Black Population Research Articles

Topological Analysis of U.S. City Demographics

AbstractWe apply persistent homology, the main method in topological data analysis, to the study of demographic data. Persistence diagrams efficiently summarize information about clusters or peaks in a region’s demographic data. To illustrate how persistence diagrams can be used for exploratory analysis, we undertake a study of the 100 largest U.S. cities and their Black and Hispanic populations. We use our method to find clusters in individual cities, determine which cities are outliers and why, measure and describe change in demographic patterns over time, and roughly categorize cities into distinct groups based on the topology of their demographics. Along the way, we highlight the advantages and disadvantages of persistence diagrams as a tool for analyzing geospatial data.

ANÁLISE DO PERFIL EPIDEMIOLÓGICO DAS INTERNAÇÕES E ÓBITOS POR LEUCEMIA NO BRASIL NA FAIXA ETÁRIA PEDIÁTRICA: UMA ANÁLISE DO ANO DE 2017 ATÉ A ATUALIDADE.

The present study is based on the epidemiological analysis of leukemia, the most common childhood cancer, which has a high prevalence and incidence rate in the pediatric population, as well as a significant impact on mortality in this age group. The objective of this research is to analyze the national profile of hospital admissions and deaths due to leukemia from 2017 to the present. For this purpose, secondary data from the Hospital Information System (SIH) and the Mortality Information System (SIM), collected from the DATASUS digital platform, were used. The selected variables included age groups under 1 to 19 years, male and female gender, and racial/ethnic categories of white, mixed-race, black, Asian, and indigenous populations. The results revealed a higher prevalence and incidence of hospitalizations for leukemia over the years, particularly in the Southeast, Northeast, and South regions, with a significant concentration in the 1 to 9-year age group, among males, and in the mixed-race and white populations. Regarding the number of deaths, substantial data were observed in the Southeast, Northeast, and North regions, predominantly in individuals aged 10 to 19 years, among males, and in the white and mixed-race populations. Given the above, the urgency of addressing leukemia in the pediatric population in Brazil is evident, as it impacts patients’ quality of life, the vital statistics of this population, and the healthcare system. The data highlight the need for public health actions to reduce regional disparities in specialized cancer care, late diagnoses, and ineffective and limited treatments.

Genocide, Peripheral Fascisms, and Late Neocolonialism in Palestine/Israel and Brazil

The Israeli genocide of the Palestinians in Gaza and the Brazilian genocide against Black and Indigenous populations provide an opportunity to investigate the processes of elimination in settler-colonial nations. This article aims to examine the conditions under which settler states can exercise sovereign power against subaltern populations. It is argued that the escalation of structural genocide to expand settler colonization and govern surplus populations was facilitated by the rise of far-right governments. Nevertheless, the Brazilian state’s capacity to exercise sovereign power has been restricted by the transition to neocolonialism, which enabled Brazilians to contain the far right. The space for the promotion of the largest genocide in recent history in Gaza was created by the Israeli effort to abort any possibility of transition to neocolonialism in Palestine, resulting in the maintenance of direct settler colonialism, the far-right government, and its close alliance with the United States.

VIOLÊNCIA INSTITUCIONAL: DESIGUALDADES RACIAIS NO ATENDIMENTO HOSPITALAR A MULHERES NEGRAS: REVISÃO DE LITERATURA.

ABSTRACT: Institutional violence in the healthcare sector is manifested through racial inequalities that disproportionately affect Black women in hospital care. This study aims to review the existing literature on the barriers faced by these women, such as limited access to services, lower quality of care, and resulting psychological impacts. The research seeks to analyze how institutional racism affects hospital care for Black women, identifying the main factors that perpetuate these inequalities and their consequences for physical and mental health. The methodology includes a bibliographic review of studies published between 2016 and 2023, obtained from databases such as SciELO, PubMed, and LILACS, with an emphasis on the impact of institutional racism on the health of the Black population, with a primary focus on Black women.

