Combined Effects Of Race Research Articles

The combined effect of race, dual-eligibility and neighborhood deprivation on medicare spending after cancer surgery

IntroductionDisparities in clinical outcomes following high-risk cancer operations are well documented, but, whether these disparities contribute to higher Medicare spending is unknown. MethodsUsing 100% Medicare claims, White and Black beneficiaries undergoing complex cancer surgery between 2016 and 2018 with dual eligibility status and census tract Area Deprivation Index score were included. Linear regression was used to assess the association of race, dual-eligibility, and neighborhood deprivation on Medicare payments. ResultOverall, 98,725 White(93.5%) and 6900 Black(6.5%) patients were included. Black beneficiaries were more likely to live in the most deprived neighborhoods(33.4% vs. 13.6%; P < 0.001) and be dual-eligible(26.6% vs. 8.5%; P < 0.001) compared to White beneficiares. Overall, Medicare spending was higher for Black compared to White patients($27,291 vs. 26,465; P < 0.001). Notably, when comparing Black dual-eligible patients living in the most deprived neighborhoods to White non-dual eligible patients living in the least deprived spending($29,507 vs. $25,596; abs diff $3911; P < 0.001). ConclusionIn this study, Medicare spending was significantly higher for Black patients undergoing complex cancer operations compared to White patients due to higher index hospitalization and post-discharge care payments.

The intersection of race and ethnicity, gender, and primary diagnosis on lung transplantation outcomes

Reducing racial disparities in lung transplant outcomes is a current priority of providers, policymakers, and lung transplant centers. It is unknown how the combined effect of race and ethnicity, gender, and diagnosis group is associated with differences in 1-year mortality and 5-year survival. This is a longitudinal cohort study using Standard Transplant Analysis Research files from the United Network for organ sharing. A total of 25,444 patients undergoing first time lung transplantation between 2006 and 2019 in the United States. The primary exposures were lung transplant recipient race and ethnicity, gender, and primary diagnosis group at listing. Multivariable regression models and cox-proportional hazards models were used to determine adjusted 1-year mortality and 5-year survival. Overall, 25,444 lung transplant patients were included in the cohort including 15,160 (59.6%) men, 21,345 (83.9%) White, 2,318 (9.1%), Black and Hispanic/Latino (7.0%). Overall, men had a significant higher 1-year mortality than women (11.87%; 95% CI 11.07-12.67 vs 12.82%; 95% CI 12.20%-13.44%). Black women had the highest mortality of all race and gender combinations (14.51%; 95% CI 12.15%-16.87%). Black patients with pulmonary vascular disease had the highest 1-year mortality (19.77%; 95% CI 12.46%-27.08%) while Hispanic/Latino patients with obstructive lung disease had the lowest (7.42%; 95% CI 2.8%-12.05%). 5-year adjusted survival was highest among Hispanic/Latino patients (62.32%) compared to Black (57.59%) and White patients (57.82%). There are significant differences in 1-year and 5-year mortality between and within racial and ethnic groups depending on gender and primary diagnosis. This demonstrates the impact of social and clinical factors on lung transplant outcomes.

Evidence for neuropsychological health disparities in Black Americans with HIV disease

ABSTRACT Objective: Black Americans are at high risk for HIV disease and associated morbidity. The impact and clinical correlates of HIV-associated neurocognitive impairment among Black Americans is not fully understood. The current study uses a full factorial design to examine the independent and combined effects of race and HIV disease on neurocognitive functioning, including its associations with everyday functioning and clinical disease markers in Black and White persons with HIV (PWH). Method: Participants included 40 Black PWH, 83 White PWH, 28 Black HIV- and 64 White HIV- individuals. Neurocognition was measured by raw sample-based z-scores from a clinical battery. Everyday functioning was assessed using self- and clinician-rated measures of cognitive symptoms and activities of daily living. HIV-associated neurocognitive disorders were also classified using demographically adjusted normative standards and the Frascati criteria. Results: We observed a significant three-way interaction between HIV, race, and domain on raw neurocognitive z-scores. This omnibus effect was driven by medium and large effect size decrements in processing speed and semantic memory, respectively, in Black PWH compared to other study groups. Black PWH also demonstrated higher frequencies of HIV-associated neurocognitive disorders as compared to White PWH. Unexpectedly, global neurocognitive performance was negatively related to everyday functioning impairments for White PWH, but not for Black PWH. Conclusions: Systemic disadvantages for Black Americans may combine with HIV disease to compound some neurocognitive impairments in this under-served population. Prospective studies are needed to identify better ways to prevent, measure, diagnose, and manage HIV-associated neurocognitive disorders among Black Americans.

