Black Admissions Research Articles

Racial and ethnic disparities in the management and outcomes of cardiogenic shock complicating acute myocardial infarction.

It remains unclear if there remain racial/ethnic differences in the management and in-hospital outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in contemporary practice. We used the National inpatient Sample (2012-2017) to identify a cohort of adult AMI-CS hospitalizations. Race was classified as White, Black and Others (Hispanic, Asian/Pacific Islander, Native Americans). Primary outcome of interest was in-hospital mortality, and secondary outcomes included use of invasive cardiac procedures, length of hospital stay and discharge disposition. Among 203,905 AMI-CS admissions, 70.4% were White, 8.1% were Black and 15.7% belonged to Other races. Black AMI-CS admissions were more often female, with lower socio-economic status, greater comorbidity, and higher rates of non-ST-segment-elevation AMI-CS, cardiac arrest, and multi-organ failure. Compared to White AMI-CS admissions, Black and Other races had lower rates of coronary angiography (75.3% vs 69.3% vs 73.6%), percutaneous coronary intervention (52.7% vs 48.6% vs 54.8%), and mechanical circulatory devices (48.3% vs 42.8% vs 43.7%) (all p<0.001). Unadjusted in-hospital mortality was comparable between White (33.3%) and Black (33.8%) admissions, but lower for other races (32.1%). Adjusted analysis with White race as the reference identified lower in-hospital mortality for Black (odds ratio [OR] 0.85 [95% confidence interval {CI} 0.82-0.88]; p<0.001) and Other races (OR 0.97 [95% CI 0.94-1.00]; p=0.02). Admissions of Black race had longer hospital stay, and less frequent discharges to home. Contrary to previous studies, we identified Black and Other race AMI-CS admissions had lower in-hospital mortality despite lower rates of cardiac procedures when compared to White admissions.

Abstract 12600: Racial and Ethnic Disparities in the Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock

Background: We sought to evaluate the impact of race/ethnicity on the in-hospital outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in contemporary practice. Methods: This is a retrospective cohort study of AMI-CS admissions from the National inpatient Sample (2012-2017). Race was classified as White, Black and, Others (Hispanic, Asian/Pacific Islander, Native Americans). The primary outcome was in-hospital mortality, and secondary outcomes included use of invasive cardiac procedures, length of hospital stay and discharge disposition. Multivariate logistic regression and univariate analysis were used to analyze trends and outcomes. Results: We identified 203,905 (5.8%) AMI-CS admissions, of which 70.4% were White, 8.1% were Black and 15.7% of Other race. Black admissions were more often female, with lower socio-economic status, had higher comorbidities, and higher rates of non-ST-segment-elevation AMI-CS, cardiac arrest, and multi-organ failure. Black and Other races had lower rates of coronary angiography (69.3% vs 73.6% vs 75.3%), percutaneous coronary intervention (48.6% vs 54.8% vs 52.7%), coronary artery bypass grafting (15.1% vs 16.6% vs 19.7%) and mechanical circulatory devices (42.8% vs 43.7% vs 48.3%) compared to White races (all p &lt;0.001). Unadjusted in-hospital mortality was comparable for White (33.3%) and Black (33.8%) and lower for Other race (32.1%). After multivariable regression, the mortality for Black (odds ratio [OR] 0.85 [95% confidence interval {CI} 0.82-0.88]; p &lt;0.001) and Other race (OR 0.97 [95% CI 0.94-1.00]; p= 0.02) was lower than White race. Admissions of Black race had longer hospital stay, and lower rates of discharges to home. Conclusion: Contrary to previous studies, this contemporary study of racial disparities in AMI-CS noted Black and Other races had lower in-hospital mortality despite lower rates of cardiac procedures compared to White admissions.

Changes in neonatal admissions, care processes and outcomes in England and Wales during the COVID-19 pandemic: a whole population cohort study

ObjectivesThe COVID-19 pandemic instigated multiple societal and healthcare interventions with potential to affect perinatal practice. We evaluated population-level changes in preterm and full-term admissions to neonatal units, care processes and...