Structural discrimination and HIV-related health outcomes among Black transgender populations in the Southern United States: a scoping review

Background Transgender populations are disproportionately impacted by HIV with an overall HIV rate of 13.7%. Non-Hispanic Black/African Americans (44.2%) have the highest transgender HIV prevalence compared to Hispanics (25.8%) and White (6.7%). Moreover, Black transgender populations face debilitating structural level factors including: racism and discrimination, stigma, poverty, unemployment or underemployment, high rates of food insecurity, unstable housing, lack of insurance, criminalization, incarceration, and violence that negatively impact their health and well-being. Methods In this article, we conducted a scoping review to analyze the impact of structural discrimination on HIV prevention, care, and treatment among Black transgender people in the Southern United States. Results Of the 397 articles identified, twelve manuscripts eligible for full-text review were assessed based on the inclusion/exclusion criteria. A total of five articles with a combined total of 341 study participants met the eligibility criteria. All five studies included in this scoping review reported different yet interrelated structural discrimination factors. These were grouped into three categories: (a) socioeconomic factors, (b) access to healthcare, and (c) stigma and discrimination. Conclusions Black transgender populations face extreme structural discrimination creating barriers to access and adherence to HIV prevention, care, and treatment programs. There is an urgent need for additional research and the implementation of tailored, culturally-appropriate, multi-level interventions to address structural discrimination-related factors that increase HIV vulnerability for Black transgender populations.

Sickle cell trait in non-firearm arrest-related deaths of Black persons.

The role of sickle cell trait (SCT) in sudden exertional death is well-recognized in sports and military training. However, it is not yet studied for non-firearm arrest-related death (NF-ARD). With extensive multi-pronged searches, a large database (n = 1389) of NF-ARDs was established. For the years 2006-2021 (inclusive) there were 50 NF-ARDs of Black persons in which postmortem evidence of SCT was found. A control cohort consisted of 414 NF-ARDs of Black persons with no reported SCT. The mean age for SCT cases was 33.1 ± 10.4 years versus 37.0 ± 10.4 years for the control group (p = 0.01). The body-mass index for SCT cases was 28.3 ± 6.6 kg/m2 versus 30.7 ± 7.6 kg/m2 for the control group (p = 0.03). The prevalence of cardiomegaly was 21% for SCT cases versus 39% in the control cohort (p = 0.008). The postmortem prevalence of SCT in NF-ARDs of Black persons (n = 50, 10.7%) was higher than the prevalence of SCT in the US Black population, which is 7.1% (p = 0.003). In this study of NF-ARDs in Black persons, the prevalence of SCT and the differences between the SCT cases and the control cohort suggest that exertional collapse associated with sickle cell trait may be a contributory factor in NF-ARDs.

Interventions employed to address vaccine hesitancy among Black populations outside of African and Caribbean countries: a scoping review.

Black people are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. This scoping review explored interventions that have been employed to address vaccine hesitancy among Black population outside of African and Caribbean countries. This review provides several strategies for addressing this deep-rooted public health problem. The scoping review followed the five-step framework outlined by Arksey and O'Malley. It complies with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Research studies that examined interventions utilized to promote vaccine confidence within Black populations living outside of African and Caribbean countries were reviewed. A total of 20 articles met the inclusion criteria for this study: 17 were quantitative studies and three were mixed-method studies. This scoping review highlighted six themes: educational advancement, messaging, multi-component approaches, outreach efforts, enhancing healthcare access, and healthcare provider leadership. The review identified effective interventions for addressing vaccine hesitancy among Black populations outside Africa and the Caribbean, emphasizing education, multidimensional approaches, and healthcare provider recommendations. It calls for more qualitative research and interventions in countries like Canada and the UK to enhance vaccine confidence and reduce mistrust.

Population genetic structure of the bottlenose dolphin in the Turkish waters based on mtDNA sequences with implications for the Black Sea subspecies Tursiops truncatus ponticus

The bottlenose dolphin is a widely distributed species found in temperate waters, including the Mediterranean and Black Seas. The Black Sea population is recognized as a distinct subspecies, Tursiops truncatus ponticus, due to genetic and morphological differences. This study analyzed mitochondrial DNA (mtDNA) sequences of 73 bottlenose dolphin samples collected between 1999 and 2016 along the Turkish Black Sea coast, Turkish Straits System (TSS), Aegean, and Mediterranean Seas revealing 14 haplotypes, eight of which are reported here for the first time. The haplotype network shows two main nodes with star-like sub-networks, but no apparent geographic pattern. The lack of geographical groupings of haplotypes indicates the high mobility of the species within the sampled area. The northern Black Sea bottlenose dolphins (NBS) appear to be genetically differentiated from those in the southwestern Black Sea (SBS), Mediterranean, and Atlantic Ocean, but not from the TSS and Aegean Sea populations. Besides, SBS bottlenose dolphins were differentiated only from those in the western Mediterranean (WM) and the Atlantic. Therefore, NBS and SBS bottlenose dolphins should at least be categorized as different populations. However, contrary to some previous studies there was no evidence supporting the classification of Black Sea bottlenose dolphins as a separate subspecies. The TSS differs only from the Atlantic and the Aegean, and functions like a migratory ‘melting pot’ for surrounding populations. Despite the largest sample size, NBS bottlenose dolphins exhibited the lowest haplotype and nucleotide diversity. This low genetic diversity and potential isolation from adjacent populations highlight the need for prioritizing the conservation of NBS bottlenose dolphins.

