Ethnic Groups Research Articles

Individual, household, and socio-economic predictors of COVID-19 testing and vaccination outcomes: a whole population linked data analysis

ObjectiveThe COVID-19 pandemic has exposed numerous social inequities in health outcomes across nations, despite early warnings of their potential. Poorer outcomes for ethnic minorities, and to a lesser extent Indigenous peoples, have been widely reported, and may be explained in part by household conditions and poorer socio-economic circumstances. This study aimed to identify the effects of diverse individual and social conditions on COVID-19 outcomes within the New Zealand population. MethodWe conducted a whole population analysis of the association between individual (e.g. ethnicity, disability status), household (e.g. household composition), and socio-economic (e.g. crowding, housing quality, income) factors and four COVID-19 health outcomes – infection, hospitalisation, mortality, and vaccination status. We constructed variables of interest from linked administrative data in New Zealand’s Integrated Data Infrastructure, and examined associations within the 2018 Census usually resident population (analysis Ns = 518,571 - 3,216,696). ResultsAnalyses showed that Māori (the Indigenous people of New Zealand) and Pacific peoples, an ethnic minority, experienced worse outcomes than other New Zealanders across all COVID-19 outcomes. These ethnic group differences were persistent, yet reduced, when accounting for household and socio-economic variables. Factors including disability status, high housing mobility, poor quality housing, and household crowding were also widely predictive of worse outcomes. ConclusionEthnic inequity in a range of COVID-19 outcomes is present in a country where the overall impacts of the pandemic were relatively limited. Individual, household, and socio-economic factors are associated with diverse COVID-19 outcomes, and policy amenable factors may help explain the presence of ethnic inequities.

Myocardial Infarction Quality of Care and Outcomes in Asian Ethnic Groups in the United States.

National-level differences in myocardial infarction (MI) quality of care among Asian patients in the United States are unclear. We assessed the quality of MI care in the 6 largest US Asian ethnic groups. Patients aged ≥18 years with ST-segment-elevation MI or non-ST-segment-elevation MI in the Get With The Guidelines-Coronary Artery Disease registry (711 US hospitals, 2015-2021) were assessed. The odds of MI-related quality of care and process outcomes were evaluated in Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asian adults compared with non-Hispanic White adults. Sex-stratified logistic regression models were adjusted for age and clinical characteristics. There were 5691 Asian patients (1520 Asian Indian, 422 Chinese, 430 Filipino, 114 Japanese, 283 Korean, 553 Vietnamese, and 2369 other Asian) and 141 271 non-Hispanic White patients, overall 30% female, and mean age of 66.5 years. Relative to non-Hispanic White adults, among patients with ST-segment-elevation MI, door-to-ECG time ≤10 minutes was less likely in Asian Indian (adjusted odds ratio [aOR], 0.64 [95% CI, 0.50-0.82]), Chinese (aOR, 0.65 [95% CI, 0.46-0.93]), and Korean (aOR, 0.57 [95% CI, 0.33-0.97]) men and in other Asian women (aOR, 0.61 [95% CI, 0.41-0.90]). Door-to-balloon time ≤90 minutes was less likely in Asian Indian men (aOR, 0.71 [95% CI, 0.56-0.90]) and Filipina women (aOR, 0.48 [95% CI, 0.24-0.98]). In patients with ST-segment-elevation MI or non-ST-segment-elevation MI, optimal medical therapy for MI was less likely in Korean men (aOR, 0.65 [95% CI, 0.47-0.90]) and more likely in Asian Indian men (aOR, 1.22 [95% CI, 1.06-1.40]) and women (aOR, 1.32 [95% CI, 1.04-1.67]) and Filipina women (aOR, 1.84 [95% CI, 1.27-2.67]). MI quality of care varies among US Asian patients with ST-segment-elevation MI and non-ST-segment-elevation MI. Quality improvement programs must identify and address the factors that result in suboptimal MI quality of care among US Asian patients.

„W tej sytuacji sprawę znów odłożono”. Kwestia prawosławia w województwie krakowskim na marginesie sprawozdania Wydziału do spraw Wyznań z 1969 r.