Substance use disorders among older populations: What role do race and ethnicity play in treatment and completion?

Research that explores the role of substance use treatment among older individuals is scarce. This paper offers a historical investigation of admissions and discharges for treatment episodes over the past two decades across race, ethnicity, gender, and age. Our results suggest that although older individuals are not typically associated with risky behavior, they are increasingly seeking treatment for substance use disorders. We find that substance use treatment admissions for people aged 50 and older have persistently increased over our sample period. Our findings also indicate that, on average, Black (relative to white) admissions across all ages are less likely to complete treatment and more likely to have their treatment terminated by a treatment facility. We also find some evidence that Hispanic admissions are relatively less likely to complete treatment across all age groups. Hispanics over 50 years old are also more likely to terminate treatment. Interestingly, among younger individuals in the most recent years of our sample, the disparity between minority completion rates has improved. Lastly, we find that males (relative to females) are more likely to complete a substance use treatment program but no more likely to have their treatment terminated by a substance use treatment facility.

Changes in Neonatal Admissions, Care Processes and Outcomes in England and Wales During the COVID-19 Pandemic

Background: The COVID-19 pandemic instigated multiple societal and healthcare interventions with potential to affect perinatal practice. We evaluated population-level changes in preterm and full-term admissions to neonatal units, care processes, and outcomes.Methods: We obtained information from the National Neonatal Research Database on all admissions to National Health Service neonatal units in England and Wales from 2012-2020. We evaluated admissions by gestational age, ethnicity, and Index of Multiple Deprivation, and key care processes and outcomes. We calculated the differences in numbers and rates between April-June 2020 (spring), the first three months of national lockdown and December 2019-February 2020 (winter), prior to introduction of mitigation measures (COVID period), and compared them with the corresponding differences in the seven previous years. We considered the COVID period highly unusual if the difference was smaller or larger than all previous corresponding differences, and calculated the level of confidence in this conclusion.Findings: Marked fluctuations occurred in all measures over the eight years with several highly unusual changes during the COVID period. Total admissions fell, having risen over all previous years (COVID difference: -1492; previous seven-year difference range: +100, +1617; pInterpretation: Our findings indicate substantial changes occurred in care pathways and clinical thresholds, with disproportionate effects on Black ethnic groups, during the immediate COVID-19 period, and raise the intriguing possibility that non-healthcare interventions may reduce extremely preterm births.Funding Information: Medical Research Council; Health Data Research UK.Declaration of Interests: NM reports grants outside the submitted work from the Medical Research Council, National Institute of Health Research, March of Dimes, British Heart Foundation, HCA International, Health Data Research UK, Shire Pharmaceuticals, Chiesi Pharmaceuticals, Prolacta Life Sciences, and Westminster Children’s Research Fund; NM is a member of the Nestle Scientific Advisory Board and accepts no personal remuneration for this role. NM reports travel and accommodation reimbursements from Chiesi, Nestle and Shire. All other authors report no declarations of interest.Ethics Approval Statement: The study was undertaken under approval from the Health Research Authority and Health and Care Research Wales, and with the agreement of all NHS neonatal units in England and Wales.

Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock.

Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2012–2017) was used to identify adult AMI-CS admissions receiving MCS support. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) or extracorporeal membrane oxygenation (ECMO). Self-reported race was classified as white, black and others. Outcomes included in-hospital mortality, hospital length of stay and discharge disposition. During this period, 90,071 admissions were included with white, black and other races constituting 73.6%, 8.3% and 18.1%, respectively. Compared to white and other races, black race admissions were on average younger, female, with greater comorbidities, and non-cardiac organ failure (all p < 0.001). Compared to the white race (31.3%), in-hospital mortality was comparable in black (31.4%; adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.93–1.05); p = 0.60) and other (30.2%; aOR 0.96 (95% CI 0.92–1.01); p = 0.10). Higher in-hospital mortality was noted in non-white races with concomitant cardiac arrest, and those receiving ECMO support. Black admissions had longer lengths of hospital stay (12.1 ± 14.2, 10.3 ± 11.2, 10.9 ± 1.2 days) and transferred less often (12.6%, 14.2%, 13.9%) compared to white and other races (both p < 0.001). In conclusion, this study of AMI-CS admissions receiving MCS devices did not identify racial disparities in in-hospital mortality. Black admissions had longer hospital stay and were transferred less often. Further evaluation with granular data including angiographic and hemodynamic parameters is essential to rule out racial differences.

Abstract 127: Racial Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

Introduction: Racial disparities in outcomes of acute myocardial infarction (AMI) and cardiac arrest (CA) exist. This study assessed the racial differences in the management and outcomes of CA complicating AMI to better inform clinical care. Hypothesis: We hypothesized that racial minorities would have worse outcomes with AMI-CA as compared to white patients. Methods: During 2012-2017, AMI admissions with a concomitant diagnosis of CA were identified from the National Inpatient Sample. Race was classified as white, black and others (Hispanic, Asian or Pacific Islander, Native American, Others). The primary outcome was racial disparities in in-hospital mortality. Secondary outcomes included racial disparities in invasive procedures and hospitalization characteristics. Results: We identified 3,504,225 admissions for AMI in the study period, of which 182,750 (5.2%) were complicated by CA. 74.8% were white, 10.7% were black and 14.5% belonged to other races. Black and other race AMI-CA admissions received less frequent early coronary angiography (41.4% vs 50.2% vs 52.8%), coronary angiography (61.9% vs 70.2% vs. 73.1% %), PCI (44.6% vs 53.0% vs 58.1%), CABG and mechanical circulatory support compared to white and other races. The mean time to coronary angiography was highest among blacks (3.4 ± 4.2 days) and lowest among whites (3.0 ± 3.7 days). Black and other races had significantly higher unadjusted mortality, however in a multivariable logistic regression analysis with white race as referent, black race was associated with lower in-hospital mortality (OR 0.95 [95% CI 0.91-0.99]; p =0.007) whereas other races had higher in-hospital mortality (OR 1.11 [95% CI 1.08-1.15]; p &lt;0.001) compared to white race. AMI-CA admissions of black race had longer length of hospital stay, higher rates of palliative care consultation, less frequent DNR status use, and fewer discharges to home. Admissions of other races had higher use of DNR status and higher hospitalization costs compared to whites and blacks. Conclusions: Significant racial disparities exist in in-hospital mortality among AMI admissions complicated with CA. Further quantitative and qualitative research into the equitable care of racial minorities with AMI-CA is needed to address this disparity.

Prospective payment system and racial/ethnic disparities: a national retrospective observational study in anaemia complication among end-stage renal disease patients in the US

BackgroundA series of policy changes in 2011 altered reimbursement arrangements and guidance on use of erythropoiesis-stimulating agents for end-stage renal disease (ESRD) patients with anaemia in the US. While the policy changes were principally directed at care delivered in an outpatient setting, these had the potential to affect inpatient care also. This study used HCUP-NIS data (2008–2016) to examine trends in recorded anaemia among ESRD hospitalizations and analyse disparities in inpatient outcomes among ethnic groups following policy changes.MethodsThe International Classification of Diseases codes were used to identify ESRD admissions, recorded anaemia due to chronic kidney disease (CKD), and to generate an age-adjusted Deyo-Charlson comorbidity index. Linear splines with a knot placed at the time point of policy changes and multivariable logistic regression were used to examine the likelihood of recorded anaemia, adjusted for a range of socio-demographic and clinical covariates. Difference-in-difference analyses investigated the impact of policies on recorded anaemia. Other outcomes included hospital cost, mortality and place of discharge.ResultsThe percentage of inpatient episodes with recorded anaemia arising from CKD increased from 26.2% in 2008 to 50.0% in 2016. Anaemia was more likely to be recorded as a complication of ESRD among minority ethnic groups and Native American admissions, in particular, (OR 1.20, 95%CI 1.15–1.25) relative to White American admissions; and these disparities widened following changes to reimbursement. Minorities were less likely to die in hospital and to be discharged to another healthcare facility, and (with the exception of Black American admissions) they were more expensive to treat.ConclusionsOur findings provide evidence of an increase in recorded anaemia consistent with a shift of patients from outpatient to inpatient settings in the wake of changes to reimbursement enacted in 2011. In addition, the study highlights the existence of ethnic disparities that widened after the policy initiated reimbursement changes.

