Ethnic Groups Research Articles

A - 81 Gender Bias in Collateral Informant Ratings of the Lawton & Brody Instrumental Activities of Daily Living Scale Varies by Ethnolinguistic Group

Abstract Objective Building on our prior work showing that sociocultural factors influence the nature of one’s daily activities and the degree of assistance rendered once cognitive difficulties emerge, the present study aimed to examine gender differences in the frequency of abnormal IADLS ratings [Not Applicable (N/A), Requires Assistance (R/A), Dependent] in cognitively healthy older adults from different ethnic (Hispanic vs. Non-Hispanic) and linguistic (English vs. Spanish) groups. Method Baseline data from 1060 healthy older adults [Non-Hispanic English-speakers (NE) = 597; Hispanic English-speakers (HE) = 249; Hispanic Spanish-speakers (HS) = 214] 50–90 years of age enrolled in the Texas Alzheimer’s Research and Care Consortium were analyzed using univariate analyses of variance and multivariate chi-squares within each ethnolinguistic group. Results Women obtained significantly (p < 0.001) higher IADLS total scores (indicative of greater impairment) than men in each ethnolinguistic group. A significant difference (p < 0.01) was found between gender across the sample for items related to Food Preparation, Housekeeping, and Laundry, wherein 7–25% of all men vs. < 1% of all women received “N/A” ratings. Significantly more HE men vs. women also received “N/A” ratings for Finances (4:1) and Medications (7:1), while a similar trend was observed in the NH and HS groups but did not reach statistical significance. No participants received an “N/A” rating and no significant gender differences were observed for remaining IADLs. Conclusion(s) Obtained findings highlight considerable gender bias on the Lawton & Brody IADLS in healthy older adults, which clearly limits the utility of this instrument in the provision of patient-centered neuropsychological services and may confound the interpretation of clinical trial outcomes.

Telehealth Utilization to Address Health Care Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review.

Research has reported health care disparities, including low rates of health care utilization, among racial and ethnic minority groups compared to Whites. Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) have experienced these disparities, attributed to various barriers such as limited access to linguistically and culturally concordant health care services. Telehealth may offer a viable mode of health service delivery for AANHPIs. The coronavirus disease of 2019 (COVID-19) pandemic sparked the adoption of technology for receiving health services. However, the literature on telehealth utilization before and during the COVID-19 pandemic among AANHPIs is limited. To address this gap, we conducted a scoping review of telehealth intervention empirical studies serving AANHPIs published between January 2010 and February 2024, using five databases. Twenty-four articles met our inclusion criteria, which required the use of a telehealth intervention program, provision of disaggregated AANHPIs, and targeting of physical and/or mental health outcomes. Our review revealed positive findings of telehealth interventions in helping AANHPIs access health care, with a primary focus on education and consultation for self-management. The review highlighted a range of technological platforms used in AANHPIs telehealth interventions, including web-based, mobile, and blended approaches. Additionally, the review emphasized the need for improved access to technology and reduction in digital exclusion. The findings affirm the usefulness and potential of telehealth interventions, providing implications for how health professionals can serve AANHPIs. Telehealth technology offers the ability for greater accessibility and individualization to address health care disparities in AANHPIs.

Who Wants to be Legible? Digitalization and Intergroup Inequality in Kenya

Governments across the Global South have begun introducing biometric IDs (eIDs) in an attempt to improve citizen-state legibility. While such initiatives can improve government efficiency, they also raise important questions about citizen privacy, especially for groups with a history of mistrust in the state. If concerns about increased legibility produce differential uptake or changes in political behavior, eID initiatives may exacerbate societal inequalities. In a conjoint experiment with 2,072 respondents from four Kenyan regions, we examine how perceptions of and willingness to register for eID under different policy conditions vary across politically dominant, opposition, and “securitized” (heavily policed) ethnic groups. We find meaningful group-level variation in support for specific policy features, and suggestive evidence that policies facilitating surveillance may discourage opposition political participation. Our most surprising finding, however, is that there is such broad support for expanded legibility. The promise of access to government services appears to outweigh other considerations.