The convergence of racial and income disparities in health insurance coverage in the United States

ObjectiveThis study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US.Data sourceThe household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study.Study designLogistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively.Data collection/extraction methodsWe constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk.Principal findingsWhile income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health.ConclusionResults of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

The association of maternal obesity and race with serum adipokines in pregnancy and postpartum: Implications for gestational weight gain and infant birth weight

Adiponectin and leptin are hormones known to play roles in maternal metabolism during pregnancy. Levels of these hormones have been demonstrated to vary based on adiposity and race. However, there is a lack of data concerning the relationship between race and the change of adiponectin and leptin throughout pregnancy. The purpose of this study was to examine serum levels of adiponectin, leptin, and leptin-to-adiponectin ratio (LAR) throughout pregnancy and to assess their association with gestational weight gain (GWG) and infant birth weight while considering the effects of race and pre-pregnancy body mass index (BMI). Serum levels of adiponectin, leptin, gestational weight gain, and infant birth weight were measured in 80 pregnant women at early (12.4 ​± ​1.3 weeks gestation), mid (20.6 ​± ​1.3 weeks gestation), late pregnancy (29.2 ​± ​1.4 weeks gestation), and 7–11 weeks postpartum (8.8 ​± ​0.8 weeks). In women overall, serum adiponectin decreased across pregnancy and increased at postpartum (p ​= ​0.17.) At each prenatal timepoint, both black race and obesity were associated with lower adiponectin (ps ​< ​0.05). In women overall, serum leptin increased across pregnancy, and declined at postpartum. At every assessment, a stepwise increase in leptin was observed in relation to BMI class. Black women with obesity had markedly higher LAR in mid- and late pregnancy and postpartum than all other groups (p ​< ​0.05). Serum leptin during pregnancy was significantly associated with total GWG in both black and white women (ps ​< ​0.005). Neither adiponectin, leptin, nor LAR were associated with infant birth weight. Race and BMI both have significant effects on serum adiponectin, leptin, and LAR levels in pregnancy and postpartum. Notably, the combined effects of race and BMI result in markedly higher LAR among black women with obesity. Implications for racial disparities in metabolic syndrome and postpartum weight retention remain to be explicated.

Health outcomes in US children with abdominal pain at major emergency departments associated with race and socioeconomic status.

ObjectiveOver 9.6 million ED visits occur annually for abdominal pain in the US, but little is known about the medical outcomes of these patients based on demographics. We aimed to identify disparities in outcomes among children presenting to the ED with abdominal pain linked to race and SES.MethodsData from 4.2 million pediatric encounters of abdominal pain were analyzed from 43 tertiary US children’s hospitals, including 2.0 million encounters in the emergency department during 2004-2011. Abdominal pain was categorized as functional or organic abdominal pain. Appendicitis (with and without perforation) was used as a surrogate for abdominal pain requiring emergent care. Multivariate analysis estimated likelihood of hospitalizations, radiologic imaging, ICU admissions, appendicitis, appendicitis with perforation, and time to surgery and hospital discharge.ResultsBlack and low income children had increased odds of perforated appendicitis (aOR, 1.42, 95% CI, 1.32- 1.53; aOR, 1.20, 95% CI 1.14 – 1.25). Blacks had increased odds of an ICU admission (aOR, 1.92, 95% CI 1.53 - 2.42) and longer lengths of stay (aHR, 0.91, 95% CI 0.86 – 0.96) than Whites. Minorities and low income also had lower rates of imaging for their appendicitis, including CT scans. The combined effect of race and income on perforated appendicitis, hospitalization, and time to surgery was greater than either separately.ConclusionsBased on race and SES, disparity of health outcomes exists in the acute ED setting among children presenting with abdominal pain, with differences in appendicitis with perforation, length of stay, and time until surgery.