The Ecology of Race and Punishment across Cities

In an era of mass incarceration in the United States, neighborhood context plays a significant role in demographic patterns of imprisonment. This paper examines the preprison neighborhood environment of racial and ethnic groups within the Massachusetts prison admission population. The data include over 12,000 prison records of individuals sentenced to state prison for a criminal offense between 2009 and 2014. Findings indicate significant spatial variation across racial groups: The most disadvantaged preprison neighborhoods exist in small cities outside of Boston. Whites and Hispanics who enter prison from small cities, suburbs, and rural towns in Massachusetts lived in significantly more concentrated disadvantage than their counterparts in Boston. However, black men and women coming from Boston and small cities lived in the greatest concentrated disadvantage among the black admission population. Black– and Hispanic–incarcerated people lived in significantly higher levels of concentrated disadvantage as compared to the average neighborhood of white–incarcerated people. Results indicate that the prison population is drawn from a diverse set of communities, and suggest that an understanding of the full picture of differences in neighborhood context may play an important role in understanding community–level conditions of mass incarceration and inform interventions aimed at ameliorating the community–level impacts of imprisonment.

Abstract 22: Association of Hospital Race and Payer Mix With Inpatient Mortality Among Patients Admitted for Acute Coronary Syndrome, Heart Failure and Arrhythmia

Background: Patient characteristics insufficiently explain observed disparities in cardiovascular outcomes among hospitalized patients, suggesting a role for community or hospital-level factors. Here, we evaluate the association of hospital segregation by black race and payer mix with inpatient mortality using a nationally representative sample of hospitalizations. Methods: Using the National Inpatient Sample (NIS), we identified adult hospitalizations with a primary diagnosis of acute coronary syndrome (n=550,005), heart failure (n=863,870) and atrial/ventricular arrhythmia (n=656,070). We divided NIS hospitals in to quartiles based on percent of hospital black and low payer (Medicaid or uninsured) admissions. We utilized logistic regression to determine whether hospital race or low payer quartile was associated with inpatient mortality among those admitted for acute coronary syndrome (ACS), heart failure (HF) and atrial/ventricular arrhythmia. Models were adjusted for age, sex, patient comorbidities, and hospital characteristics. Results: The mean age (95% CI) of the ACS, HF, and arrhythmia cohorts was 66.8 (66.7-67.0), 71.7 (71.5-71.9) and 70.0 (69.8-70.1) years, respectively. In adjusted models, ACS patients admitted to hospitals with &gt;18.7-25.7% (Q2), &gt;25.7%-34.0% (Q3), and &gt;34.0% (Q4) low payer admissions experienced a 12% (OR 1.12, 1.03-1.20), 10% (OR 1.10, 1.01-1.19), and 12% (OR 1.12, 1.02-1.23) increased odds of inpatient mortality, respectively, when compared to hospitals with ≤18.7% low payer admissions (Q1). In the arrhythmia cohort, patients admitted to hospitals with &gt;34.0% (Q4) low payer admissions experienced a 25% increased odds of inpatient mortality compared to those admitted to hospitals with ≤18.7% (Q1) low payer admissions (OR 1.25, 1.11-1.41). Among heart failure patients, those admitted to hospitals with &gt;20.5% (Q4) black patients experienced a 17% (OR 0.83, 0.74-0.93) decreased odds of inpatient mortality compared to those admitted to hospitals with ≤4% (Q1) black admissions. Conclusion: Hospital low payer makeup positively associates with odds of inpatient mortality among patients admitted for acute coronary syndrome and arrhythmia. Hospital black makeup inversely associates with odds of inpatient mortality among patients admitted for heart failure.