After World War II, the displacement of the population irreversibly changed the ethnic and religious structure of south-eastern Poland. The Lemko people who lived in the districts of Nowy Sącz and Nowy Targ were displaced from the area of the Kraków voivodeship. Most of the people belonging to this ethnic group were of the Greek Catholic faith. In the interwar period, however, some of them converted to Orthodoxy. There were nine churches of this religion in the Nowy Sącz district. All of them were closed due to the displacement of the faithful. The liberalization of the system allowed expatriates to return. For many reasons only few of them returned. None of the Orthodox parishes in the Krakow Province resumed their activities. However, efforts were made to set up pastoral centers. This was met with the reluctance of the local authorities. In 1969, the national religious administration conducted a survey on the functioning of the Orthodox Church in the country. In response, a report was prepared on the situation of this religion in the Krakow Province.

Assessing the Impact of Multidisciplinary Cancer Consultations on Cancer Quality Metrics

Objective: Multidisciplinary cancer consultations play a critical role in the delivery of quality cancer care by promoting treatment planning and collaborative decision-making. The objective of this study was to evaluate associations between multidisciplinary cancer consultations and receipt of guideline-recommended adjuvant treatments among breast, colorectal, or non-small cell lung cancer patients and assess these associations between and within racial and ethnic groups. Materials and Methods: This is a population-based retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER), Medicare-linked data (2006–2016) to identify Medicare beneficiaries diagnosed with nonmetastatic breast, colorectal, or non-small cell lung cancer. Multidisciplinary cancer consultation was based on encounters with 2 or more oncology providers within 2 months of diagnosis. Cancer quality metrics assessed included receipt of guideline-recommended adjuvant cancer treatment for each cancer type. Results: Patients with multidisciplinary cancer consultations were more likely to receive adjuvant cancer treatment compared with patients without multidisciplinary cancer consultations within racial and ethnic groups. However, non-Hispanic Black and Hispanic breast cancer patients with multidisciplinary cancer consultations were 24% and 41% less likely to receive hormone and radiation therapy, respectively, compared with NHWs with multidisciplinary cancer consultations. Conclusions: Patients with multidisciplinary cancer consultations were more likely to receive adjuvant cancer treatment, but racial and ethnic disparities in cancer care persist. Multidisciplinary cancer consultations are likely an important, but not fully sufficient, contributor to the receipt of adjuvant cancer treatment and may be a tool in the implementation of multipronged, team-based cancer care delivery models to reduce inequities in cancer-related outcomes.

SP8.6 - Exploring Barriers of Entry for Women Pursuing Surgery: Impact of a Conference on the Confidence, Understanding, and Preparedness of Attendees

Abstract In the UK, women are underrepresented in surgery. Women make up only 16% of consultant surgeons and 34% of surgical registrars in the UK, whilst 59% of medical students are female. This project aims to explore the impact of conferences on perceived barriers and attitudes of female medical students aspiring to become surgeons. A survey was administered to 130 attendees, yielding 95 eligible responses, at a national student-led conference held at UCL encompassing speaker events, workshops, and speed mentoring. Pre- and post- questionnaires were provided. This included an open ended question on personal barriers, and a 5-Point Likert Scale to assess opinions on barriers of entry, confidence in surgical skills, preparedness for a surgical career, and understanding of challenges faced by women in surgery. Wilcoxon Signed-Ranks Test was used to assess statistical significance. The study included participants aged 18-30 from 23 universities and NHS trusts, representing 7 ethnic groups and 12 medical professions, with medical students comprising 87% of the cohort. Following the conference, 14 barriers of entry were analysed and there was a notable average increase in measured outcomes: confidence in surgical skills by 175%; preparedness by 192%; and understanding of the challenges faced by 177%. Overall, an average increase of 181% across reported metrics. Overall, the study data has demonstrated the effectiveness of the UCL Women in Surgery conference in empowering students pursuing surgical careers. Specialised conferences offer safe spaces for networking, mentorship, and field insights, while also mitigating financial barriers through low registration costs. Representation matters, and supporting aspiring surgeons by addressing barriers of entry for women is crucial.