Effects of COVID-19 Pandemic on Patients with Kidney Disease and Kidney Replacement Therapy: Focus on Black, Asian, and Minority Ethnic Groups: A Systematic Review

Background COVID-19 pandemic significantly affected health services globally, resulting in poorer outcomes, especially in patients with chronic long-term illnesses. For patients with chronic kidney disease (CKD), potential effects might include, among others, disruption of dialysis services, reduced kidney transplant rates, and increased incidence of severe COVID-19 infections and death. Such differences may be further exacerbated in patients from Black, Asian, and Minority Ethnic (BAME) populations with CKD. Aim To conduct a systematic review to identify the global impact of COVID-19 on kidney replacement therapy and to determine the extent of any disparities in BAME patients with CKD. Materials and Methods PubMed, Embase (OVID), and CINAHL (EBSCO) databases were searched for relevant studies published between January 1, 2019, and November 24, 2023. Predetermined inclusion/exclusion criteria were utilized to shortlist abstracts. Two reviewers independently appraised articles and systematically extracted data and assessed the quality of studies. Thematic analysis was used for evidence synthesis; no quantitative meta-analysis was conducted. The review was registered with PROSPERO (CRD42020201771). Results Two hundred and eleven abstracts were shortlisted, 52 articles were identified for full-text review, and 20 articles published worldwide were included in the final review. Themes identified included: effects of the COVID-19 pandemic on patients with CKD undergoing dialysis (six studies); impact on kidney transplant recipients and transplant programs (eight studies); and differential impact of COVID-19 on BAME patients in comparison with the general population (six studies). The presence of CKD in patients with COVID-19 was identified as a poor prognostic factor, along with obesity, lower socioeconomic status, and BAME population. Conclusion The findings of this targeted review demonstrate the global impact of COVID-19 on various aspects of kidney replacement therapy and provide evidence of important disparities for BAME patients. In case of any future pandemic, vulnerable groups undergoing hemodialysis and those with kidney allografts will require special attention and care.

Abstract 4136145: All-cause and Cause-specific Mortality Disparities in the District of Columbia: Temporal Trends from 2000 to 2020

Background: A report evaluating all-cause mortality in 30 major U.S. cities documented that inequality between Black and White populations in Washington, D.C. was the greatest. However, little is known about disparities in cause-specific mortality over time or by racial groups. Aims: Evaluate trends in all-cause and cause-specific mortality in D.C. from 2000 to 2020 by race, and concurrently examine trends in cardiovascular (CV) risk factors. Methods: Using the CDC WONDER database, we calculated age-adjusted mortality rates per 100,000 persons (2000-2020) for Non-Hispanic Black and Non-Hispanic White populations in D.C. and corresponding rate ratios. Average Annual Percentage Change (AAPC) was examined with joinpoint regression. We examined the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) using the Behavioral Risk Factor Surveillance System (2000-2020). Results: Among 102,710 deaths that occurred in D.C. (80% Black), cardiovascular diseases (CVD, 32%) and cancer (22%) accounted for over half of the deaths. All-cause mortality declined between 2000-2012 (AAPC: -2.9%, 95% CI: -5.6, 1.0) but stagnated between 2012-2018 (AAPC:-1.1%, 95% CI: -4.6, 0.9) and increased after 2018 (AAPC: 7.7%, 95% CI: 0.6, 11.9). CVD mortality declined between 2000-2011 and plateaued thereafter among Black individuals, contrasting with a monotonous decline (AAPC: -4.7%, 95% CI: -5.3, -4.0) among White individuals, resulting in a magnification of the disparities. Cancer mortality decreased over time for both White and Black individuals (AAPC: -3.4%, 95% CI: -3.9, -2.9 vs. AAPC: -1.8%, 95% CI: -2.1, -1.4, respectively), with a greater magnitude in White individuals. Risk factors were more prevalent among Black individuals over the period. Conclusion: In D.C., the mortality rate is higher in Black vs. White populations, and disparities are increasing over time. While CVD and cancer mortality rates declined overall, profound disparities remain. CVD risk factors are more common in Black populations, with persisting disparities. There is an urgent need for CVD prevention and management, tailored to Black populations in D.C.