The Paradox of End-of-Life Hospital Treatment Intensity among Black Patients: A Retrospective Cohort Study.

Black patients are more likely than white patients to die in the hospital with intensive care and life-sustaining treatments and less likely to use hospice. Regional concentration of high end-of-life (EOL) treatment intensity practice patterns may disproportionately affect black patients. We calculated and compared race-specific hospital-level EOL treatment intensity in Pennsylvania. We conducted a retrospective cohort analysis of Pennsylvania acute care hospital admissions, 2001-2007, among black and white admissions ≥21 years old at high probability of dying (HPD) (≥15% predicted probability of dying at admission). We calculated hospitals' race-specific observed, expected, and Bayes' shrunken observed-to-expected ratios of intensive care unit (ICU) admission, ICU length of stay (LOS), intubation/mechanical ventilation, hemodialysis, tracheostomy, and gastrostomy among HPD admissions; and an empirically weighted EOL treatment intensity index summing these ratios. There were 35,609 black HPD admissions (27,576 unique patients) and 311,896 white HPD admissions (252,662 unique patients) to 182 hospitals. Among 95 hospitals with ≥30 black HPD admissions, 80% of black admissions were concentrated in 29 hospitals, where black-specific observed and expected EOL measures were usually higher than white-specific measures (p < 0.001 for all but 5/24 measures). Hospitals' black-specific and white-specific observed-to-expected ratios of ICU and life-sustaining treatment (LST) (rho 0.52-0.90) and EOL index (rho = 0.92) were highly correlated. However, black-specific observed-to-expected ratios and overall EOL intensity index were consistently lower than white-specific ratios (p < 0.001 for all except hemodialysis). In Pennsylvania, black-serving hospitals have higher standardized EOL treatment intensity than nonblack-serving hospitals, contributing to black patients' relatively higher use of intensive treatment. However, conditional on being admitted to the same high-intensity hospital and after risk adjustment, blacks are less intensively treated than whites.

Racial disparities in primary prevention of incontinence among older adults at nursing home admission.

Maintaining continence of nursing home (NH) residents promotes dignity and well-being and may reduce morbidity and healthcare treatment costs. To determine the prevalence of older continent adults who received primary prevention of incontinence at NH admission, assess whether there were racial or ethnic disparities in incontinence prevention, and describe factors associated with any disparities. The design was an observational cross-sectional study of a nation-wide cohort of older adults free of incontinence at NH admission (n = 42,693). Four US datasets describing NH and NH resident characteristics, practitioner orders for NH treatment/care, and socioeconomic and sociodemographic status of the community surrounding the NHs were analyzed. Disparities were analyzed for four minority groups identified on the minimum data set using the Peters-Belson method and covariates at multiple levels. Twelve percent of NH admissions received incontinence prevention. There was a significant disparity (2%) in incontinence prevention for Blacks (P < 0.05): Fewer Black admissions (8.6%) were observed to receive incontinence prevention than was expected had they been part of the White group (10.6%). The percentage of White admissions receiving incontinence prevention was 10.6%. Significant factors associated with disparity in receiving incontinence prevention were having greater deficits in ADL function and cognition and more comorbidities. No disparity disadvantaging the other minority groups was found. Greater efforts for instituting incontinence prevention at the time of NH admission are needed. Eliminating racial disparities in incontinence prevention seems an attainable goal. Appropriate staff training, organizational commitment, and monitoring progress toward equitable outcomes can help achieve this goal. Neurourol. Urodynam. 36:1124-1130, 2017. © 2016 Wiley Periodicals, Inc.