FP2.5 - Predictors for anastomotic leak (AL) in inflammatory bowel disease (IBD) patients and its associated postoperative (PO) complications; A cohort of a single institution experience

Abstract Introduction IBD patients are highly susceptible to PO morbidities. This study aimed to look at the predictors of AL and the associated morbidities during hospital stays to increase the awareness of these patients. Methods A 5-year retrospective study in DGH. All variables were evaluated:patient-dependent (Age, Gender, BMI, ethnic group, comorbidities),disease-dependent (type of IBD, disease location, disease duration), surgery-dependent (duration, CEPOD type, approach, type of resection),Postoperative(CRP level, VTE, ITU admission, LOS, complications).All data were analysed using SPSS22, and Chi-square test. Results 131 patients were admitted for IBD resection. Median age 37 years. 76 (58%) were female, Chron’s disease was 98 (74.8%). 101 (77.1%) were done laparoscopically, 87 (66.4%)were elective, and the median LOS was 7days.63 (48.1%) has bowel anastomosis and 15 (23.8%) have AL. The median CRP on PO day3 for AL patients was 118. There was no significant association between PO day3CRP and IBD type with AL (P=0.4, 0.7); however, DVT and PE were associated with AL (P=0.001 and 0.039). Patients with AL had a high tendency for ITU admission with longer LOS (P=0.000).Long stays were seen in patients with leaks post-emergency than elective resections (P=0.047, 0.112). AL was associated with chest infection (P=0.001), collection (P=0.006),wound infection (p=0.000), and a higher rate of re-operation within 30 days (p=0.019). Conclusion PO day3CRP is not an independent predictor for AL. Our cohort of IBD patients who had bowel anastomosis showed a significant correlation between VTE and AL.AL was associated with chest and wound infections, high chance of a long ITU stay and subsequently, a long hospital stay. IBD patients with AL are vulnerable to VTE so need high care on these regards.

The 5T's of health disparities in multiple myeloma in Latin America.

Health disparities or inequities, which are defined as differences in the quality of medical and healthcare between populations among racial, ethnic, and socioeconomic groups, have been validated in numerous studies as determinants of survival and quality of life in different diseases, including cancer.Compared to the improvement in overall survival in developed countries in relation to better diagnostic opportunity and novel therapeutic approaches, low and middle-income countries still have significant barriers in accessing these therapies.The potential impact of overcoming these barriers is immense and offers hope for better outcomes. There is great heterogeneity in the diagnostic and therapeutic approach to multiple myeloma among different latitudes. Latin America has been characterized by important limitations in using the best technologies currently available in developed countries. Overcoming health disparities in multiple myeloma in LMICs could help improve survival and quality of life outcomes. Likewise, it is necessary to increase the representation of the Latin population in clinical studies, primarily in our region.

The Roma Population: Migration, Settlement, and Resilience

The Roma population—with a unique history marked by migration, settlement issues, and ongoing resilience—has always faced significant social marginalization and has often been subjected to forced migration. Despite being one of the largest and most diverse ethnic groups in Europe, Roma continue to face systemic discrimination and social exclusion, leading to poor outcomes in education, employment, health, and housing. This article analyses the migration pathways, settlement experiences, and persistent obstacles faced by Roma. We argue that removing historical and systemic barriers to create a more equitable and welcoming environment for the Roma community is their right. The resilience of the Roma community in the face of adversity is a testament to their cultural strength and adaptability. This research aims to document these aspects and thus provide a basis for policies that promote social inclusion, equality, and respect for cultural diversity.

Racial microaggressions on the initial teacher education programmes: implications for minority ethnic teacher retention

ABSTRACT The representation and retention in the teaching profession are lower for people from all minority ethnic groups in England. The most significant ethnic disparities were found to occur in the early career stages (Worth et al., 2022). This article draws on critical race theory to investigate how racism, in the form of racial microaggressions, contributes to these disparities. It shares the findings from a small-scale research project on student teachers’ experiences of racial microaggressions while learning to teach and discusses the implications for retention in the profession. It draws on a pilot survey (N = 42) and interview data from 14 pre-service teachers from a variety of ethnic and subject backgrounds to explore participants’ racialised experiences on school placements, as well as university elements of the Initial Teacher Education (ITE) programme in England. The findings suggest that microaggressions were more common on school placements than at universities. There is evidence to suggest that experiences of racial microaggressions may negatively affect minority ethnic student teachers’ thoughts on viability in the teaching profession.