Assessment of the public perception of the hospital pharmacist and their satisfaction level with the pharmacy services provided in a developing country: a cross-sectional survey in Malaysia.

To assess the public perception of the role of hospital pharmacists, their satisfaction with the pharmacy service provided, and the factors associated with their perception and satisfaction. A cross-sectional, questionnaire survey was conducted on adults older than 18 years who utilized public pharmacy services. A self-developed, validated questionnaire consisting of three parts was used, i.e., demographic data, perception, and satisfaction. The questionnaire was tested in a pilot study of 50 study participants and demonstrated good reliability results of 0.900 for the perception section and 0.836 for the satisfaction section. Therefore, all items were used in the final questionnaire. Four hundred and seventy-nine completed questionnaires were collected with a response rate of 91.6%. The Cronbach's α for perception and satisfaction scores were0.938 and 0.841, respectively. The median total score for public perception was 83 (interquartile range [IQR]: 15), whereas the median total score for public satisfaction was 38 (IQR: 33). The level of public perception was significantly associated with the age groups (P = .009), ethnic groups (P < .001), respondents' locality groups (P < .001), the level of education achieved group (P = .017), and the income groups (P = .006). Satisfaction was not significantly associated with any sociodemographic factors. This study has found that the general public had a favorable perception of the role of hospital pharmacists, and they were generally satisfied with the pharmacy service provided.

Racial and ethnic differences in the receipt of continuous positive airway pressure treatment for obstructive sleep apnea

ObjectiveTo examine the pattern of health services access and utilization that may contribute to racial/ethnic disparities in receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). MethodsThis cross-sectional study used a national sample from the All of Us Research Program, which included over 80 % of participants from underrepresented populations in biomedical research. Study participants included adults aged 18 years and older diagnosed with OSA (N = 8518). Diagnosis of OSA and CPAP treatment were ascertained by diagnostic and procedural codes from the electronic health records. Sociodemographic characteristics and health service utilization factors were identified using self-reported survey data. ResultsWith this national survey, the overall diagnosed prevalence of OSA was 8.8 %, with rates of 8.12 % in non-Hispanic (NH) Black adults, 5.99 % in Hispanic adults, and 10.35 % in NH White adults. When comparing to NH White adults, Hispanic adults were less likely to receive CPAP treatment for OSA after adjusting for socioeconomic and demographic characteristics, access to and utilization of health services, and comorbidities such as obesity and having multiple chronic conditions (OR = 0.73, 95 % CI = 0.59,0.90), p < 0.01. ConclusionsThe rates of CPAP treatment among OSA patients are not consistent across racial and ethnic groups. Unequal access to health services based on residence may contribute to these differences. Interventions that target disparities in OSA diagnosis, access to treatment, and barriers in insurance coverage could potentially help reduce racial and ethnic differences in OSA diagnosis and management.

Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors

South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population. To evaluate whether a culturally adapted, group lifestyle intervention will improve CVD risk factors more effectively than written health education materials among US South Asian adults. This single-blind randomized clinical trial was conducted from March 6, 2018, to February 11, 2023 at community sites in the Chicago, Illinois, metropolitan area. South Asian adults aged 18 to 65 years who were overweight or obese, had no history of CVD events, and had at least 1 additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes) were eligible for inclusion. A 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches. Lifestyle modification counseling was delivered in English, Gujarati, Hindi, and Urdu. Participants tracked their diet and physical activity (PA) and received 4 optional group maintenance sessions between months 5 and 11 of follow-up. The intervention was delivered in person prior to the onset of the COVID-19 pandemic and via videoconference starting in March 2020. The control group received written health education materials, delivered monthly. Primary outcomes were the between-group differences in CVD risk factor changes from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol, estimated using multivariate mixed-effects regression models. Secondary outcomes were self-reported diet quality, PA, and self-efficacy, estimated using univariate mixed-effects regression models. Among 549 randomized participants, 318 (57.9%) were women, and mean (SD) participant age was 49.2 (9.5) years. Mean differences in CVD risk factor changes from baseline to 12 months in the intervention vs control group were calculated for weight (mean difference, -0.07 kg; 95% CI, -0.55 to 0.42), SBP (mean difference, 0.47 mm Hg; 95% CI, -1.85 to 2.79), DBP (mean difference, 0.44 mm Hg; 95% CI, -1.06 to 1.95), cholesterol (mean difference, -2.47 mg/dL; 95% CI, -8.51 to 3.57), and HbA1c (mean difference, -0.07%; 95% CI -0.20% to 0.07%). Intervention participation was associated with greater improvements in dietary quality, PA, and self-efficacy than control. In the SAHELI randomized clinical trial, a culturally adapted, group lifestyle intervention was not more effective than written health education materials for CVD risk factor reduction among US South Asian adults, but the intervention was associated with small improvements in self-reported health behaviors. Effective CVD prevention interventions for this elevated-risk population require further investigation. ClinicalTrials.gov Identifier: NCT03336255.

