Disparities In Women Research Articles

Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020.

Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial-ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps. We summarized national data for several reproductive health measures, such as contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancies, by race-ethnicity to inform health-equity strategies. Studies were retrieved by systematically searching the PubMed (2010-2020) electronic database to identify most recently published national estimates by race-ethnicity (non-Hispanic Black or African American, Hispanic or Latinx, and non-Hispanic White women). Disparities were found in each reproductive health category. We describe relevant components of the Affordable Care Act (ACA) and the Preventing Maternal Deaths Act, which can help to further strengthen reproductive health care, close gaps in services and outcomes, and decrease racial-ethnic reproductive health disparities. Owing to continued diminishment of certain components of the ACA, to optimally reach reproductive health equity, comprehensive health insurance coverage is vital. Strengthening policy-level strategies, along with ACOG's heightened commitment to eliminating racial disparities in women's health by confronting bias and racism, can strengthen actions toward reproductive health equity.

Women and men in orthopaedics.

Purpose: To compare and discuss the gender disparities in the Orthopaedic specialty. Methods: We reviewed the literature to find the rates of women applying for an orthopaedic residency, fellowship, and academic career program, to understand the causes of the disparities in women in orthopaedics, and how this relates to orthopaedic surgical practice. Results: The idea that men and women are different and have different working styles and skills and the belief that males are more dominant and more status-worthy than females leads to gender barriers and stereotypes that restrict women from entering male-dominated specialties. It is important to mention that equivalent barriers restrict men from pursuing female-dominated specialties such as Gynecology. Economic disparities and gender stereotypes that divide medical specialties into masculine and feminine, creating a gender gap in health care are major concerns. However, the number of women in the health sector is expected to increase due to the growing amount of female students that are expected to soon graduate. A leadership gender gap also exists; although women consist of 70% of the health care workforce they occupy only 25% of leadership positions. Conclusion: The existence of gender-based disparities in healthcare is multifactorial. The explanation behind the existence of a so-called gender gap lies in organizational and individual factors. Early development and family relations, the decision between work and life balance, personal choices and interests, as well as working conditions, absence of role models and mentorship and institutional policies make gender disparities even more evident.

Disparities in Women Being Up to Date With Breast, Cervical, and Colorectal Cancer Screening: An Analysis of 2018 BRFSS Data

Disparities in Women Being Up to Date With Breast, Cervical, and Colorectal Cancer Screening: An Analysis of 2018 BRFSS Data

Racial Disparities in Hysterectomy Route for Benign Disease: Examining Trends from 2007-2018 Using the NSQIP Database

Study Objective To examine national trends among race/ethnicity and route of benign hysterectomy from 2007-2018. Design This cohort study from 2007-2018 was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and included the 2014-2018 targeted hysterectomy files. Setting NSQIP is a nationally validated, outcomes-based program containing perioperative data. Patients or Participants Current Procedural Terminology codes identified women undergoing benign hysterectomy and perioperative data including race and ethnicity were obtained. To determine relative trends in hysterectomy among racial cohorts (White, Black, Other) and ethnicity cohorts (Hispanic, Non-hispanic), we examined the proportion of each procedure performed annually compared to the others in the same category. Interventions N/A Measurements and Main Results From 2007 to 2018, 322,834 hysterectomies were collected (216,413 White, 46,248 Black, 60,173 Other; and 33,881 Hispanic). From 2007 to 2018, rates of laparoscopic hysterectomy increased in all cohorts (29% to 71% for White, 23% to 56% for Black, 16% to 60% for Other; and 20% to 64% for Hispanic; ptrend Conclusion As compared to White women, black women are less likely to undergo benign hysterectomy via a minimally invasive approach. Black women are more likely to have larger uteri and comorbid conditions which may attribute to higher rates of abdominal hysterectomy. Higher prevalence of abdominal hysterectomy among younger Black women highlights potential racial disparities in women's healthcare.

The effect of multidisciplinary team integration on treatment completion disparities in women undergoing treatment for cervical cancer

Objective: Cervical cancer disparities are often attributed to inadequate receipt of guideline-adherent care. In July 2016, our institution integrated radiation and gynecologic oncology to provide multidisciplinary team care (MTC). We sought to determine whether racial disparities in treatment completion improved after this practice change.

Socioeconomic and Racial Disparities in Cancer Stage at Diagnosis, Tumor Size, and Clinical Outcomes in a Large Cohort of Women with Breast Cancer, 2007-2016.