The Change of Thaiyung Language

This research is to study the change of Thaiyung language, particularly the change of words in Yang language that use in the three generation. There are 400 w0rds are used to test the three generation at Namfa village, Viengphouka district, Luangnamtha province. There are 30 samples such as over 70 years old generation, 35-55 years old generation and 15-25 years old generation. The research is used linguistic separation use and linguistic voice translation criteria of words that use by three generations. The result found out that, there are three types of the same words used by three generations. There are four types of the same words used by two generations and there is a type of the different words used by three generations. The language used by three generations still use a lots of Yang words for communication. The first generation use Yang word (A) more than second and third generations. The second and third generations used Yang words with other words in social more than the first generation. And the third generation use other words (B) more than the first and second generations. This is because the third generation of teenagers is open and ready to accept new things all the time and prefer to use the national language (standard Lao language) to communicate with other ethnic groups in society. As a result, the use of the Yang language has diminished in daily life, or may have been used only when living with parents, families, and in a group of people who use the Yang language.

The Requiem of Taidam Ethnic Group

The objective of this study is to analyze the pattern of using spoken words and life styles of Taidam ethnic group through the requiem. The sample of the study includes 485 words and 147 texts in the requiem of Taidam ethnic group. The study is analyzed by qualitative method under the concept of Jaralvilai CHARUNROCHANA, Souk XAIYALEUD, Phonesiri OUTHAIVANH and faculty, Onekeo NUANNAVONG and faculty, KhamhoungSANMANI, and Houmphanh RATTANAVONG. The results of the study has found that in the patterns of using words there were 7 patterns; such as, there were the majority of 14 duplicated words; 49 overlapping words 119 hyponymy 17 polysemy words, In addition, it is found that there are 286 dialect words, among those, there are 67 words used in the religious requiem; there are 35 antonym words that have 18 pairs of words; and there are 97 group of words that have 12 words of head word group and 87 words of sub word group.For life style, such as belief, Taidam ethnic group believes in the spirit or ghost such as the spirit of house, the protected spirit at bath river bank, the protected ghost at the ghost district gate, Maebao sipirit, a deity or spirit of heaven, mermaid, and soul of beginning and ending. Furthermore, Taidam ethnic group has yet believed in the prediction of being reborn of the dead’s spirit. The tradition of Taidam still includes prediction of ghost, funeral ceremony, Baci ceremony, prohibitive practice, shelf of ghost by family. Sending off the spirit has three shelves including sending to Damdoi, sending Lienparnnoy and sending to Lienparnluang

High Resolution Class I HLA -A, -B, and -C Diversity in Eastern and Southern African Populations.

Africa remains significantly underrepresented in high-resolution Human Leukocyte Antigen (HLA) data, despite being one of the most genetically diverse regions in the world. This critical gap in genetic information poses a substantial barrier to HLA-based research on the continent. In this study, Class I HLA data from Eastern and Southern African populations were analyzed to assess genetic diversity across the region. We examined allele and haplotype frequency distributions, deviations from Hardy-Weinberg Equilibrium (HWE), linkage disequilibrium (LD), and conducted neutrality tests of homozygosity across various populations. Additionally, the African HLA data were compared to those of Caucasian and African American populations using the Jaccard index and multidimensional scaling (MDS) methods. The study revealed that South African populations exhibited 50.4% more genetic diversity within the Class I HLA region compared to other African populations. Zambia showed an estimated 36.5% genetic diversity, with Kenya, Rwanda and Uganda showing 35.7%, 34.2%, and 31.1%, respectively. Furthermore, an analysis of in-country diversity among different tribes indicated an average Class I HLA diversity of 25.7% in Kenya, 17% in Rwanda, 2.8% in South Africa, 13.6% in Uganda, and 6.5% in Zambia. The study also highlighted the genetic distinctness of Caucasian and African American populations compared to African populations. Notably, the differential frequencies of disease-promoting and disease-preventing HLA alleles across these populations emphasize the urgent need to generate high-quality HLA data for all regions of Africa and its major ethnic groups. Such efforts will be crucial in enhancing healthcare outcomes across the continent.

Use and perception of risk: traditional medicines of Pakistani immigrants in Norway

BackgroundPakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants’ experiences and perceptions of risk regarding the use of TM to treat illnesses.MethodsA qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke’s reflexive thematic analysis (RTA) using Nvivo.ResultsRTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants’ mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities.ConclusionThe study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway.