Nursing strategies to address health disparities in genomics-informed care: a scoping review.

The objective of this review was to map the available global evidence on strategies that nurses can use to facilitate genomics-informed health care to address health disparities to inform the development of a research and action agenda. The integration of genomics into health care is improving patient outcomes through better prevention, diagnostics, and treatment; however, scholars have noted concerns with widening health disparities. Nurses work across the health system and can address health disparities from a clinical, research, education, policy, and leadership perspective. To do this, a comprehensive understanding of existing genomics-informed strategies is required. Published (qualitative, quantitative, mixed methods studies, systematic and literature reviews and text and opinion papers) and unpublished (gray) literature that focuses on genomics-informed nursing strategies to address health disparities over the last 10 years were included. No limitations were placed on language. The review was conducted in accordance with the JBI methodology for scoping reviews. A search was undertaken on May 25, 2023, across 5 databases: MEDLINE (Ovid), Embase, Cochrane Library (Ovid), APA PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). Gray literature was searched through websites, including the International Society of Nurses in Genetics and the Global Genomics Nursing Alliance. Abstracts, titles, and full texts were screened by 2 or more independent reviewers. Data were extracted using a data extraction tool. The coded data were analyzed by 2 or more independent reviewers using conventional content analysis and the summarized results are presented using descriptive statistics and evidence tables. In total, we screened 818 records and 31 were included in the review. The majority of papers were published in either 2019 (n=5, 16%), 2020 (n=5, 16%), or 2021 (n=5, 16%). Most papers came from the United States (n=25, 81%) followed by the Netherlands (n=3, 10%), United Kingdom (n=1, 3%), Tanzania (n=1, 3%) and written from a global perspective (n=1, 3%). Nearly half the papers discussed cancer-related conditions (n=14, 45%) and most of the others did not specify a disease or condition (n=12, 30%). In terms of population, nurse clinicians were mentioned the most frequently (n=16, 52%) followed by nurse researchers, scholars, or scientists (n=8, 26%). The patient population varied, with African American patients or communities (n=7, 23%) and racial or ethnic minorities (n=6, 19%) discussed most frequently. The majority of equity issues focused on inequitable access to genetic and genomics health services amongst ethnic and racial groups (n=14, 45%), individuals with lower educational attainment or health literacy (n=6, 19%), individuals with lower socioeconomic status (n=3, 10%), migrants (n=3, 10%), individuals with lack of insurance coverage (n=2, 6%), individuals living in rural or remote areas (n=1, 3%) individuals of older age (n=1, 3%). Root causes contributing to health disparity issues varied at the patient, provider, and system levels. Strategies were grouped into 2 categories: those to prepare the nursing workforce and those nurses can implement in practice. We further categorized the strategies by domains of practice, including clinical practice, education, research, policy advocacy, and leadership. Papers that mentioned strategies focused on preparing the nursing workforce were largely related to the education domain (n=16, 52%), while papers that mentioned strategies that nurses can implement were mostly related to clinical practice (n=19, 61%). Nurses in all domains of practice can draw on the identified strategies to address health disparities related to genomics in health care. We found a notable lack of intervention and evaluation studies exploring the impact on health and equity outcomes. Additional research informed by implementation science and that measures health outcomes is needed to identify best practices. A French-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A65 ].