Abstract 4138301: Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data

Background: Hyperlipidemia (HLD) is a major risk factor for cardiovascular disease (CVD). Little is known regarding temporal variation in CVD mortality related to HLD. The COVID-19 pandemic added complexity to factors influencing CVD mortality. Question: What are the yearly trends and impact of the COVID-19 pandemic on HLD-related CVD mortality in the United States? Methods: Mortality and demographic data for adults were obtained from CDC repository from 1999-2020, using ICD-10 codes HLD (E78.0-E78.5) and CVD (I00-I99). Age adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models evaluated mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to calculate projected AAMR in 2020, subsequently compared to actual 2020 death rates to estimate pandemic-attributed excess deaths. Results: A total of 483,155 HLD-related CVD deaths were recorded between 1999-2020. Despite the CVD mortality decline in general population, HLD-related CVD AAMR rose from 36.33 [95% CI, 35.52-37.13] in 1999 to 99.77 [98.67-100.87] in 2019. Ischemic heart diseases (AAMR 49.39) were the most common causes of death while hypertension had the highest annual mortality increase (AAPC +10.23%) in populations with HLD. Higher HLD-related CVD mortality was observed in males (AAMR 104.87) than females (AAMR 61.93), in those ≥75 years (AAMR 646.45) than 35-75 years (AAMR 54.11), in non-Hispanic (NH) (AAMR 82.49) than Hispanic (AAMR 58.98) populations, and in rural (AAMR 89.98) than urban (AAMR 78.94) regions. NH Black populations (AAMR 84.35) and Western US regions (AAMR 96.88) had the highest HLD-related CVD. The first year of COVID-19 pandemic resulted in 10.55% excess HLD-related CVD death, with the most prominent increase in the 35-75 years age group (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) populations. Conclusions: Our study revealed an increase in HLD-related CVD mortality which was exacerbated by the COVID-19 pandemic. Higher CVD mortality disproportionately affected males, Black, elderly (≥75 years), and rural populations with HLD. Further research is needed to validate our findings and identify contributing factors.

Abstract 4141457: Forms of Childhood Maltreatment and Subclinical Cardiovascular Disease Risk in Black men and women

Background: Exposure to specific forms of childhood maltreatment have been associated with cardiovascular disease (CVD) risk factors and CVD events in adulthood. Heterogenous experiences of childhood maltreatment across race and sex exist, yet there is little evidence regarding these relationships and CVD risk in Black populations. Aims: To investigate the association between various forms of childhood maltreatment (emotional, general, physical, and sexual abuse) and surrogate markers of vascular dysfunction and test whether sex modify these associations. Methods: Forms of childhood maltreatment and indices of vascular function were assessed in a cohort of healthy Black adults without known CVD (n=404) from a large metropolitan southeastern city. Childhood maltreatment was assessed using the Early Trauma Inventory short form (ETISR-SF) consisting of physical, sexual, emotional, and general domains. A trauma severity index score was calculated by summing the indexes for each of the four domains. Higher scores are indicative of higher traumatic life events before age 18 years. Outcomes of central augmentation index (cAIx) corrected for a heart rate of 75 bpm and carotid femoral pulse wave velocity (CfPWV) were measured as indices of wave reflections and arterial stiffness using applanation tonometry (Sphygmocor Inc.), and central pulse pressure (CPP) was calculated as the difference between the aortic systolic and diastolic blood pressures. Associations between each domain and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models. Results: Mean age of the cohort was 53 + 10.3 years, 61% women. Exposure to emotional [ b = -1.5%, 95%CI: -2.7,-0.3] and physical abuse [ b = -1.3%, 95%CI: -2.5,-0.2] was associated with cAIx overall but not CPP or CfPWV after adjusting for sociodemographic, clinical factors, health behaviors, and depressive symptoms. Significant emotional abuseXsex ( P= 0.014) and physical abuseXsex ( P=< 0.001) interactions were identified for cAIx. Among women, physical abuse was associated with higher cAIx [ b =1.5%, 95%CI: 0.6, 2.4] and among men emotional [ b =-1.6%, 95%CI: -3.2, -0.0] and physical [ b =-1.7%, 95%CI: -3.1, -0.3] abuse was associated with lower cAIx. Conclusions: Exposure to emotional and physical abuse as children was associated with vascular dysfunction; moreover, exposure to physical abuse among women and not men have adverse clinical implications for CVD risk and prospects for enhanced preventive care.