Socioeconomic and treatment factors contribute to diagnosis of early-stage (local-stage) breast cancer, as well as excess deaths among African American women. We evaluated socioeconomic and treatment predictive factors for early-stage breast cancer among African American women compared to Caucasian women. A secondary aim evaluated predictors and overall risks associated with all-cause and breast cancer-specific mortality. We used retrospective cohort population-based study data from the Surveillance, Epidemiology, and End Results (SEER) Program on 547,703 women aged ≥ 20years diagnosed with breast cancer primary tumors from 2007 to 2016. Statistical analysis used logistic regression to assess predictors of early-stage breast cancer and Cox proportional hazards regression for mortality risks. African American women were more likely to be diagnosed at advanced-stage, had larger tumor size at diagnosis, and received less cancer-directed surgery, but more chemotherapy than Caucasian women. Insured women (> 50%) were more likely to be diagnosed at early-stage and to have smaller tumors (p < 0.05). Education level, poverty level, and household income had no impact on racial disparities or socioeconomic disparities in women diagnosed at early stage. We found increased risks for all-cause mortality (hazard ratio = 1.18; 95% confidence interval, 1.16-1.21) and breast cancer-specific mortality (HR = 1.22; 95% CI, 1.19-1.25) among African American women compared to Caucasian women after adjusting for demographic, socioeconomic, and treatment factors. In this population-based study using the most recent SEER data, African American women with breast cancer continued to exhibit higher all-cause mortality and breast cancer-specific mortality compared to Caucasian women.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Race, gender, and scholarly impact: Disparities for women and faculty of color in clinical psychology.

We sought to determine if gender and race are associated with scientific impact, scholarly productivity, career advancement, and prestige. Publicly available data on publications, h-index, advancement, and prestige were assessed across core faculty in all American Psychological Association-accredited clinical psychology programs at R1 institutions in the United States (87 programs, 918 scientists). There were significant effects of both gender and race on productivity and impact, which were most apparent among the most senior faculty. Men and white faculty in associate and full professor ranks had higher scholarly productivity and impact. Among associate professors, men were more likely to get tenure earlier, even when controlling for scientific impact (h-index). Neither gender nor race was associated with prestige among full professors. These findings, along with under-representation of non-White faculty across levels (11.2%) and women at the full professor level (42.8%), suggest disparities in academic clinical psychology that must be addressed.

Editors' note: Understanding and addressing gender equity for women in neurology

In “Understanding and addressing gender equity for women in neurology,” Dr. Julie Silver proclaims the need for medical schools, academic medical centers, funding agencies, journals, and medical societies to recognize and correct gender disparities for women in medicine and in neurology, in particular. Dr. Jennifer Graves responds that systematic biases must be overcome via advocacy from all neurologists, akin to the actions of NIH Director Francis Collins who refused to sit on an all-male scientific panel. Dr. Jill Farmer praises both Dr. Silver and the women who paved the way to allow today's women physicians to be “liberate[d], empower[ed] and embolden[ed].” Dr. Elizabeth Loder also lauds Dr. Silver for drawing attention to the multitude of challenges women clinicians face including sexual harassment, pay disparities, blatant discrimination, and sexism. Dr. Silver responds to the comments of these 3 women physicians in a befitting manner by highlighting and praising the accomplishments of each in addition to addressing the substance of their replies. In “Understanding and addressing gender equity for women in neurology,” Dr. Julie Silver proclaims the need for medical schools, academic medical centers, funding agencies, journals, and medical societies to recognize and correct gender disparities for women in medicine and in neurology, in particular. Dr. Jennifer Graves responds that systematic biases must be overcome via advocacy from all neurologists, akin to the actions of NIH Director Francis Collins who refused to sit on an all-male scientific panel. Dr. Jill Farmer praises both Dr. Silver and the women who paved the way to allow today's women physicians to be “liberate[d], empower[ed] and embolden[ed].” Dr. Elizabeth Loder also lauds Dr. Silver for drawing attention to the multitude of challenges women clinicians face including sexual harassment, pay disparities, blatant discrimination, and sexism. Dr. Silver responds to the comments of these 3 women physicians in a befitting manner by highlighting and praising the accomplishments of each in addition to addressing the substance of their replies.

Variation in Postpartum Use of Most and Moderately Effective Contraceptive Methods Among Louisiana Women.