Beliefs, taboos, usages, health perceptions, and practices toward wildlife among different ethnicities in Tak and Mae Hong Son Provinces, Thailand

This concurrent qualitative study was carried out with the main objective to determine wildlife beliefs, taboos, usages, health perceptions, and practices among ten ethnic groups in four communities in Tak and Mae Hong Son provinces of Thailand from November 2020 to January 2021. We also gathered comprehensive information on study respondents’ knowledge related to potential risk behaviors that could lead to zoonotic disease transmission and infection. Furthermore, we intended to use the study’s findings to develop communication strategies and health literacy improvement interventions for mitigating risky behaviors, with a focus on ethnic groups and particular individuals who live in close proximity to forests and wildlife, to prevent future pandemics. Sixty-five respondents were purposively selected based on their extensive knowledge, active participation in local cultural contexts, beliefs, and exposure to wildlife contact or consuming game animals. Twenty (30.8%) participated in in-depth interviews (IDIs), while 45 (69.2%) participated in eight focused group discussions (FGDs). The results revealed that the characteristics of wildlife contact are similar and distinct based on their beliefs and taboos among various ethnic groups and study locations, which are influenced by cultural backgrounds and traditions. Although some ethnic groups do not have explicit restrictions on the consumption of wildlife, others adhere to specific beliefs and taboos that forbid the consumption or killing of specific wild animals. These beliefs frequently correspond with conservation initiatives, thereby facilitating the preservation of threatened species. The study also revealed a lack of appropriate health knowledge, perceptions, and practices regarding wildlife contact and consumption. As a result, it is recommended that public health officials and local governments develop and execute communication and education initiatives. These campaigns should aim to increase health literacy and promote safe handling, preparation, and cooking practices to reduce the risk of zoonotic disease transmission and infection effectively. Moreover, it is necessary to design and implement wildlife conservation education and outreach activities. The programs should promote environmental stewardship while considering the cultural contexts, beliefs, and practices of various ethnic groups. The activities should involve diverse stakeholders, including local leaders, religious influencers, community members, schoolteachers, students, health professionals, village health volunteers, and civil society organizations.

Acceptability of de-intensified screening for women at low risk of breast cancer: a randomised online experimental survey

BackgroundRisk-stratified approaches to breast screening show promise for increasing benefits and reducing harms. But the successful implementation of such an approach will rely on public acceptability. To date, research suggests that while increased screening for women at high risk will be acceptable, any de-intensification of screening for low-risk groups may be met with less enthusiasm. We report findings from a population-based survey of women in England, approaching the age of eligibility for breast screening, to compare the acceptability of current age-based screening with two hypothetical risk-adapted approaches for women at low risk of breast cancer.MethodsAn online survey of 1,579 women aged 40–49 with no personal experience of breast cancer or mammography. Participants were recruited via a market research panel, using target quotas for educational attainment and ethnic group, and were randomised to view information about (1) standard NHS age-based screening; (2) a later screening start age for low-risk women; or (3) a longer screening interval for low-risk women. Primary outcomes were cognitive, emotional, and global acceptability. ANOVAs and multiple regression were used to compare acceptability between groups and explore demographic and psychosocial factors associated with acceptability.ResultsAll three screening approaches were judged to be acceptable on the single-item measure of global acceptability (mean score > 3 on a 5-point scale). Scores for all three measures of acceptability were significantly lower for the risk-adapted scenarios than for age-based screening. There were no differences between the two risk-adapted scenarios. In multivariable analysis, higher breast cancer knowledge was positively associated with cognitive and emotional acceptability of screening approach. Willingness to undergo personal risk assessment was not associated with experimental group.ConclusionWe found no difference in the acceptability of later start age vs. longer screening intervals for women at low risk of breast cancer in a large sample of women who were screening naïve. Although acceptability of both risk-adapted scenarios was lower than for standard age-based screening, overall acceptability was reasonable. The positive associations between knowledge and both cognitive and emotional acceptability suggests clear and reassuring communication about the rationale for de-intensified screening may enhance acceptability.

Worldwide analysis of actionable genomic alterations in lung cancer and targeted pharmacogenomic strategies