Abstract 4132212: Trends in Atrial Fibrillation or Flutter Related Mortality Among Adults in the United States: Insights from CDC WONDER Database from 1999-2020

Background: Atrial fibrillation or flutter (Afib/AFL) incidence rates continue to rise and are linked to significant mortality, particularly in older populations. Our analysis examines Afib/AFL mortality trends across different demographics and regions in the U.S. from 1999 to 2020, highlighting the importance of understanding these patterns. Aim: To guide preventive measures that alleviate the impact of Afib/AFL and identify high-risk populations and regions, we sought to quantify trends associated with Afib/AFL related mortality in the U.S. Methods: We conducted a comprehensive search of death certificates from 1999-2020 using Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database focusing on Afib/AFL mortality in adults with ICD-10 codes I48. Gender, race, geographical and urban-rural parameters were investigated by calculating annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons using the Joinpoint Regression Program (Joinpoint V 4.9.0.0, National Cancer Institute). Results: A total of 2,581,488 deaths occurred in patients with Afib/AFL from 1999 to 2020. The AAMR displayed an abrupt rise from 2018 to 2020 (APC: 8.51; 95% CI: 4.84-10.47). Men consistently exhibited a higher AAMR (overall AAMR male: 79.4, 95% CI 79.3-79.6; female: 60.8, 95% CI 60.7-60.9). Non-metropolitan areas showed higher AAMRs than metropolitan areas (overall AAMR non-metropolitan areas: 74.9, 95% CI 74.7-75.1; metropolitan: 67.2, 95% CI 67.1-67.2). Disparities were also observed in AAMRs by region with the West region showing the highest mortality rate with a notable rise between 2010 and 2020 (APC: 3.70, 95% CI 3.30-5.37). Non-hispanic (NH) White population showed the highest mortality (overall AAMR: 74.2, 95% CI 74.1-74.3), followed by NH American Indian (AAMR: 50.3), NH Black (AAMR: 45.8), NH Asian (AAMR: 35.0) and Hispanic (AAMR: 37.9) populations. Conclusion: Mortality from Afib/AFL has risen from 1999 to 2020. Men, NH white populations, and residents in non-metropolitan areas and Western U.S. are at higher risk. Targeted interventions and strategic healthcare resource allocation are needed to address these disparities and improve outcomes.

Abstract 4137949: Trends in Hypertensive Related Heart Disease Mortality Among Older Adults in the United States, 1999 - 2020

Background: Hypertensive heart disease (HHD) is a major global health concern that impairs quality of life and causes significant morbidity and mortality, especially among older adults. We aimed to examine the temporal trends in HHD-related mortality in the United States (U.S.) between 1999 to 2020. Methods: The CDC WONDER multiple-cause of death database was utilized to identify HHD-related mortality among adults aged ≥ 55 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, gender, race, and geographic region. Results: A total of 1,186,183 HHD-related deaths were recorded among individuals ≥ 55 years old. Overall, AAMR increased from 36.7 in 1999 to 133.9 in 2020. AAMRs showed a steady increase between 1999 and 2017 (APC: 3.72 [95% CI: 2.72 to 4.49]), followed by a surge from 2017 to 2020 (APC: 14.28 [95% CI: 8.21 to 22.93]). Gender-based analysis showed a constantly higher AAMR among older men compared to older women. Variations in AAMR based on race revealed that Non-Hispanic (NH) Black or African American population had the highest AAMRs. Geographic disparities among states showed that the District of Columbia had the highest AAMR while Nebraska had the lowest. The southern U.S. also had a consistently higher AAMR followed by the West, Northeast, and Midwest. Moreover, metropolitan areas had a higher AAMR than nonmetropolitan areas. Conclusion: Our findings reveal an increase in HHD-related deaths and demonstrate that NH Blacks consistently bear a higher burden of disease mortality. These insights underscore the importance of integrating demographic and geographic variables into public health planning and interventions.