Racial and insurance disparities in the utilization of supportive care after inpatient admission for proximal humerus fracture.

Post-discharge supportive services such as home health assistance and rehabilitation or skilled nursing facilities are often utilized after inpatient care for fracture of the proximal humerus. It is unclear whether sociodemographic disparities exist in the utilization of post-hospital supportive care. The present study aimed to evaluate the individual and combined effects of race and insurance status on the utilization of supportive services after hospital admission for fracture of the proximal humerus. Among the more than 40,000 patients with a proximal humerus fracture identified in the Nationwide Inpatient Sample (2008 to 2011), 85% were white, 7.7% were Hispanic and 7.0% were black. More black patients (19%) and Hispanic patients (15%) were uninsured compared to white patients (8.7%). Multivariable logistic regression was performed to determine the effect of race/ethnicity and insurance status on the utilization of post-hospital supportive care. Sixty-nine percent of patients were discharged home, 13% went to home health care and 15% went to rehabilitation or skilled nursing facilities. Compared to white patients, Hispanic patients [odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.64 to 0.79] and black patients (OR = 0.79; 95% CI = 0.71 to 0.88) exhibited lower odds for the utilization of specialized post-hospital supportive services. Uninsured patients were significantly less likely to use post-discharge supportive services (OR = 0.38; 95% CI = 0.33 to 0.42) compared to privately insured patients. Even when insured at levels comparable to whites, Hispanic and black patients tended to experience decreased rates of discharge to post-acute supportive care. The utilization of post-hospital supportive services varies by race, ethnicity and insurance status after an inpatient admission for proximal humerus fracture.

Multiple Risk Factors and the Likelihood of Patient-Physician Communication and Health Maintenance Services in Medicare Health Plans

This study examined both individual and combined effects of race, education, and health-based risk factors on health maintenance services among Medicare plan members. Data were from 110 238 elderly completing the 2006 Medicare Health Outcomes Survey. Receipt of recommended patient-physician communication and interventions for urinary incontinence, physical activity, falls, and osteoporosis was modeled as a function of risk factors. Low education decreased the odds of receiving services; poor health increased odds. Race had little effect. Evidence suggested moderation among competing effects. While clinicians target services to most at-risk elderly individuals, patients with low education experience gaps. Synergies among co-occurring risks warrant further research.

The Imprisonment Penalty for Young Black and Hispanic Males

In the United States, there are well-known racial, ethnic, age, and sex differences in incarceration rates. Younger offenders are more likely to be sentenced to prison than are older offenders. Black and Hispanic rates of incarceration are six to eight times that of White offenders and males are 14 times as likely as women to be sentenced to prison. This research explores how the combined effects of race, ethnicity, age, and sex, net of legally relevant factors, influence the decision to incarcerate. We examine these effects across nine offense categories. The analysis is based on Florida felony conviction data for the years 2000 to 2006. We find that legally relevant factors significantly influence the incarceration decision. Young Black males are most disadvantaged at the incarceration decision.

Rurality and African American Perspectives on Children’s Mental Health Services

The combined effect of race and place of residence on caregivers’ perceptions of children’s mental health services is underresearched. Differences in caregiver strain, barriers-to-care endorsement, and provider satisfaction are examined among 175 rural and urban African American caregivers from one Southern state whose children received Medicaid sponsored mental health services. Children exhibited clinical levels of externalizing and internalizing mental health symptoms and high levels of co-occurring physical health problems. Almost one quarter were cared for by someone other than biological parents. Almost all caregivers reported strain associated with children’s mental health problems, compromised personal health status, and high levels of depression. Family perception barriers (such as concern about potential negative reactions of significant others) were most endorsed. Most caregivers were satisfied with their children’s mental health services, with lowest levels on the provider sensitivity subscale. Initial rural—urban differences in caregiver strain did not remain significant in multiple regression analyses after other covariates were included.

