.29]) among Black individuals. High segregation was associated with lower odds of prenatal depression among Asian (AOR, 0.75 [95% CI, 0.69-0.82]), Hispanic (AOR, 0.88 [95% CI, 0.82-0.94]), and White (AOR, 0.91 [95% CI, 0.86-0.96]) individuals. Similar associations were found for anxiety among Asian (AOR, 0.80 [95% CI, 0.73-0.87]) and Hispanic (AOR, 0.88 [95% CI, 0.82-0.93]) but not White (AOR, 0.95 [95% CI, 0.90-1.00]) individuals. In this cross-sectional study, racial and ethnic residential segregation was associated with worse prenatal mental health for Black individuals but better mental health for Asian, Hispanic, and White individuals. Policies reducing segregation and its impact may improve mental health outcomes in pregnant Black individuals.

The effect of race/ethnicity and adversities on smoking cessation among U.S. adult smokers

Performance of the Pooled Cohort Equations in Hispanic Individuals Across the United States: Insights From the Multi‐Ethnic Study of Atherosclerosis and the Dallas Heart Study

Racial Differences in Natriuretic Peptide Levels: The Dallas Heart Study

Childhood family structures are crucial for long-term health and well-being. However, the effects of an increasingly common family structure—multigenerational households comprising a child, parent(s), and grandparent(s)—remained underexplored. Using panel data from the National Longitudinal Survey of Youth 1979 and its young adult sample (N = 8,230), we examine trajectories of psychological distress among White, Black, and Hispanic adolescents and young adults across three dimensions of early life multigenerational coresidence: presence, duration, and onset. We find that Hispanic children who lived in multigenerational households, especially those beginning coresidence before age 1, reported steeper declines in distress and improved mental health over time. By contrast, multigenerational coresidence was consistently associated with higher distress levels among White adolescents and young adults. We do not find evidence of an association between multigenerational coresidence and Black children’s mental health trajectories. These findings highlight potential racial patterns and add to our understanding of racial disparities in health.

Apolipoprotein E (APOE)*2 and APOE*4 are, respectively, the strongest protective and risk-increasing, common genetic variants for late-onset Alzheimer disease (AD), making APOE status highly relevant toward clinical trial design and AD research broadly. The associations of APOE genotypes with AD are modulated by age, sex, race and ethnicity, and ancestry, but these associations remain unclear, particularly among racial and ethnic groups understudied in the AD and genetics research fields. To assess the stratified associations of APOE genotypes with AD risk across sex, age, race and ethnicity, and global population ancestry. This genetic association study included case-control, family-based, population-based, and longitudinal AD-related cohorts that recruited referred and volunteer participants. Data were analyzed between March 2022 and April 2023. Genetic data were available from high-density, single-nucleotide variant microarrays, exome microarrays, and whole-exome and whole-genome sequencing. Summary statistics were ascertained from published AD genetic studies. The main outcomes were risk for AD (odds ratios [ORs]) and risk of conversion to AD (hazard ratios [HRs]), with 95% CIs. Risk for AD was evaluated through case-control logistic regression analyses. Risk of conversion to AD was evaluated through Cox proportional hazards regression survival analyses. Among 68 756 unique individuals, analyses included 21 852 East Asian (demographic data not available), 5738 Hispanic (68.2% female; mean [SD] age, 75.4 [8.8] years), 7145 non-Hispanic Black (hereafter referred to as Black) (70.8% female; mean [SD] age, 78.4 [8.2] years), and 34 021 non-Hispanic White (hereafter referred to as White) (59.3% female; mean [SD] age, 77.0 [9.1] years) individuals. There was a general, stepwise pattern of ORs for APOE*4 genotypes and AD risk across race and ethnicity groups. Odds ratios for APOE*34 and AD risk attenuated following East Asian (OR, 4.54; 95% CI, 3.99-5.17),White (OR, 3.46; 95% CI, 3.27-3.65), Black (OR, 2.18; 95% CI, 1.90-2.49) and Hispanic (OR, 1.90; 95% CI, 1.65-2.18) individuals. Similarly, ORs for APOE*22+23 and AD risk attenuated following White (OR, 0.53, 95% CI, 0.48-0.58), Black (OR, 0.69, 95% CI, 0.57-0.84), and Hispanic (OR, 0.89; 95% CI, 0.72-1.10) individuals, with no association for Hispanic individuals. Deviating from the global pattern of ORs, APOE*22+23 was not associated with AD risk in East Asian individuals (OR, 0.97; 95% CI, 0.77-1.23). Global population ancestry could not explain why Hispanic individuals showed APOE associations with less pronounced AD risk compared with Black and White individuals. Within Black individuals, decreased global African ancestry or increased global European ancestry showed a pattern of APOE*4 dosage associated with increasing AD risk, but no such pattern was apparent for APOE*2 dosage with AD risk. The sex-by-age-specific interaction effect of APOE*34 among White individuals (higher risk in women) was reproduced but shifted to ages 60 to 70 years (OR, 1.48; 95% CI, 1.10-2.01) and was additionally replicated in a meta-analysis of Black individuals and Hispanic individuals (OR, 1.72; 95% CI, 1.01-2.94). Through recent advances in AD-related genetic cohorts, this study provided the largest-to-date overview of the association of APOE with AD risk across age, sex, race and ethnicity, and population ancestry. These novel insights are critical to guide AD clinical trial design and research.