Women experiencing unintended and short-interval pregnancies are at increased risk for adverse outcomes. Nationally, researchers report disparities in women's use of effective contraceptive methods based on demographic, cultural, financial and system-level factors. Despite 58% of Louisiana births being unplanned, researchers have not reported on these relationships in Louisiana. We used Louisiana Pregnancy Risk Assessment Monitoring System data from 2015 to 2018. Among postpartum women who were not abstinent, pregnant, or trying to become pregnant, we estimated use of five categories of effective contraception versus no effective method. We used multivariable multinomial logistic regression to investigate the association between effective contraceptive use and race/ethnicity, postpartum insurance and education. Among Louisiana postpartum women who were not abstinent, pregnant, or trying to become pregnant, 35.4% were not using effective contraception. Women with public insurance had greater odds of using long-acting reversible contraception than women with private insurance (adjusted odds ratio [AOR] 1.55; 95% confidence interval [CI] 1.11-2.16). Compared to women with a bachelor's or higher, women with less than high school (AOR 2.09; CI 1.22-3.56), high school (AOR 3.11; CI 2.01-4.82) or some college education (AOR 2.48; CI 1.64-3.75) had greater odds of using permanent contraception. Black (AOR 3.83; CI 2.66-5.54) and Hispanic (AOR 3.85; CI 2.09-7.11) women, women with less than high school (AOR 6.79; CI 2.72-16.94), high school (AOR 7.26; CI 3.06-17.21) and some college (AOR 7.22; CI 3.14-16.60), and women with public insurance (AOR 1.91; CI 1.28-2.87) had greater odds of using injectable contraception. Results showed variation in effective contraceptive method use by race/ethnicity, insurance and education. These findings highlight the need for state-level research intothe individual, provider, and policy-level factors that influence women's contraceptive choices.

Socio-Demographic Determinants of Road Traffic Fatalities in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014).

PurposeGlobally and in the European region, the road traffic injuries (RTI) have emerged as a major public health and development problem, killing the most productive adult members of a population, including women. This study aimed to identify the key socio-demographic determinants of premature and avoidable RTI mortality in reproductive-aged women (15–49 years) in Georgia.Materials and MethodsThe study employed verbal autopsy data from the second national reproductive age mortality survey (RAMOS 2014). Univariate and multivariate logistic regression models were fitted using the Firth method to assess the crude and adjusted effects of each individual level socio-demographic factor on the odds of RTI-attributed death, with corresponding 95% confidence intervals (COR and AOR, 95% CI).ResultsOf 843 women aged 15–49 years, 78 (9.3%) were the victims of fatal traffic crashes. After multivariate adjustment, the odds of dying from RTI were significantly higher in women aged 15–29 years (AOR=7.73, 95% CI= 4.20 to 14.20), those being employed (AOR=2.11, 95% CI= 1.22 to 3.64) and the wealthiest (AOR=2.88, 95% CI= 1.44 to 5.77) compared, respectively, to their oldest (40–49 years), unemployed and poorest counterparts. Conversely, there were no statistically significant ethnic, marital, rural/urban, and educational disparities in women’s RTI fatalities. Overall, motorized four-wheeler occupants (78.2%), particularly passengers (71.8%), appeared to be the most common victims of fatal road injuries than pedestrians (20.5%). Alarmingly, the vast majority (85.9%) of any type of road users died instantly at the scene of collision, as compared to deaths en route to hospital (1.3%) or in hospital (11.5%).ConclusionAge, employment, and wealth status appeared to be the strong independent predictors of young women’s RTI mortality in Georgia. Future comprehensive research would be advantageous for further deciphering the differential impact of social determinants on traffic-induced fatalities, as a vital platform for evidence-based remedial actions on this predictable and preventable safety hazard.

Abstract A116: Occupational disparities in women’s employment after cancer

Abstract Background: Due to advances in early diagnosis and treatment, the population of working-age cancer survivor population has grown. However, few studies have examined long-term (10+ years) employment outcomes after treatment. We evaluated the impact of cancer on employment outcomes among women enrolled in the Health and Retirement Study (HRS), a nationally representative panel of non-institutionalized adults aged 51 and older in the United States Methods: Data came from nine waves of the HRS (1998-2014) (n = 7,088; Observations = 26,355). We conducted two sets of analyses: The first set of analyses examined the impact of cancer on employment status and the second set of analyses examined the impact of cancer on the number of work hours for women who were working full time (≥ 35 hours per typical work week) at baseline. For the analysis of employment status, we used a random intercept logistic regression in a multi-level growth curve framework to analyze change over time in likelihood of employment. For the analysis of hours of work per week, we used a mixed-effects coefficient regression to assess work hours trajectories in relation to cancer. Results: There were 7,088 working-age (51-64 years) women in the study sample. Approximately 7% (n=483) of the sample were cancer survivors, with a mean number of years since diagnosis of 9 years. After controlling for sociodemographic and health factors, women who were 6-10 year cancer survivors had a 2.3 times greater likelihood of being employed over time than women without a history of cancer; however, if these women had professional jobs, they were less likely to work over time (OR = 0.4) than professional women without a history of cancer. Long-term (10+ year) cancer survivors in professional occupations tended to work less hours per week at baseline (-4.1 hours) and over time (-2.4 hours) than professional women who without a history of cancer. Conclusions: Professional women may be vulnerable to job loss after cancer treatment. Identifying factors associated with continued employment for women will be key to developing strategies to promoting quality survivorship in the growing cancer survivor population. Citation Format: Christine Ekenga, Eunsun Kwon, BoRin Kim, Sojung Park. Occupational disparities in women’s employment after cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A116.

