Disparities In Progression Research Articles

Race and Sex Disparities in Metabolic/Bariatric Surgery over 20 Years: A Cohort Study

Objectives: To determine how rates of discussion of metabolic and bariatric surgery (MBS) between patients with class 2 obesity and higher and their healthcare providers as well as subsequent progression to MBS have varied by race and sex over the last 20 years. Background: Obesity is a growing public health crisis. MBS remains the most effective treatment for long-term management of obesity. Methods: Retrospective cohort study of electronic health records from a large tertiary academic health system using a previously validated natural language processing algorithm. The primary outcomes were discussion of MBS between eligible patients and providers and progression to surgery. Multivariable logistic regression was used to determine the association between sociodemographic factors, time, and discussion and receipt of MBS. Results: Among 122,487 patients included in the analysis, 11,094 (9.1%) patients discussed MBS with their providers. Of these, 1348 (12.2%) progressed to MBS. Between 2000 and 2020 the annual fraction of patients who had a discussion of MBS with their providers rose from 3.2% to 10.0% (P < 0.001). Black people were equally likely to discuss MBS with providers as non-Black people (9.5 vs 9.0%, P = 0.09) but were less likely to progress to MBS (8.4 vs 12.6%, P < 0.001). These disparities in progression narrowed over the study period (P = 0.044). Men were less likely than women to both discuss (8.1% vs 9.6%, P < 0.001) and receive MBS (7.6% vs 14.6%, P < 0.001), and these disparities increased over the study period. Conclusions: Interventions to reduce racial disparities in utilization of MBS should focus on progression from discussion to MBS. Interventions to increase the uptake of MBS among men are required across the care cascade.

Commentary to contemporary disparities in progression to orchiopexy for cryptorchidism as reported in the Pediatric Health Information System (PHIS) database

Commentary to contemporary disparities in progression to orchiopexy for cryptorchidism as reported in the Pediatric Health Information System (PHIS) database

Contemporary disparities in progression to orchiopexy for cryptorchidism as reported in the Pediatric Health Information System (PHIS) database

When evaluating the timeliness of orchiopexy for cryptorchidism, health disparities are apparent among Hispanic and African American males and those with public insurance. Since the publication of these data, the COVID-19 pandemic has stressed our healthcare system and significantly affected the provision of pediatric urology care. We sought to assess if certain groups were disproportionately affected in progression to orchiopexy after the diagnosis of cryptorchidism during and after the pandemic in US freestanding children's hospitals. Using the PHIS database, pediatric patients ≤5 years who underwent orchiopexy between January 2018 and December 2022 were retrospectively analyzed. Exclusion criteria included prematurity, retractile testes, and testicular torsion. Primary outcomes were age at orchiopexy and the proportion of individuals undergoing timely orchiopexy for cryptorchidism. Over the study period 3140 patients ≤5 years old underwent orchiopexy for cryptorchidism. Non-Hispanic Blacks and Hispanics were significantly less likely to have timely orchiopexy and underwent orchiopexy 2.13 and 3.60 months later compared to whites (p<0.01). As compared to pre-COVID-19, during the pandemic the proportion of patients who had timely surgery was higher and the median age was significantly lower (p=0.01 and p<0.01, respectively) in white patients only. Over the study period, patients with public insurance were less likely to have timely orchiopexy and underwent orchiopexy 2.94 months later (p<0.01) than patients with private insurance. Compared to during the pandemic, post-pandemic a significantly lower proportion of publicly insured patients have since undergone timely orchiopexy (p=0.04). Patients in the West were less likely to have timely orchiopexy and had a higher age at time of orchiopexy (p<0.01) than other regions. However, in the West during the pandemic, the proportion of children who had timely surgery was higher compared to pre-and post-COVID-19 (p<0.01). Overall, regardless of insurance status, race, or location, a significant proportion of patients did not undergo timely orchiopexy. During the pandemic white patients had a lower median age and an increased proportion underwent timely orchiopexy, despite the number of orchiopexies remaining constant. Disparities in the post-COVID-19 era have been further exacerbated for publicly insured patients, who a significantly lower proportion of have since undergone timely orchiopexy. Specific efforts are required across the United States to increase timely orchiopexy for all boys. Progression to timely orchiopexy remains low for all boys in the era surrounding COVID-19; certain groups appear to be more adversely affected.