Minoritized racial and ethnic groups, such as American Indian and Black individuals, often receive lower quality health care compared with White individuals. There is limited understanding of how these disparities extend to obstetric care, particularly when comparing the quality of care at the actual delivery hospital vs the nearest obstetric hospital based on the birthing individual's residence. To examine inequality in care based on the actual delivery hospital and the closest delivery hospital to the birthing individual's residential zip code centroid. This population-based retrospective cohort study used data from 5 states (2008 to 2020 for Michigan, Oregon, and South Carolina; 2008 to 2018 for Pennsylvania; and 2008 to 2012 for California). Individuals delivering a fetal death or a live birth with gestational age between 22 to 44 weeks were included. Analysis was conducted between February and August 2024. Race and ethnicity. The obstetric inequality index was calculated using Gini coefficients from Lorenz curves for American Indian, Asian, Black, and Hispanic birthing individuals compared with White individuals, with hospitals ranked by their standardized morbidity ratio for nontransfusion severe maternal morbidity. There were 6 418 635 birthing individuals across 549 hospitals (23 050 American Indian individuals [0.4%], 463 342 Asian individuals [7.2%], 807 738 Black individuals [12.6%], 1 645 922 Hispanic individuals [25.6%], and 3 279 315 White individuals [51.1%]). Compared with White individuals, American Indian and Black individuals delivered at lower-quality hospitals, while there was no significant difference for Asian and Hispanic individuals (delivery hospital inequality index: American Indian, 0.07 [95% CI, 0.03 to 0.11]; Asian, -0.02 [95% CI, -0.08 to 0.04]; Black, 0.15 [95% CI, 0.12 to 0.19]; Hispanic -0.04 [95% CI, -0.09 to 0.01]). Black individuals lived closer to lower-quality hospitals than White individuals (closest hospital inequality index for Black individuals: 0.11 [95% CI, 0.07 to 0.14]). Asian and Hispanic individuals had similar closest hospital inequality indices to White individuals. The inequality index for Black individuals would have been lower if individuals had delivered at their nearest hospital. This cohort study found that American Indian and Black individuals delivered at lower-quality hospitals than White individuals. The disparity in care between Black and White birthing individuals would have been reduced if individuals had delivered at their nearest hospital.