OB/GYN Providers’ Knowledge of Racial and Ethnic Reproductive Health Disparities

ObjectiveThis study explores OB/GYN providers' knowledge about published health and healthcare disparities in women's reproductive health. MethodWe collected demographic and health disparities knowledge information from OB/GYN providers who were members of ACOG District IV using an online survey (n = 483). We examined differences across groups using statistical tests and regression analyses in a structural equation modeling approach. ResultsReceiving disparities education was positively associated with higher self-reported disparities knowledge and disparities quiz performance (p < 0.05). African American/Black providers had higher quiz scores than their white counterparts, and providers varied in their levels of disparities knowledge across practice settings (p < 0.05). ConclusionsDifferences in levels of knowledge of racial/ethnic disparities in health and healthcare outcomes among OB/GYN providers varied across race/ethnicity, practice context, and whether providers had received formal disparities education. Future research should explore these differences at a population level and develop interventions to improve health disparities education among OB/GYN providers.

How Collaborative Practice Agreements Impede the Administration of Vital Women's Health Services.

Women's health services delivered by nurse practitioners (NP) and certified nurse-midwives (CNM) are safe and effective, often providing a crucial point of access in underserved regions. However, restrictive and unnecessary regulatory requirements, such as collaborative practice agreements, create artificial barriers to practice. This analysis used a subsample of respondents from a large national study focused on the common challenges and practice restrictions introduced by collaborative practice agreements. This cohort included respondents licensed in all 22 states that place some level of restriction on one or both roles. This study used univariable and multivariable logistic regression to examine the financial and administrative constraints collaborative practice agreements place on NPs and CNMs. The median fee to establish a collaborative agreement was $500 (n = 25; interquartile range [IQR], $175-$1200; range, $30-$3000). The monthly median fee to maintain a collaborative agreement was $500 (n = 29; IQR, $250-$1200; range, $100-$2000). NPs and CNMs working in rural areas and remotely are more likely to encounter barriers to practice. Similarly, the loss or lack of supervising physicians and fees were also identified as impediments to care. Removing unnecessary regulatory requirements permits NPs and CNMs to be full market participants, thereby allowing them to address health care disparities in women's health and primary care settings. Targeted legislative efforts should seek to improve access to these vital services and re-establish evidence-based patient care and safety best practices as the drivers of health care regulation.

Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome.

Although health disparities in women presenting with acute coronary syndrome (ACS) have received growing attention in recent years, clinical outcomes from ACS are still worse for women than for men. Women continue to experience higher patient and system delays and receive less aggressive invasive treatment and pharmacotherapies. Gender- and sex-specific variables that contribute to ACS vulnerability remain largely unknown. Notwithstanding the sex differences in baseline coronary anatomy and function, women and men are treated the same based on guidelines that were established from experimental and clinical trial data over-representing the male population. Importantly, younger women have a particularly unfavourable prognosis and a plethora of unanswered questions remains in this younger population. The present review summarizes contemporary evidence for gender and sex differences in vascular biology, clinical presentation, and outcomes of ACS. We further discuss potential mechanisms and non-traditional risk conditions modulating the course of disease in women and men, such as unrecognized psychosocial factors, sex-specific vascular and neural stress responses, and the potential impact of epigenetic modifications.

Hypertension and Diabetes in Non-Pregnant Women of Reproductive Age in the United States.