Agroforestry Model in Leimea Sorin Village, Emerera District, Timor Leste

Agroforestry is an optimal and sustainable management of land use, by combining forestry and agricultural activities on the same land management unit by taking into account physical, social and economic environmental conditions. The purpose of this study is to calculate the value of farmers' income from the results of the agroforestry model, and the best feasibility analysis on consideration of three factors, namely economic, social and ecological. This research was carried out in the village of Leimea Sorin, Ermera District, Timor Leste in March-May 2021 using qualitative and quantitative methods. The data used in this study are data obtained directly from agroforestry farmers in the Ermera district of Timor Leste by means of interviews with the help of a questionnaire. Economic data analysis using three criteria NPV, BCR and IRR, and social and ecological analysis using qualitative descriptive. The results of the financial analysis show that the NPV is $ 220,184.66, the BCR is 28.7 and the IRR is 35%. The results of the social analysis show that the social aspect in the application of agroforestry in the village of Leimea Sorin Balu is the local community of the Kemak ethnic group of agricultural crops as their daily livelihood such as vanilla, coffee, teak, and others. And the ecological aspect is the results of the study show that the agroforestry model in the village of Leimea Sorin is an agroforestry system that has polycultural properties, and provides various benefits for the community compared to non-agroforestry systems.

Genome-wide association study and polygenic risk score analysis for schizophrenia in a Korean population

Although large-scale genome-wide association studies (GWASs) have revealed the genetic architecture of schizophrenia, these studies have mainly focused on populations of European ancestry. This study aimed to identify common genetic variants associated with schizophrenia in the Korean population and evaluate the performance of polygenic risk scores (PRSs) derived from large-scale GWASs across ancestries. In the Korean psychiatric GWAS project (KPGP), seven academic institutes and their affiliated hospitals across South Korea recruited a cohort of 1670 patients with DSM-IV-defined schizophrenia and 2271 healthy controls. A total of 6690,822 SNPs were tested for association with schizophrenia. We identified one previously unreported genome-wide significant locus rs2423464 (P = 2.83 × 10−11; odds ratio = 1.65; 95 % confidence interval = 1.43–1.91, minor allele frequency = 0.126). This variant was also associated with increased lysosomal-associated membrane protein family member 5 (LAMP5) gene expression. The PRS derived from the meta-analysis results of East Asian and European GWASs explained a larger proportion of the phenotypic variance in the Korean schizophrenia sample than the PRS of an East Asian or European GWAS. (R2 = 0.073 for meta-analysis; 0.028 for East Asian GWAS; 0.037 for European GWAS). GWASs involving diverse ethnic groups will expand our understanding of the genetic architecture of schizophrenia.

Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis

IntroductionExperiences of violence are important risk factors for worse outcome in people with mental health conditions; however, they are not routinely collected be mental health services, so their ascertainment depends on extraction from text fields with natural language processing (NLP) algorithms.MethodsApplying previously developed neural network algorithms to routine mental healthcare records, we sought to describe the distribution of recorded violence victimisation by demographic and diagnostic characteristics. We ascertained recorded violence victimisation from the records of 60,021 patients receiving care from a large south London NHS mental healthcare provider during 2019. Descriptive and regression analyses were conducted to investigate variation by age, sex, ethnic group, and diagnostic category (ICD-10 F chapter sub-headings plus post-traumatic stress disorder (PTSD) as a specific condition).ResultsPatients with a mood disorder (adjusted odds ratio 1.63, 1.55-1.72), personality disorder (4.03, 3.65-4.45), schizophrenia spectrum disorder (1.84, 1.74-1.95) or PTSD (2.36, 2.08-2.69) had a significantly increased likelihood of victimisation compared to those with other mental health diagnoses. Additionally, patients from minority ethnic groups (1.10 (1.02-1.20) for Black, 1.40 (1.31-1.49) for Asian compared to White groups) had significantly higher likelihood of recorded violence victimisation. Males were significantly less likely to have reported recorded violence victimisation (0.44, 0.42-0.45) than females.DiscussionWe thus demonstrate the successful deployment of machine learning based NLP algorithms to ascertain important entities for outcome prediction in mental healthcare. The observed distributions highlight which sex, ethnicity and diagnostic groups had more records of violence victimisation. Further development of these algorithms could usefully capture broader experiences, such as differentiating more efficiently between witnessed, perpetrated and experienced violence and broader violence experiences like emotional abuse.