Introduction: Black, American Indian/Alaska Native (AI/AN), and Hispanic individuals are more likely to be diagnosed with distant stage colorectal cancer (CRC). Racial/ethnic disparities in diagnosis stage are largely driven by gaps in screening/early detection steps, including whether testing is routine screening vs. diagnostic after symptom onset and whether there is adequate receipt of follow-up after abnormal routine screening. Identifying these unexplored gaps can help inform targeted efforts. Methods: Data from the 2019, 2021, and 2023 nationally representative National Health Interview Survey were pooled to identify 50–75-year-old individuals age-eligible for CRC screening without a prior diagnosis of colon or rectum cancer. Prevalence of self-reported colonoscopy in the past 10 years (alone or in combination with stool testing) and the main reason for this test was estimated by race/ethnicity. Reported reasons of “routine exam” or “follow-up after earlier exam or screening test” were used to operationalize preventative testing and “because of a problem” as diagnostic testing for symptom follow-up. Logistic regression models estimated adjusted prevalence ratios (aPR) comparing race/ethnic groups, adjusted for age, sex, US region, and survey year. Education level and insurance type was explored as a potential mediators to race/ethnic disparities via sequential adjustment analyses. Results: 3999 Hispanic, 28722 non-Hispanic (NH)-White, 4388 NH-Black, 1700 NH-Asian, and 567 NH-AI/AN individuals were age-eligible for CRC screening. Overall, 63.3% reported colonoscopy receipt, with about 82% of these individuals receiving the test as a “routine exam”, 5.3% as a follow-up from an earlier test or screening exam (7% when restricted to those who also had a stool test), and 9.8% “because of a problem”. Colonoscopy testing as a “routine exam” was lower in AI/AN individuals (69.1% vs. 81.6% in White individuals, aPR:0.87, 95% CI:0.8-0.94) while testing “because of problems” was higher for both AI/AN (17.2%, aPR:1.60, 95% CI: 1.20-2.13) and Hispanic (13.4%, aPR:1.30, 95% CI:1.13-1.51) individuals. Conversely, colonoscopy as "follow-up after an earlier exam or screening test" was lower in Black (3.6%, aPR:0.66, 95% CI:0.52-0.84) and Asian (3.1%, aPR:0.51, 95% CI:0.34-0.76) individuals compared to White (5.8%) individuals. Adjustment for education and insurance type attenuated but did not eliminate disparities for Hispanic, AI/AN and Black individuals, whereas adjustment did not alter the magnitude of disparities for Asian individuals. Conclusion: Gaps in whether testing was routine vs. symptom follow up were prominent for AIAN and Hispanic individuals whereas follow-up testing gaps were prominent for Black and Asian individuals. Mediation analysis suggested that improving equitable healthcare access could partially remediate disparities for Hispanic, AI/AN, and Black, but addressing other barriers (linguistic, cultural, knowledge or psychosocial) may be important for Asian individuals. Citation Format: Priti Bandi, Rebecca Landy, Jessica Star, Rebecca Siegel, Larry G. Kessler, Chyke A. Doubeni. Racial/ethnic disparities in reasons for colonoscopy testing: Contribution of education level and insurance type, US adults, 2019-2023 [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C137.

Bridging the Racial Disparity Gap in Lipid-Lowering Therapy.

Poor hypertension awareness and underuse of guideline-recommended medications are critical factors contributing to poor hypertension control. Using data from 8095 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey (2011-2018), we examined recent trends in racial and ethnic differences in awareness and antihypertensive medication use, and their association with racial and ethnic differences in hypertension control. Between 2011 and 2018, age-adjusted hypertension awareness declined for Black, Hispanic, and White individuals, but the 3 outcomes increased or did not change for Asian individuals. Compared with White individuals, Black individuals had a similar awareness (odds ratio, 1.20 [0.96-1.45]) and overall treatment rates (1.04 [0.84-1.25]), and received more intensive antihypertensive medication if treated (1.41 [1.27-1.56]), but had a lower control rate (0.72 [0.61-0.83]). Asian and Hispanic individuals had significantly lower awareness rates (0.69 [0.52-0.85] and 0.74 [0.59-0.89]), overall treatment rates (0.72 [0.57-0.88] and 0.69 [0.55-0.82]), received less intensive medication if treated (0.60 [0.50-0.72] and 0.86 [0.75-0.96]), and had lower control rates (0.66 [0.54-0.79] and 0.69 [0.57-0.81]). The racial and ethnic differences in awareness, treatment, and control persisted over the study period and were consistent across age, sex, and income strata. Lower awareness and treatment were significantly associated with lower control in Asian and Hispanic individuals (P<0.01 for all) but not in Black individuals. These findings highlight the need for interventions to improve awareness and treatment among Asian and Hispanic individuals, and more investigation into the downstream factors that may contribute to the poor hypertension control among Black individuals.