Supply vs. demand under an affirmative action ban: Estimates from UC law schools

Affirmative action bans can reduce black enrollment not only by reducing black admission advantages (contracting demand) but also by reducing applications (contracting supply) from black students who can still gain admission but prefer alternative schools that still practice affirmative action. When affirmative action was banned at UC law schools, Berkeley's black applications and enrollment declined by almost half even as black admission rates rose relative to whites. I ask whether black enrollment at UC law schools would have markedly declined even if black supply had not contracted. I find in a large sample of students applying to law schools nationwide that black supply contractions were driven mostly or entirely by students unlikely to gain admission under the ban, yielding stronger post-ban black applicant pools. Holding applicant pools constant, I estimate that the ban reduced black admission rates at both Berkeley and UCLA by half. Hence, black enrollment would likely have plummeted even if black supply had not contracted—as could occur under a nationwide ban that eliminates affirmative-action-practicing alternatives.

Disparities in 30-Day Rehospitalization Rates Among Medicare Skilled Nursing Facility Residents by Race and Site of Care.

To examine racial and site-of-care disparities in all-cause and potentially avoidable 30-day rehospitalization rates among a national cohort of Medicare skilled nursing facility (SNF) residents. We analyzed the 2012 Minimum Data Set, Medicare inpatient claims, and other data. Multivariable logistic regressions were used to adjust for resident demographic, functional, and diagnostic characteristics, as well as observed SNF and geographic factors. Conditional fixed effects for SNFs were further used to adjust for both observed and unobserved factors. Independent effects of black race and site-of-care groups were estimated, where sites were defined using proportions of black Medicare admissions to the SNF. The 30-day all-cause and potentially avoidable rehospitalization rates were 21.9% and 8.8%, respectively, for black residents (n=120,508), and 17.7% and 7.9% for white residents (n=1,182,003). Racial disparities persisted after adjustment for resident characteristics. Moreover, risk-adjusted disparities were essentially related to the type of SNFs to which residents were admitted; after controlling for SNF sites, significant racial disparity disappeared for potentially available rehospitalizations. Black residents and white residents admitted to SNFs with high proportions of black admissions (>25%) were 31% and 19%, respectively, more likely to be rehospitalized than white residents admitted to SNFs caring for only a small percentage of black postacute residents (<3%). Compared with white SNF residents, black SNF residents are more likely to be rehospitalized even after adjusting for patient risk factors. Black-white disparities, especially in potentially preventable rehospitalizations, are largely due to the fact that black residents tend to be admitted to the small number of SNFs with very high rehospitalization rates.

Race is Not an Independent Risk Factor for Poor Outcomes in Clostridium difficile Infection