An exploration of the factors affecting the likelihood of young people in England progressing into higher education

ObjectivesThis research sought to identify the extent to which the likelihood of young people in England progressing into Higher Education (HE) is affected by their gender, ethnicity, socioeconomic background, area of residence, school attainment and the intersection of these characteristics.&#x0D; MethodsData from the Department for Education’s National Pupil Database concerning the entire cohort of young people in English state schools who turned 16 between September 2014 and August 2015 was accessed. Data concerned pupils’ attainment, personal characteristics and postcode of residence. This data was matched with records from the Higher Education Statistics Agency to identify whether pupils had progressed to HE by the age of 19. Raw differences in progression rates by pupil characteristic were established and binary logistic regression was used to explore how individual factors influenced the likelihood of progression once attainment and other characteristics were controlled for.&#x0D; ResultsFemales were more likely than males to progress to HE, however this could be explained predominantly by their higher average attainment in school examinations. Pupils in receipt of free school meals were substantially less likely to progress to HE, though this trend reversed once attainment was controlled for.&#x0D; Pupils residing in London were considerably more likely to progress to HE than pupils in all other regions of England, though this can be explained almost entirely by the higher average attainment of pupils in London as well as average demographic differences between London and other English regions.&#x0D; There are large disparities in progression to HE by pupil ethnicity and these disparities persist even once prior attainment and other characteristics are controlled for.&#x0D; ConclusionThe results overall suggest that some disparities in access to HE (such as by gender and FSM status) might be eliminated if corresponding disparities in school attainment were eliminated. The relationship between attainment disparities and HE progression disparities is less straightforward with respect to other characteristics such as pupil ethnicity.

Progress in reducing cancer mortality in the United States by congressional district, 1996-2003 to 2012-2020.

United States cancer death rates have been steadily declining since the early 1990s, but information on disparities in progress against cancer mortality across congressional districts is lacking. This study examined trends in cancer death rates, overall and for lung, colorectal, female breast, and prostate cancer by congressional district. County level cancer death counts and population data from the National Center for Health Statistics were used to estimate relative change in age-standardized cancer death rates from 1996-2003 to 2012-2020 by sex and congressional district. From 1996-2003 to 2012-2020, overall cancer death rates declined in every congressional district, with most congressional districts showing a 20%-45% decline among males and a 10%-40% decline among females. In general, the smallest percent of relative declines were found in the Midwest and Appalachia, whereas the largest declines were found in the South along the East Coast and the southern border. As a result, the highest cancer death rates generally shifted from congressional districts across the South in 1996-2003 to districts in the Midwest and central divisions of the South (including Appalachia) in 2012-2020. Death rates for lung, colorectal, female breast, and prostate cancers also declined in almost all congressional districts, although with some variation in relative changes and geographical patterns. Progress in reducing cancer death rates during the past 25years considerably vary by congressional district, underscoring the need for strengthening existing and implementing new public health policies for broad and equitable application of proven interventions such as raising tax on tobacco and Medicaid expansion.

Race, Sex, and Kidney Disease Trial Participation

Race, Sex, and Kidney Disease Trial Participation

Racial Disparities in Progression to ESRD and Mortality in Rural vs. Urban Veterans

Racial Disparities in Progression to ESRD and Mortality in Rural vs. Urban Veterans

Global trends of obesity, malnutrition and dietary risk factors

Abstract Background The burden of malnutrition across the world remains unacceptably high. Children under five years are facing multiple burdens, including stunting and wasting; conversely, overweight and obesity among adults are at record levels while global trends in chronic non-communicable diseases (NCDs) are rising globally. Methods Data from the NCD Risk Factor Collaboration (NCD-RisC) and the Global Burden of Disease (GBD) Study and insights from the Global Nutrition Report will be discussed. Results No changes in age-standardised mean BMI in girls and boys from 1975 to 2016 were registered in eastern Europe, while an increase of up to 1.00 kg/m2 per decade was reported in central Latin America (for girls) and in Polynesia and Micronesia (for boys), with lower but significant variations over time all around the world. There has been some progress in reducing malnutrition at a global level but there are significant disparities in progress at the national and subnational level. Fewer than one in five children aged 6 to 23 months eat a minimally acceptable diet while only half of children aged 6 to 23 months get the recommended minimum number of meals. Regardless of wealth, children, adolescents and adults are eating too many refined grains and sugary foods and drinks, and not enough foods that promote health such as fruits, vegetables, legumes and whole grains. A total of 11 million deaths are attributable to dietary risk factors. High intake of sodium, low intake of whole grains, and low intake of fruits are the leading dietary risk factors for deaths globally. However, important differences between regions and outcome (i.e., cardiovascular disease vs. cancer) have been registered. Conclusions Current data allow us to assess what people are eating at global level, but nutrition quality in all countries and wealth groups pose a significant threat to achieving ideal targets. Focus on healthy diets to drive better nutrition everywhere is crucial to prevent NCDs globally.

Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review

BackgroundThere are a growing number of studies on ethnic differences in progression and mortality for pre-dialysis chronic kidney disease (CKD), but this literature has yet to be synthesised, particularly for studies on mortality.MethodsThis scoping review synthesized existing literature on ethnic differences in progression and mortality for adults with pre-dialysis CKD, explored factors contributing to these differences, and identified gaps in the literature. A comprehensive search strategy using search terms for ethnicity and CKD was taken to identify potentially relevant studies. Nine databases were searched from 1992 to June 2017, with an updated search in February 2020.Results8059 articles were identified and screened. Fifty-five studies (2 systematic review, 7 non-systematic reviews, and 46 individual studies) were included in this review. Most were US studies and compared African-American/Afro-Caribbean and Caucasian populations, and fewer studies assessed outcomes for Hispanics and Asians. Most studies reported higher risk of CKD progression in Afro-Caribbean/African-Americans, Hispanics, and Asians, lower risk of mortality for Asians, and mixed findings on risk of mortality for Afro-Caribbean/African-Americans and Hispanics, compared to Caucasians. Biological factors such as hypertension, diabetes, and cardiovascular disease contributed to increased risk of progression for ethnic minorities but did not increase risk of mortality in these groups.ConclusionsHigher rates of renal replacement therapy among ethnic minorities may be partly due to increased risk of progression and reduced mortality in these groups. The review identifies gaps in the literature and highlights a need for a more structured approach by researchers that would allow higher confidence in single studies and better harmonization of data across studies to advance our understanding of CKD progression and mortality.

Adapting Care Groups to Urban Slums: A Case Study of a Church-Based Effort to Improve Maternal and Child Health Outcomes in Mathare, Nairobi, Kenya

Progress on maternal and child health has been slow and uneven in Africa, with widening geographic and socio-economic disparities despite economic growth and continued investments in health systems. In Kenya, modest national-level gains mask wide disparities in progress, with near stagnation among the very poor, those with the least education, and those living in either extremely rural contexts or dense informal urban slums. Progress toward Kenya’s maternal and child health Sustainable Development Goals will depend on finding new ways to work effectively in dense urban slums where poverty and ill-health are increasingly concentrated. Effective approaches require addressing significant knowledge, behavior, and trust gaps, especially with the most vulnerable residents of slum communities like Nairobi’s Mathare. Care groups were designed to address these gaps but have only been effectively tested and scaled in rural and peri-urban environments. The Center for Peacebuilding and Nationhood’s Maternal and Child Health Care Group project supported by Mennonite Central Committee in Mathare, one of the largest informal settlements in Kenya, was one of the first to adapt the Care Group model to an urban slum. Adapting the model was necessary in this challenging context characterized by high population density, crowding, extremely transient and unstable populations, low social trust, lack of traditional social structures, high crime, political disruption, and frequent rapid onset disasters. This study shows the pilot’s success and challenges in adapting care groups to the realities of a dense African urban slum, the innovative strategies the project has used, and the unique benefits of doing this work on a small scale rooted in a local church organization.

Local variations in exclusive breastfeeding rates in Africa.

Large-scale analysis of 49 countries in Africa shows improvements in the prevalence of babies under 6 months of age being fed only breast milk, but there are large disparities in progress across and within countries.

Parasitological research in the molecular age.

New technological methods, such as rapidly developing molecular approaches, often provide new tools for scientific advances. However, these new tools are often not utilized equally across different research areas, possibly leading to disparities in progress between these areas. Here, we use empirical evidence from the scientific literature to test for potential discrepancies in the use of genetic tools to study parasitic vs non-parasitic organisms across three distinguishable molecular periods, the allozyme, nucleotide and genomics periods. Publications on parasites constitute only a fraction (<5%) of the total research output across all molecular periods and are dominated by medically relevant parasites (especially protists), particularly during the early phase of each period. Our analysis suggests an increasing complexity of topics and research questions being addressed with the development of more sophisticated molecular tools, with the research focus between the periods shifting from predominantly species discovery to broader theory-focused questions. We conclude that both new and older molecular methods offer powerful tools for research on parasites, including their diverse roles in ecosystems and their relevance as human pathogens. While older methods, such as barcoding approaches, will continue to feature in the molecular toolbox of parasitologists for years to come, we encourage parasitologists to be more responsive to new approaches that provide the tools to address broader questions.