Maternal characteristics and infant and child mortality: A cohort study in England linking Census and health data

Child mortality is a common measure of the overall health of society. Maternal characteristics, such as ethnicity and socioeconomic status are known to contribute to inequalities in health and mortality in babies and children. Overall, in the UK babies born to non-white mothers have a higher risk of mortality, and there is also a strong association between deprivation and risk of death. However, population data is currently lacking for England and Wales disentangling the various socioeconomic risk factors which are known to contribute to increased risk. We utilise population level data to assess the association between socioeconomic status, ethnicity, and child mortality. Our cohort consisted of all live singleton births in England and Wales between 2011 and 2016. We linked birth notifications to mothers’ 2011 Census records using NHS number, which provides person-level sociodemographic information. Death registration data was linked to identify all-cause and cause-specific deaths in babies. Babies were followed from date-of-birth for up to 10-years, or date-of-death. We report cumulative incidence of all-cause mortality for a 10-year follow-up for neonatal, infant and child deaths based on maternal socioeconomic and ethnic groups. Cox proportional hazard models are used to estimate hazard ratios for neonatal, infant and child deaths, with both minimally adjusted (maternal age and baby sex) and fully-adjusted models (accounting for other maternal, household and birth characteristics). This presentation will give an overview of our unique linked data sources, the statistical techniques employed, the latest available analytical results, and the emerging implications of the research.

Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database.

Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS. This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI). Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, p < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, p < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, p < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, p < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, p < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, p < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups. Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.

Associations between household overcrowding and adult mental illness in an ethnically diverse urban population: cross-sectional study using linked primary care and housing records.

ObjectiveWe hypothesised that adults living in overcrowded households were more likely to be diagnosed with Serious Mental Illness (SMI) or depression after accounting for individual, household and area-level factors. ApproachWe linked primary care records of adults currently registered with all general practices in the north-east London region on 21/03/2021 to housing data using pseudonymised unique property reference numbers (pUPRNs), giving a sample of 762,718 adults in 329,948 households. Primary outcomes were a primary care diagnosis of SMI or depression. Overcrowding was defined as &lt;32.5m2 per person. We estimated the adjusted odds (aOR) and 95% confidence intervals (CI) of SMI or depression when living in an overcrowded household, adjusting for individual (age, sex, ethnic group), household (size, composition), and area (Index of Multiple Deprivation) characteristics. We conducted logistic regression models with robust standard errors in RStudio. ResultsSMI and depression were diagnosed in 6,492 (0.9%) and 45,053 (5.9%) adults respectively; 584,515 (76.6%) adults lived in overcrowded households. In univariable analyses, household overcrowding was inversely related to risk of SMI or depression (aOR[CI]: 0.42 [0.39,0.44]; 0.62 [0.61,0.64]). The direction of effect reversed on adjustment for household size, composition, and area-level deprivation: 1.22 [1.12,1.33]; 1.07 [1.04,1.10] for SMI and depression respectively. ConclusionsWe found significant associations between SMI and depression and household overcrowding, using a novel method of record linkage to estimate household overcrowding but are not able to establish causality of observed associations in this cross-sectional study. ImplicationsMore research is needed to understand how housing conditions affect mental health.

Unmasking and quantifying racial bias of large language models in medical report generation

BackgroundLarge language models like GPT-3.5-turbo and GPT-4 hold promise for healthcare professionals, but they may inadvertently inherit biases during their training, potentially affecting their utility in medical applications. Despite few attempts in the past, the precise impact and extent of these biases remain uncertain.MethodsWe use LLMs to generate responses that predict hospitalization, cost and mortality based on real patient cases. We manually examine the generated responses to identify biases.ResultsWe find that these models tend to project higher costs and longer hospitalizations for white populations and exhibit optimistic views in challenging medical scenarios with much higher survival rates. These biases, which mirror real-world healthcare disparities, are evident in the generation of patient backgrounds, the association of specific diseases with certain racial and ethnic groups, and disparities in treatment recommendations, etc.ConclusionsOur findings underscore the critical need for future research to address and mitigate biases in language models, especially in critical healthcare applications, to ensure fair and accurate outcomes for all patients.