Purpose: To determine if race is a predictor of poor C. difficile infection (CDI) outcomes, as measured by rates of colectomy and death. Methods: Demographic and clinical data for all admissions to Rhode Island Hospital (RIH) from January 1st 2006 to December 31st 2010 were collected. All CDI cases during this period were reviewed to determine age, gender, race, mode of acquisition [hospital-acquired (HA), healthcare-associated (HCA), or community-acquired (CA)], need for colectomy, and death. Poor outcome was defined as CDI in a patient who underwent colectomy and/or died during the same hospitalization. We performed bivariate analyses of CDI cases with or without poor outcome by age, gender, mode of acquisition, relapse status, and race. Multiple logistic regression was performed to determine if race was an independent predictor of poor outcome. Results: There were 142,122 admissions to RIH. Of these, 82% were white, while 9% were black. Over the same time period, there were 2,109 cases of CDI in 1,951 unique patients. The mean (±SD) age of CDI patients was 68 (±18). Of the CDI cases, 86% occurred in whites and 8% in blacks. CDI acquisition was HA in 59%, HCA in 13%, and CA in 28%. Colectomy occurred in 42 patients (2%). There were 318 deaths (15%). Whites had a significantly higher proportion of CDI cases when compared to overall RIH admissions (86% vs. 82%, p<0.001). However, there was no significant difference in the proportions of black CDI cases and overall black admissions (8% vs. 9%, p=0.7). A subgroup analysis of CDI relapsers vs. non-relapsers revealed no significant differences in age, gender, or race. Individuals who died were significantly older than survivors (74±14 vs. 67±19, p<0.001). There were significant differences in mortality by mode of acquisition, with HA and HCA infections resulting in death in 18% and 17% of cases, respectively, while CA infection had a lower mortality rate of 8% (p<0.001). There was no significant difference in colectomy rate between blacks and whites (3% vs. 2%, p=0.7). Similarly, there was no significant difference in mortality between blacks and whites (13% vs. 15%, p=0.4). In a multiple logistic regression model, accounting for age and mode of acquisition, black race was neither protective against nor a risk factor for a poor outcome (OR 1.0, 95% CI 0.6-1.7). Conclusion: White individuals may contract CDI more frequently than would be expected from their proportion of overall hospital admissions. However, race does not appear to be an independent predictor of poor CDI outcomes. As shown in previous studies, both age and mode of acquisition are associated with poor outcomes in CDI.

Nathan Glazer's Warning: The Secondary Consequences of the Sharp Drop in Black Admissions to the Most Selective Law Schools: Racial Conservatives Say Not to Worry

Nathan Glazer's Warning: The Secondary Consequences of the Sharp Drop in Black Admissions to the Most Selective Law Schools: Racial Conservatives Say Not to Worry

Inpatient admissions to specialty mental health organizations: Forecasts 1990 to 2010

This paper projects inpatient admissions to specialty mental health organizations for white, nonwhite, and black persons in five year intervals between 1990 and 2010. The authors suggest that it is reasonable to expect significant increases in the number of white, nonwhite, and black inpatient admissions to all specialty mental health organizations, except state and county mental hospitals, during the next 20 years. Among the different specialty mental health organizations, non-federal general hospitals are expected to have the largest increases, and state and county mental hospitals, the smallest.

Black Admissions at Top-Tier Liberal Arts Colleges

Black Admissions at Top-Tier Liberal Arts Colleges

Wits as an ‘open’ university 1939–1959: black admissions to the university of the Witwatersrand

In 1959 the Nationalist government, after a decade of power, finally secured the passage through parliament of legislation to impose apartheid structures on South Africa's university system. The country's two previously ‘open universities‘, the University of the Witwatersrand, Johannesburg (Wits) and the University of Cape Town (UCT), were now largely ‘closed’ to black applicants. This paper examines the process by which Wits became an ‘open university’ in the first instance, with particular emphasis on the significance of World War II for the opening of the medical school, but it also demonstrates that the university's doors were never much more than half open to blacks. Certain faculties and departments, most prominently Dentistry, never admitted black students, and in 1953–4 the university appeared to wish to appease the Nationalist government by instituting a quota system for black admissions to its medical school. In the formal social and sporting spheres, official university policy was one of applyi...

Police Admissions to a Psychiatric Hospital

Between October 1983 and December 1985, 268 patients were brought by police to a psychiatric hospital in south London under section 136 of the Mental Health Act 1983. Comparisons were made between 'blacks' and 'whites' on several clinical and demographic variables. The vast majority of admissions received a psychiatric diagnosis. An excess of black admissions was recorded. Black men were younger, were more likely than whites to be given neuroleptics, to be put on compulsory orders, and to be given an out-patient appointment when discharged from hospital. More black men were given a case-note diagnosis of schizophrenia or drug-induced psychosis. The differences in clinical management between ethnic groups could be at least partly accounted for by these differences in diagnosis. Treatment did not appear to be independent of diagnosis among the black admissions.