Racial differences in completion of the living kidney donor evaluation process.

Racial disparities in living donor kidney transplantation (LDKT) persist but the most effective target to eliminate these disparities remains unknown. One potential target could be delays during completion of the live donor evaluation process. We studied racial differences in progression through the evaluation process for 247 African American (AA) and 664 non-AA living donor candidates at our center between January 2011 and March 2015. AA candidates were more likely to be obese (38% vs 22%: P<.001), biologically related (66% vs 44%: P<.001), and live ≤50 miles from the center (64% vs 37%: P<.001) than non-AAs. Even after adjusting for these differences, AAs were less likely to progress from referral to donation (aHR for AA vs non-AA: 0.26 0.47 0.83; P=.01). We then assessed racial differences in completion of each step of the evaluation process and found disparities in progression from medical screening to in-person evaluation (aHR: 0.41 0.620.94; P=.02) and from clearance to donation (aHR: 0.28 0.510.91; P=.02), compared with from referral to medical screening (aHR: 0.78 1.021.33; P=.95) and from in-person evaluation to clearance (aHR: 0.59 0.931.44; P=.54). Delays may be a manifestation of the transplant candidate's social network, thus, targeted efforts to optimize networks for identification of donor candidates may help address LDKT disparities.

Cancer burden in the United States—a review

The cancer burden in the United States is substantial, with more than 1.6 million new invasive cases of cancer (excluding non-melanoma skin cancers) and about 600,000 cancer deaths occurring each year. In this review, we provide a brief description of recent trends in cancer incidence, mortality, and survival; prevalence and trends in major potentially modifiable risk factors for cancer; uptake of recommended cancer screening tests; access to cancer treatment; and health insurance coverage in the United States. During the most recent 10 years of available data (2005–2014), overall cancer incidence rates declined by about 2% annually in men and were stable in women. The overall decline in the incidence rate among men has been largely driven by decreasing prostate, lung, and colorectal cancer rates; among women, declines in lung and colorectal cancer rates have been offset by increases in breast, corpus uteri, and thyroid cancer rates. The overall cancer death rate in the United States has declined 26% since peaking in 1991, and from 2006 to 2015 decreased annually by about 1.8% in men and 1.4% in women. Death rates continue to decline for many cancer types, including cancers of the colorectum, lung, prostate, and female breast, but are increasing for cancers of the liver and intrahepatic bile duct and corpus uteri. Cigarette smoking is the greatest contributor to cancer incidence and mortality in the United States—despite a substantial decline in prevalence—followed by excess body weight. Screening prevalence has substantially increased since 2000 for colorectal cancer but not for female breast or cervical cancer, and use of screening tests remain below public health targets. In addition, despite overall declines in cancer death rates in the United States, substantial disparities in progress against cancer persist by race/ethnicity, geographic location, and socioeconomic status. Comprehensive implementation of proven interventions to curb potentially modifiable risk factors, optimal participation in recommended cancer screening programs, and equitable access to preventive care and treatment could substantially reduce the cancer burden and disparities.

Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response.

Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown. To evaluate ethnic differences in the natural history of CHC and the impact of SVR. We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis. Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status. Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.

Cathode Ray Tube Recycling in South Africa

Households and businesses produce high levels of electrical and electronic waste (ewaste), fueled by modernization and rapid obsolescence. While the challenges imposed by e-waste are similar everywhere in the world, disparities in progress to deal with it exist, with developing nations lagging. The increase in e-waste generation highlights the need to develop ways to manage it. This paper reviews global and South African e-waste management practices with a specific case study on Cathode Ray Tube (CRT) waste. CRTs present the biggest problem for recyclers and policy makers because they contain lead and antimony. Common disposal practices have been either landfilling or incineration. Research into South African CRT waste management practices showed there is still more to do to manage this waste stream effectively. However, recent developments have placed e-waste into a priority waste stream, which should lead to intensified efforts in dealing with it. Overall, these efforts aim to increase diversion from landfill and create value-adding opportunities, leading to social and environmental benefits.

Where People Live and Die Makes a Difference: Individual and Geographic Disparities in Well-Being Progression at the End of Life

Lifespan psychological research has long been interested in the contextual embeddedness of individual development. To examine if and how regional factors relate to between-person disparities in the progression of late-life well-being, we applied three-level growth curve models to 24-year longitudinal data from deceased participants of the German Socio-Economic Panel Study (N = 3,427; age at death: 18 to 101 years). Results indicate steep declines in well-being with impending death, with some 8% of the between-person differences in both level and decline of well-being reflecting between-county differences. Exploratory analyses revealed that individuals living and dying in less affluent counties reported lower late-life well-being, controlling for key individual predictors including age at death, gender, education, and household income. The regional factors examined did not directly relate to well-being change, but were found to moderate (e.g., amplify) the disparities in change attributed to individual factors. Our results suggest that resource-poor counties provide relatively less fertile grounds for successful aging until the end of life and may serve to exacerbate disparities. We conclude that examinations of how individual and residential characteristics interact can further our understanding of individual psychological outcomes and suggest routes for future inquiry.