Physical activity and indices of physical well-being in children and adolescents with trisomy 21

Introduction: Trisomy 21 (Down syndrome) is the most common genetic disorder, which is caused by a chromosomal abnormality and presents various deviations in areas such as mental and motor levels. The presence of extra information corresponding in whole or in part to chromosome 21 affects the development of children with trisomy 21, and abnormal gene expression leads to changes in brain function. The overall prevalence of the syndrome is one (1) to two (2) per thousand (1,000) live births, although the prevalence may have variability among racial or ethnic groups. The purpose of this research is to highlight the deviations in the balance ability, the strength of the upper limbs, and to what extent they affect the quality of life of children and adolescents with trisomy 21. Methods: Eighteen (18) children and adolescents with trisomy 21 participated in the research, with three (3) being excluded due to exclusion criteria. Fifteen (15) children and adolescents with trisomy 21 were finally included, of which four (4) were boys and eleven (11) were girls.

Self-reported Ethnicity Changes over Time: A Population Level Study using Public Voter Databases

ObjectivesAdministrative databases such as voter registries contain a wealth of information about a large proportion of a population. This is especially true when longitudinal information about individuals is available, such as changes in their names, addresses, or self-reported ethnic attributes. Apparent changes in ethnic attributes might be due to perceptions of majority evaluations of ethnic groups. In this project, we analysed snapshots of a publicly available US voter database from 2015 to 2022, exploring if and how recent presidential elections impacted changes in voters' self-reported ethnic attributes. ApproachUsing bi-monthly snapshots of a publicly available US voter database from 2015 to 2022, we generated cohorts by linking active voters during seven twelve-month periods (2015/16 to 2021/22). These seven time periods included one mid-term and two presidential elections, and four control time spans before, between, and after these elections. We compared changes in self-reported ethnic attributes of voters during the times of elections versus the control time periods. ResultsPreliminary results reveal a substantial change to self-reported ethnic attributes during the periods leading to an election. A majority of such changes are by individuals from a specific ethnic group choosing not to report an ethnicity, an indication of their preference to not disclose ethnicity-related sensitive information. ConclusionsWe have shown how a publicly available voter database can be used to explore how self-reported ethnic attributes are modified by individual voters over time, and how the prevalence of such changes is influenced by political events such as presidential elections.

Impact of Tibetan ethnicity and residence altitude on complications during total knee arthroplasty and difficulties of measurement of perioperative blood loss.

Tibetan patients undergoing total knee arthroplasty (TKA) have greater fluctuations in perioperative haemoglobin levels and blood hypercoagulability. This study was to investigate whether ethnicity and altitude affect perioperative blood loss and the risk of complications after TKA. We retrospectively enrolled 1,116 patients undergoing TKA for knee osteoarthritis at our hospital between January 2016 and September 2021. We divided patients into four groups according to whether they were of Tibetan or Han ethnicity and whether they lived above or below 2500m above sea level. Primary outcomes were total, intraoperative, and hidden blood losses, while secondary outcomes were complications and homologous transfusion. Factors associated with increased blood loss were analyzed by multivariate regression. Total blood loss was higher among patients residing at high altitude compared with lower altitude, whether they were of Han (794.6 mL vs. 667.2 mL, P = 0.020) or Tibetan (904.4 mL vs. 663.8 mL, P < 0.001). Total blood loss was similar between the two ethnic groups at the same altitude. Altitude, but not Tibetan ethnicity, remained associated with increased blood loss after being analyzed by multivariate regression. Complications among the four groups were generally similar, although the frequency of calf muscular venous thrombosis was higher among Tibetan patients, while the frequency of blood transfusion was higher among Han subjects. Our findings indicate that residence at high altitude, but not ethnicity, may contribute to increased total blood loss during TKA. Thrombotic complications were more frequent among Tibetan than Han patients.