Abstract 4139135: Trends in Stroke Related Mortality in Atrial Fibrillation Patients Aged 25 and Older in the United States: Insights from the CDC WONDER Database

Background: Stroke associated with atrial fibrillation (AF) is a significant cause of mortality. This CDC analysis delves into mortality trends due to stroke in AF patients aged ≥ 25 years, from 1999 to 2020. By analyzing extensive datasets we scrutinized how factors such as gender, race, region of residence, and level of urbanization intersect with mortality rates. Methods: Death data from 1999 to 2020 was analyzed using the Centers for Disease Control and Prevention database, employing ICD codes I48 for AF and I64 for stroke. Age-adjusted mortality rate (AAMR) per 100,000 people with 95% confidence intervals was calculated for the total population, stratified by gender, race, urban/rural status, and census region. The Joinpoint regression software was used to calculate annual percentage change (APC) trend for each stratification. Results: In the U.S. between 1999 and 2020, total of 331,106 deaths occurred among adults due to AF associated with stroke. Deaths occurred predominantly in medical facilities (43.2%). The overall AAMR for AF associated stroke decreased from 26.8 per 100,000 in 1999 to 18.4 in 2020, with an AAPC of -2.05 (p value < 0.000001). Additionally, AAMR declined significantly from 1999 to 2018 (APC: -2.65, p value = 0.012398), followed by an increase from 2018 to 2020 (APC: 3.90, p value = 0.220356). Women had slightly higher AAMRs compared to men (men: 6.6; women: 7.1). The AAMR for women reduced substantially from 1999 to 2020 than for men. AAMRs varied among racial/ethnic groups, with White patients having the highest AAMR (7.4), followed by Blacks (5.4), American Indian or Alaska Natives (4.6), Asian or Pacific Islanders (4.5), and Hispanic population (4.1). AAMRs decreased for all races except for Black population. Geographically, AAMRs ranged from 4.3 in Nevada to 11.9 in Vermont, with the Western region showing the highest mortality (AAMR: 7.9). Nonmetropolitan areas had slightly higher AAMRs than metropolitan areas, with both experiencing a decrease over the study period. Conclusion: This analysis depicts significant disparities in mortality rates attributed to stroke associated with AF and underscores the need for larger population-based studies to further understand the primary factors influencing the observed geographical, racial, and gender differences. Targeted interventions and equitable healthcare access are crucial to mitigate these disparities and improve outcomes for this population.

Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data.

Hyperlipidemia is a major cardiovascular disease (CVD) risk factor, but limited data on its mortality trends in CVD over time. We assessed annual hyperlipidemia-related CVD mortality trends in the United States, including the COVID-19 pandemic's impact. Mortality data were obtained from CDC repository between 1999 and 2020 among patients ≥15 years old, using ICD-10 codes hyperlipidemia (E78.0-E78.5) and CVD (I00-I99). Age-adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models were used to evaluate mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to project 2020 AAMR, estimating pandemic-attributed excess deaths. From 1999 to 2020, 483,155 hyperlipidemia-related CVD deaths occurred. Despite a general CVD mortality decline, hyperlipidemia-related CVD AAMR rose from 36.33 in 1999 to 99.77 in 2019. Ischemic heart diseases (AAMR 49.39) were the leading cause while hypertension had the highest mortality increase (AAPC +10.23%). Mortality rates were higher in males (AAMR 104.87), non-Hispanic (AAMR 82.49), and rural populations (AAMR 89.98). Highest mortality was observed in Black populations (AAMR 84.35), those ≥75 years (AAMR 646.45), and Western US regions (AAMR 96.88). During the first pandemic year, deaths exceeded projections by 10.55%, with notable increases among ages 35-75 (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) groups. Hyperlipidemia-related CVD mortality has risen over the past two decades, further heightened by the COVID-19 pandemic, with higher impact on males, Black Americans, the elderly, and rural residents. Further study is needed to understand contributing factors and mitigate disparities.

An Urgent Need to Promote Equitable Buprenorphine Administration for Opioid Use Disorder in the Emergency Department.