The (In)Significance of Race and Discrimination among Latino Youth: The Case of Depressive Symptoms

Despite the growing population of Latinos in the United States, there is little research that explores how discrimination affects the mental health of Latino youth along racial lines. In this paper we ask two closely related questions. First, do black Latino youth have higher or lower symptoms of depression than nonblack Latinos? Second, is the relationship between race and depression among Latino youth buffered by discrimination stress? Results from the Transitions Study show that black Latino youth have significantly higher symptoms of depression than nonblack Latinos. The relationship between race and depression depends on daily—but not on lifetime—experiences of discrimination. The combined effect of race and discrimination holds in the face of a wide range of measures of stress, including major lifetime events, recent life events, and chronic stressors. These findings encourage future research that considers the mental health effects of racial variation among Latinos.

Barriers to Reintegration: An Audit Study of the Impact of Race and Offender Status on Employment Opportunities for Women

Previous research has illustrated that the stigma of a criminal record can severely impede employment opportunities for ex offenders, especially African American men, however there is very little research examining how women are affected by crimi nal records. I expand upon prior research by testing the effects of criminal histoty and race on female employment prospects. I predict that as research has shown for men, race will present a significant barrier for women seeking to find employment and further predict that a criminal history will be even more stigma tizing for women than it is for men. To test these predictions I employed an audit methodology and submittedfictitious resumes to Chicago-land employers for entry-leveljobs. I then compared employer callback rates to test the separate and combined ef fects of race and criminal history. Results indicate that a prior criminal history had little impact on employer response rates (the white female without a criminal record received responses to 19% of the jobs applied for, the white female with a criminal record 14%, the African American female without a criminal record 14%, and the African American female with a criminal record 12%). Results initially indicated that race had no signifi cant impact on employer response rates. Due to the continuing decline of the economy over the data collection period I ran tests to compare data collected prior to the midpoint of data collec tion to that collected after the midpoint. The results were weak evidence for racial disparity (favoring white applicants) over the first half of the data collection period suggesting that future research should investigate whether African American women in

Spanish Maintenance among English-Speaking Latino Youth: The Role of Individual and Social Characteristics

This paper investigates the effects of individual, family, social and demographic characteristics on the maintenance of Spanish among English-speaking Latino youth. This research finds effects of generation, gender, race, parent's English proficiency, single-parent status, parental income, and neighborhood concentration of co-ethnics as well as combined effects of race and gender on Spanish oral proficiency. The findings presented here suggest support for elements of the assimilation and the segmented assimilation theoretical perspectives as well as the race-gender experience theory. The author suggests that Spanish-speaking proficiency may be associated with opportunities to speak Spanish that are structured differently, not only by family and neighborhood contexts that allow for greater or lesser contact with Spanish, but also by gender and race.

Predictors of antihypertensive response to a standard dose of hydrochlorothiazide for essential hypertension