Generating synthetic identifiers to support development and evaluation of data linkage methods

We aimed to develop a framework for generating synthetic identifier datasets to support development and evaluation of data linkage methods. We evaluated whether replicating associations between attributes and identifiers improved the utility of the synthetic data for assessing linkage error. We determined the steps required to generate synthetic identifiers that replicate the properties of real-world data collection. We generated synthetic versions of a large United Kingdom cohort study (the Avon Longitudinal Study of Parents and Children), according to the quality and completeness of identifiers recorded over several waves of the cohort. We evaluated the utility of the synthetic identifier data in terms of assessing linkage quality (false matches and missed matches). Comparing data from two collection points in ALSPAC, we found within-person disagreement in identifiers (differences in recording due to both natural change and non-valid entries) in 18% of surnames and 12% of forenames. Rates of disagreement varied by maternal age and ethnic group. Synthetic data provided accurate estimates of linkage quality metrics compared with the original data (within 0.13-0.55% for missed matches and 0.00-0.04% for false matches). Incorporating associations between identifier errors and maternal age/ethnicity improved synthetic data utility. Replicating dependencies between attribute values (e.g. ethnicity), values of identifiers (e.g. name), identifier disagreements (e.g. missing values, errors or changes over time), and their patterns and distribution structure enables generation of realistic synthetic data that can be used for robust evaluation of linkage methods. Our framework provides a novel and generalisable mechanism for developing and benchmarking record linkage algorithms.

Mutation spectrum of Tyrosinemia type I in Iran, A retrospective cohort study

Hereditary Tyrosinemia Type 1 (HT1) is a genetic disorder characterized by an autosomal recessive inheritance pattern, caused by mutations in the fumarylacetoacetate hydrolase (FAH) gene, which results in a deficiency of fumarylacetoacetase. In our study, we identified a total of 15 mutations, including 12 newly discovered and 3 previously reported pathogenic mutations, in a cohort of 19 Iranian patients with the acute form of HT1. Out of the 12 novel variants identified, 11 were missense variants: p.Asp126His, p.Gln75Glu, p.Leu385Pro, p.Ser92Thr, p.Leu96Arg, p.Val167Glu, p.Ala94Asp, p.Gly353Trp, p.Ser164Pro, p.Glu86His and p.Ala163Pro. Additionally, there was one nonsense variant, p.Try244X, that had not been previously reported. Interestingly, the Arg237X variant was found to be particularly prevalent in this study. Notably, three exons, namely exons 9, 3, and 6, exhibited a higher frequency of mutations. All of the identified variants are presumed to result in loss of function, impacting the clinical signs, disease progression, increasing tyrosine level, and the specific location of the mutation. Our study has provided valuable insights into the mutation spectrum of variants associated with HT1 disease which is reported for the first time from Iran. This information can facilitate the development of targeted mutation screening protocols, focusing on the most prevalent mutations within specific regions or ethnic groups.

Islam and ethnic tolerance: assessing Kyrgyz’ Muslim religiosity and acceptance of Uzbeks in Kyrgyzstan

ABSTRACT Using a national opinion survey conducted in 2009 in Kyrgyzstan, we focused on responses from ethnic Kyrgyz respondents in the south where major riots between Kyrgyz and Uzbeks occurred in 1990 and 2010. We performed latent class analyses on these responses to assign Kyrgyz into Muslim religiosity categories and construct a social distance scale to measure Kyrgyz’ levels of acceptance of Uzbeks living in Kyrgyzstan. We discovered that, in spite of ongoing unresolved interethnic grievances in the south, Kyrgyz who were members of the highly active Muslim religiosity category exhibited a significantly higher probability for accepting the closest relations (kin through marriage) with Uzbeks than Kyrgyz who were members of the non-religious category. Because other researchers indicated that religion did not play any role in causing the riots in 2010, we believe that Muslim religiosity could potentially play a role in developing beneficial relations between these ethnic groups.