Where people live and die makes a difference: Individual and geographic disparities in well-being progression at the end of life.

Life-span psychological research has long been interested in the contextual embeddedness of individual development. To examine whether and how regional variables relate to between-person disparities in the progression of late-life well-being, we applied three-level growth curve models to 24-year longitudinal data from deceased participants of the German Socio-Economic Panel Study (N = 3,427; age at death = 18 to 101 years). Results indicated steep declines in well-being with impending death, with some 8% of the between-person differences in both level and decline of well-being reflecting between-county differences. Exploratory analyses revealed that individuals living and dying in less affluent counties reported lower late-life well-being, controlling for key individual predictors, including age at death, gender, education, and household income. The regional variables examined did not directly relate to well-being change but were found to moderate (e.g., amplify) the disparities in change attributed to individual variables. Our results suggest that resource-poor counties provide relatively less fertile grounds for successful aging until the end of life and may serve to exacerbate disparities. We conclude that examinations of how individual and residential characteristics interact can further our understanding of individual psychological outcomes and suggest routes for future inquiry.

Race and Sex Differences in Hypertension Control in CKD: Results From the Kidney Early Evaluation Program (KEEP)

African American men with chronic kidney disease (CKD) progress to end-stage renal disease more rapidly than African American women or whites. Uncontrolled hypertension worsens CKD, and disparities in hypertension control may contribute to disparities in CKD progression. Cross-sectional. 10,827 individuals with CKD and self-reported hypertension screened in the Kidney Early Evaluation Program. African American race, sex. Hypertension control (blood pressure <130 mm Hg systolic and/or <80 mm Hg diastolic). Self-report, physical examination (blood pressure), laboratory data (serum creatinine, microalbuminuria by urine dipstick). We calculated estimated glomerular filtration rates by using the 4-variable isotope dilution mass spectrometry Modification of Diet in Renal Disease Study equation. We classified CKD as early (stages 1 to 2) or late (stages 3 to 5) based on estimated glomerular filtration rate and microalbuminuria. In individuals with early CKD, African American women (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.14 to 1.88), white men (OR, 1.85; 95% CI, 1.39 to 2.46), and white women (OR, 1.69; 95% CI, 1.28 to 2.22) had greater odds of hypertension control (blood pressure <130/80 mm Hg) than African American men. In individuals with late CKD, white men (OR, 1.66; 95% CI, 1.10 to 2.52) and white women (OR, 1.67; 95% CI, 1.13 to 2.46) had greater odds of hypertension control than African American men. No differences were seen between African American men and women with late CKD. No information for medication regimens. African American men with CKD have poorly controlled hypertension compared with African American women and whites, particularly in the early stages of disease. Efforts to aggressively treat hypertension in this population may help narrow the race and sex disparities in progression to end-stage renal disease.

The military oral health care system as a model for eliminating disparities in oral health

Healthy People (HP) 2010 is a national health promotion and disease prevention initiative of the U.S. Department of Health and Human Services. The HP 2010 report highlighted a range of racial/ethnic disparities in dental health. A substantial portion of these disparities appear to be explained by differences in access to care. Members of the U.S. military have universal access to care that also has a compulsory component. The authors conducted a study to investigate the extent to which disparities in progress toward achievement of HP 2010 objectives were lower among the military population and to compare the oral health of the military population with that of the civilian population. The participants in this study were non-Hispanic white and non-Hispanic black males aged 18 to 44 years. They were drawn from the Tri-Service Comprehensive Oral Health Survey (10,869 including 899 recruits who participated in the TSCOHS Recruit Study) and the Third National Health and Nutrition Examination Survey (4,779). We found no disparities between black and white adults in untreated caries and recent dental visit rates in the military population. Disparities in missing teeth were much lower among military personnel than among civilians. A universal access-to-care system that incorporated an aspect of compulsory treatment displayed little to no racial disparity in relevant oral health outcomes. This demonstrates that it is possible for large, diverse populations to have much lower levels of disparities in oral health even when universal access to care is not provided until the patient is 18 or 19 years of age.