Racial and ethnic disparities in severe maternal morbidity from pregnancy through 1-year postpartum

Black and Hispanic patients are less likely than white patients to use oral anticoagulants for atrial fibrillation. Little is known about racial/ethnic differences in use of direct-acting oral anticoagulants (DOACs) for atrial fibrillation. To assess racial/ethnic differences in the use of oral anticoagulants, particularly DOACs, in patients with atrial fibrillation. This cohort study used data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, a prospective, US-based registry of outpatients with nontransient atrial fibrillation 21 years and older who were followed up from February 2013 to July 2016. Data were analyzed from February 2017 to February 2018. Self-reported race/ethnicity as white, black, or Hispanic. The primary outcome was use of any oral anticoagulant, particularly DOACs. Secondary outcomes included the quality of anticoagulation received and oral anticoagulant discontinuation at 1 year. Of 12 417 patients, 11 100 were white individuals (88.6%), 646 were black individuals (5.2%), and 671 were Hispanic individuals (5.4%) with atrial fibrillation. After adjusting for clinical features, black individuals were less likely to receive any oral anticoagulant than white individuals (adjusted odds ratio [aOR], 0.75 [95% CI, 0.56, 0.99]) and less likely to receive DOACs if an anticoagulant was prescribed (aOR, 0.63 [95% CI, 0.49-0.83]). After further controlling for socioeconomic factors, oral anticoagulant use was no longer significantly different in black individuals (aOR, 0.78 [95% CI, 0.59-1.04]); among patients using oral anticoagulants, DOAC use remained significantly lower in black individuals (aOR, 0.73 [95% CI, 0.55-0.95]). There was no significant difference between white and Hispanic groups in use of oral anticoagulants. Among patients receiving warfarin, the median time in therapeutic range was lower in black individuals (57.1% [IQR, 39.9%-72.5%]) and Hispanic individuals (51.7% [interquartile range {IQR}, 39.1%-66.7%]) than white individuals (67.1% [IQR, 51.8%-80.6%]; P < .001). Black and Hispanic individuals treated with DOACs were more likely to receive inappropriate dosing than white individuals (black patients, 61 of 394 [15.5%]; Hispanic patients, 74 of 409 [18.1%]; white patients, 1003 of 7988 [12.6%]; P = .01). One-year persistence on oral anticoagulants was the same across groups. After controlling for clinical and socioeconomic factors, black individuals were less likely than white individuals to receive DOACs for atrial fibrillation, with no difference between white and Hispanic groups. When atrial fibrillation was treated, the quality of anticoagulant use was lower in black and Hispanic individuals. Identifying modifiable causes of these disparities could improve the quality of care in atrial fibrillation.

Racial/ethnic and income-based differences in the use of surgery for cervical and lumbar disorders in New York State: a retrospective analysis

BackgroundThere is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States.Methods and findingsThis retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6–60.5) than Hispanic (52.7, 95% CI 52.1–53.4) and White individuals (38.6, 95% CI 38.4–38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85–2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74–1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80–1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73–1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41–2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11–1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health.ConclusionsIn this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.

Introduction: Nationally representative data evaluating recent trends in racial and ethnic differences in prevalence and treatment of metabolic syndrome (MetS) are sparse. Methods: We evaluated 21-year trends in the prevalence and treatment of MetS and individual components in 21,602 adults, using data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2020. We used weighted linear regression to estimate time trends and compared these trends by race and ethnicity. Results: Among participants, the mean age was 47.7 (SD, 2.2) years; 51 % were female; 78 %, 12.7%, and 9.3% were White, Black, and Hispanic. From 1999 to 2020, the prevalence of MetS as well as the prevalences of elevated waist circumference and elevated fasting glucose increased significantly for Black, Hispanic, and White individuals (P&lt;0.01 for all). The prevalences of elevated blood pressure and elevated triglyceride increased among Black individuals but did not change among Hispanic and White individuals. The use of antihypertensive, antihyperglycemic, and lipid-modifying medications also increased for all racial/ethnic subgroups. Racial/ethnic disparities in prevalence and treatment of MetS and individual components persisted throughout the study period. Compared with White individuals, Black individuals had higher use of antihypertensive medications but lower use of lipid-modifying medications (P&lt;0.01 for all). Hispanic individuals had lower use of antihypertensive medications and lipid-modifying medications (P&lt;0.01 for all). Across all racial/ethnic subgroups, less than 60% and 30% of people with medication indications received lipid-modifying and antihyperglycemic medications, respectively. Conclusions: Temporal trends suggest an increase in prevalence of MetS. There were persistent racial/ethnic disparities in use of antihypertensive, antihyperglycemic, and lipid-modifying medications among people with medication indications.