In recent years, there has been a marked surge in opioid overdose deaths among Black, Latino, and Native American populations. The emergency department (ED) represents a crucial opportunity to address these racial and ethnic inequities by initiating buprenorphine and providing referral for ongoing addiction treatment. Yet Black, Latino, and Native American populations encounter substantial inequities in ED-based addiction treatment access. Within this context, Koeber et al conducted their cross-sectional study of ED patients who screened positive for opioid misuse to evaluate inequities in buprenorphine administration. The authors found that Black ED patients were less likely (odds ratio, 0.56; 95% confidence interval, 0.35-0.88) to receive buprenorphine. There is an urgent need for mixed methods research to understand the drivers of these inequities and interventions to address the multilevel factors across the opioid use disorder care continuum to promote equitable, accessible, person-centered opioid use disorder treatment.

Correlation of Eight (8) Polymorphisms and Their Genotypes with the Risk Factors of Cardiovascular Disease in a Black Elderly Population

Single nucleotide polymorphisms (SNPs) have been associated with the development of cardiovascular diseases (CVDs). This study correlated eight SNPs with the risk factors of CVD in a black elderly population. Genotyping was used to detect eight polymorphisms; rs675 (ApoA-IV), rs699 (Angiotensinogen (AGT)), rs247616 and rs1968905 (Cholesteryl ester transfer protein (CETP)), rs1801278 (Insulin receptor substrate 1 (IRS-1)), rs1805087 (Methylenetetrahydrofolate reductase (MTHFR)) and rs28362286 and rs67608943 (Proprotein convertase subtilisin/kexin type 9 (PCSK9)), as well as their genotypes in deoxyribonucleic acid (DNA) extracted from peripheral blood. The cardiovascular risk (CVR) measurements were conducted on a Konelab 20i Thermo Scientific autoanalyzer and an enzyme-linked immunoassay (ELISA) assay. International Business Machines Corporation (IBM)® Statistical Package for the Social Sciences ® (SPSS) version 28 was used for statistical analysis. The heterozygous and homozygous genotypes of the eight polymorphisms were detected with the corresponding CVD risk factors. Subgroup analysis indicated that certain genotype carriers exhibited variations in their concentrations of CVR factors compared to others; however, these differences did not reach statistical significance. For example, carriers of the G genotype of the rs699 polymorphism showed marginally different blood pressure readings compared to the AG genotype carriers. The multiple linear regression analysis indicated that the only significant association was between PCSK9 and the rs28362286 (p = 0.029) polymorphism. The findings of our study show that single nucleotide polymorphisms are disseminated across the human genome. The heterozygous and homozygous genotypes of the SNPs require further investigation as they may have independent and possible collective roles in increasing the risk of CVDs.

FROM THE TRAFFICKERS TO THE OUTSKIRTS: DOMINATION, RESISTANCE AND STRUGGLE

This article examines the subordination of the black population in Brazil from the colonial period to the present day, highlighting the persistence of racist legislation in the Brazilian legal system and the marginalization of Afro-Brazilian voices in literary historiography. Using the interdisciplinary approach of Law and Literature, the research analyzes divergences and convergences in the treatment of Afro-descendants throughout Brazilian history, focusing on the short story A escrava, by Maria Firmina dos Reis. It is argued that Firmina's exclusion from canonical historiographies is a reflection of a political-ideological project rooted in Brazilian Romanticism, whose purpose was to sustain an elitist and Eurocentric national identity. The study concludes by defending the implementation of an anti-racist education, based on Law 10.639/2003, as a way to decolonize knowledge, promoting representation and recognition of Afro-Brazilian contributions in the literary, historical and cultural spheres.

THE CARE SCENARIO IN PRIMARY HEALTH CARE FOR THE BLACK POPULATION

This research aims to analyze inequalities in access to health care for the black population in Primary Health Care (PHC) in Brazil, highlighting the impact of structural and institutional racism on care practices. The overall objective is to analyze the current scenario of care and health promotion in primary care for the black population. The research methodology was a qualitative and descriptive literature review. The research shows that PHC, although it is the gateway to the Unified Health System (SUS), often fails to equitably meet the needs of the black population, resulting in worse health and quality of life indicators. The conclusion points out that it is urgent to implement inclusive public policies and anti-racist practices, in addition to promoting the continued training of health professionals with a focus on the specificities of the health of the black population. The active participation of this population in the formulation of policies and the encouragement of research on their health conditions are essential to promote comprehensive and equitable health.