Determinants of inter-individual variation in blood pressure (BP) response to antihypertensive therapy remain largely unknown. Although differences in race, age and measures of the renin-angiotensin-aldosterone system (RAAS) have been associated with variation in blood pressure response to hydrochlorothiazide, whether these characteristics make additive contributions to predicting response has not been established. We conducted a comprehensive search for predictors of BP response to a standard dose of hydrochlorothiazide in a biracial sample to estimate how much inter-individual variation in BP response could be explained by all of the identified predictors. After withdrawal of antihypertensive medications for at least four weeks (baseline) and stabilization on a diet approximating 150 mmol sodium per day, 225 African American and 280 Caucasian subjects with diagnosed essential hypertension were treated for four weeks with hydrochlorothiazide 25 mg per day. At baseline and the end of treatment, subjects were admitted to the General Clinical Research Center for measurement of activity of the RAAS and other regulators of BP. Characteristics measured at study enrollment, at baseline, and in response to drug treatment were incorporated stepwise into linear regression models in order to quantify their additive contributions to predicting BP responses to hydrochlorothiazide. Black race and female gender were both associated with significantly greater systolic (SBP) and diastolic (DBP) blood pressure responses to hydrochlorothiazide. Together the combined effects of race and gender accounted for 11% inter-individual variation in SBP response (P < 0.0001) and 4% of inter-individual variation in DBP response (P < 0.0001). Additional statistically significant predictors of greater systolic and diastolic responses to hydrochlorothiazide included, shorter duration of diagnosed or treated hypertension (P < 0.001), higher baseline BP level (P < 0.0001), lower baseline plasma renin activity (P < 0.05), lower baseline urinary aldosterone excretion (P < 0.002), and greater decrease in urinary sodium excretion (P < or = 0.004). Greater decrease in weight was an additional statistically significant predictor of SBP but not DBP response, and older age was a predictor of diastolic but not SBP response. The combined effects of all identified predictors accounted for 38% of inter-individual variation in SBP response (P < 0.0001) and 20% of inter-individual variation in DBP response (P < 0.0001). A systematic search reveals numerous predictors of BP response to a standard antihypertensive dose of hydrochlorothiazide. However, because the majority of inter-individual variation in SBP and DBP responses remains unexplained, there is considerable opportunity for future investigations to improve the ability to predict individual BP responses to antihypertensive drug therapy.

Race, religion, and support for the death penalty: A research note*

Although prior research has shown race and affiliation with a fundamentalist Protestant church to be important predictors of support for the death penalty, this research has given little attention to the possible combined effect of race and religious affiliation on views about capital punishment. Do blacks and whites with similar religious affiliations view the use of capital punishment in the same way? I test three explanations of the relationship between race and religious affiliation with views about the use of capital punishment: political views, salience of religion, and religious ideology. Black and white fundamentalists are very similar on measures of religious behavior and beliefs, but black fundamentalists show the least support for the death penalty, while white fundamentalists show the greatest support. This pattern persists even after controlling for the respondent's political views, salience of religion, and religious ideology. These results call into question the assumption of homogeneity among fundamentalist Protestants and indicate that future research on sensitive moral, social, and political issues should consider dual racial and religious contexts in understanding public views on these issues.

Improving Women's Health

Together, these three books and one video provide a comprehensive foundation of knowledge about women's health from a personal, developmental, sociopolitical, economic, and cultural-environmental perspective that can be used by researchers, educators, policymakers, and practitioners. In general, the works are of high quality and provide a critical analysis of existing knowledge in addition to advancing our understanding of women's health and illness in a way that goes beyond the biomedical perspective and points us toward new models that include race, culture, social class, economic status, gender-specific personal-identity formation, and global similarities and differences. All four publications reveal the way gender interacts with multiple personal and environmental factors to affect health and illness across a woman's lifespan. Two of the books, Doyal's and Lewis and Bernstein's, take a global perspective while Bayne-Smith and the video by Leonetti, Dannhauser, and Fox confine their discussion to the effects of race, class, gender, and health discrimination within, and by, the U.S. health and welfare system. Marcia Bayne-Smith, author of Race, Gender, and Health, is a faculty member at Queens College, City University of New York. In the first chapter Health and Women of Color: A Contextual Overview, she provides a theoretical and conceptual framework demonstrating the combined effects of race and gender as the primary determinants of the health status of women of color in the United States. Analyzing the political,

Black-White Differences in Perceptions of Fear of Crime

Abstract The combined effects of race and social factors on fear of crime were investigated. The sample consisted of 1,835 black and white residents of Mississippi, 15 years old or older. The results indicated that (a) for the pooled sample, race, age, and marital status had significant effects on fear of crime, and (b) with the exception of age, the variables had significantly different effects on fear of crime among black and white respondents.