IntroductionDiagnosis and control of chronic conditions have implications for women’s health and are major contributing factors to maternal and infant morbidity and mortality. This study estimated the prevalence of hypertension and diabetes in non-pregnant women of reproductive age in the United States, the proportion who were unaware of their condition or whose condition was not controlled, and differences in the prevalence of these conditions by selected characteristics.MethodsWe used data from the 2011–2016 National Health and Nutrition Examination Survey to estimate overall prevalence of hypertension and diabetes among women of reproductive age (aged 20–44 y), the proportion who were unaware of having hypertension or diabetes, and the proportion whose diabetes or hypertension was not controlled. We used logistic regression models to calculate adjusted prevalence ratios to assess differences by selected characteristics.ResultsThe estimated prevalence of hypertension was 9.3% overall. Among those with hypertension, 16.9% were unaware of their hypertension status and 40.7% had uncontrolled hypertension. Among women with diabetes, almost 30% had undiagnosed diabetes, and among those with diagnosed diabetes, the condition was not controlled in 51.5%.ConclusionThis analysis improves our understanding of the prevalence of hypertension and diabetes among women of reproductive age and may facilitate opportunities to improve awareness and control of these conditions, reduce disparities in women’s health, and improve birth outcomes.

Labor market and management of gender based decision making

Improving gender equality in decision-making is a very important issue in a country's economic development. The main purpose of the research is to analyze the level of central level decision making and the alignment of the labor market at Kosovo level on gender basis. Also, this paper presents a theoretical focus on the role of decision making for a better service and the possible management of gender equality counseling programs in the economic, political and social spheres. Kosovo continues to face challenges as well as a marked disparity in women's disadvantage in regards to managing the gender-based decision-making process at both the central and the local level. Although there are laws that stimulate gender equality, the position of women in decision-making in public life in terms of contributing to economic, political and social development endeavors are lacking their increase in participation and decision-making at both central and local levels.

Steven D. Townsend

At the tail end of his postdoctoral fellowship at Columbia University, Steven D. Townsend was struck by a curious trend in advertising. As he tooled around New York City with his wife, who was pregnant with their first child, he noticed that wealthy neighborhoods were dotted with signs advocating breastfeeding, while the posters hung around less affluent blocks focused on formula. That very visible display of the disparity in women’s health in the US sparked something in Townsend. As the classically trained synthetic organic chemist mulled his independent career, he decided to veer into new territory—the study of human milk oligosaccharides. Today, Townsend is one of a small but growing number of researchers trying to demystify the science of human breast milk, a topic that has been sorely underexplored. His work at Vanderbilt University spans efforts to synthesize the sugar molecules found in breast milk, understand the function and biological

Exploring Enabling Interventions for Increasing Female Students’ Access and Participation in Science, Technology, Engineering and Mathematics (Stem) Disciplines in Kenyan Public Universities

Globally, studies continue to document disparities in women’s access and participation in Science, Technology, Engineering and Mathematics (STEM) disciplines in the universities. Despite existence of policies at the national and institutional level, no single and clear road map exists on what set of interventions can best contribute to redressing this disparities. This study draws attention to the low participation of female students in STEM disciplines and especially in hard sciences in Kenyan public universities. Data for the study were collected in three public universities that were purposively sampled. Questionnaires, interviews, observations, content and documentary analysis were used as key instruments for data collection and research techniques. Data were analyzed both quantitatively and qualitatively. The study findings revealed that, despite the existing educational gender interventions, female students’ enrolment and participation in STEM disciplines in the Kenyan public universities is 30% and less than 20% in hard sciences. The study also established that there exists a continued process of gender typing in the secondary school curriculum which students pick and is further manifested in the universities. This stereotype has created a false perception among female students that soft sciences are marketable for the female gender and are feminine compared to the hard sciences. Further there exists socio-cultural and institutional barriers that affects female students’ participation in STEM disciplines. The study recommends first, the need for government and universities to develop educational STEM policies and interventions to increase female participation in STEM disciplines. Second, the STEM curricula should be made gender responsive with integration of additional STEM female faculty members to act as mentors to female students. Appropriate STEM mentoring and career guidance should be enhanced at all levels of education and all educational stakeholders should be involved in minimising socio-cultural, institutional barriers and stereotypes on masculinity of STEM disciplines.

Gender and Health in Mexico: Differences between Returned Migrants and Nonmigrants

This study considers gender differences in the health of Mexican migrants who return to Mexico from the United States, and Mexican nonmigrants. We use health data before and after migration to examine disparities in women’s and men’s childhood and adult health, comparing returned migrants and nonmigrants in Mexico. Using data on more than 14,000 household heads and their spouses interviewed between 2007 and 2016 in the Mexican Migration Project, we find evidence of only a few gendered patterns of health among migrants. Specifically, women migrants are more positively selected on height than are male migrants. We also find a stronger, positive association between migration and smoking among women: although women are less likely to smoke than men, the difference is smaller among returned migrants than among nonmigrants. In contrast, we find no evidence that the positive migrant selection on self-rated health at age 14, or negative migrant selection on emotional disorders, varies by gender, or that there is an association among migration and obesity, hypertension, diabetes, and heart disease.