Based on data from the Global Cancer Statistics 2022, lung cancer stands as the most lethal cancer worldwide, with age-adjusted incidence and mortality rates of 23.6 and 16.9 per 100,000 people, respectively. Despite significant strides in precision oncology driven by large-scale international research consortia, there remains a critical need to deepen our understanding of the genomic landscape across diverse racial and ethnic groups. To address this challenge, we performed comprehensive in silico analyses and data mining to identify pathogenic variants in genes that drive lung cancer. We subsequently calculated the allele frequencies and assessed the deleteriousness of these oncogenic variants among populations such as African, Amish, Ashkenazi Jewish, East and South Asian, Finnish and non-Finnish European, Latino, and Middle Eastern. Our analysis examined 117,707 variants within 86 lung cancer-associated genes across 75,109 human genomes, uncovering 8042 variants that are known or predicted to be pathogenic. We prioritized variants based on their allele frequencies and deleterious scores, and identified those with potential significance for response to anti-cancer therapies through in silico drug simulations, current clinical pharmacogenomic guidelines, and ongoing late-stage clinical trials targeting lung cancer-driving proteins. In conclusion, it is crucial to unite global efforts to create public health policies that emphasize prevention strategies and ensure access to clinical trials, pharmacogenomic testing, and cancer research for these groups in developed nations.

Clinical characteristics and risk factors of osteoporosis among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia

SummaryThis study investigated osteoporosis risk factors among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia in primary care. Advanced age, dementia, depression, and polypharmacy were associated with higher risks for osteoporosis. Screening strategies targeting these factors are crucial for improving bone health as part of comprehensive preventive care.PurposeAsian patients with type-2 diabetes mellitus (T2DM), hypertension, or hyperlipidaemia (DHL) are predominantly managed in primary care. They are also at risk of osteoporosis, but men are often under-screened and under-treated for this preventable bone disorder. This study aimed to identify the clinical characteristics and risk factors of osteoporosis among older men with DHL in primary care for early intervention.MethodsThis retrospective study included men aged 65 years and older managed in public primary care clinics for their DHL between 1st July 2017 and 30th June 2018. Demographic, clinical, laboratory, and imaging data were extracted from their electronic medical records based on their International Classification of Diseases-10 (ICD-10) diagnosis codes. Descriptive statistical analyses, with statistical significance set at p < 0.05, were conducted, followed by generalized estimating equation (GEE) modelling.ResultsMedical records of 17,644 men (83.1% Chinese, 16.9% minority ethnic groups, median age 71 years) were analysed. 2.3% of them had diagnosis of osteoporosis, 0.15% had fragility fracture, and 26.0% of those diagnosed with osteoporosis were treated with bisphosphonates. Their mean HbA1c was 6.9%; mean systolic and diastolic blood pressure were 133 and 69 mmHg. The GEE model showed that age (OR = 1.07, 95%CI = 1.05–1.09, p < 0.001), dementia (OR = 2.24, 95%CI = 1.33–3.77, p = 0.002), depression (OR = 2.38, 95%CI = 1.03–5.50, p = 0.043), and polypharmacy (OR = 6.85, 95%CI = 3.07–15.26, p < 0.001) were significantly associated with higher risks for osteoporosis.ConclusionAge, dementia, depression, and polypharmacy are associated with osteoporosis risks in men with DHL. Strategies to incorporate osteoporosis screening among older men with these risk factors are needed to improve their bone health.

Gestational Diabetes Mellitus and Subsequent Risks of Diabetes and Cardiovascular Diseases: the Life Course Perspective and Implications of Racial Disparities.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications worldwide and the prevalence is continuously rising globally. Importantly, GDM is not an isolated complication of pregnancy. Growing evidence suggests that individuals with GDM, compared to those without GDM, have an increased risk of subsequent type 2 diabetes (T2D) and cardiovascular diseases (CVD). Substantial racial and ethnic disparities exist in the risk of GDM. However, the role of race and ethnicity in the progression from GDM to T2D and CVD remains unclear. The purpose of the current review is to summarize recent research about GDM and its life-course impacts on cardiometabolic health, including 1) the peak time of developing T2D and CVD risks after GDM, 2) the racial and ethnic disparities in the risk cardiometabolic diseases after GDM, 3) the biological plausibility and underlying mechanisms, and 4) recommendations for screening and prevention of cardiometabolic diseases among individuals with GDM, collectively to provide an updated review to guide future research. Growing evidence has indicated that individuals with GDM had greater risks of T2D (7.4 to 9.6 times), hypertension (78% higher), and CDV events (74% higher) after GDM than their non-GDM counterparts. More recently, a few studies also suggested that GDM could slightly increase the risk of mortality. Available evidence suggests that key CVD risk factors such as blood pressure, plasma glucose, and lipids levels are all elevated as early as < 1year postpartum in individuals with GDM. The risk of T2D and hypertension is likely to reach a peak between 3-6years after the index pregnancy with GDM compared to normal glycemia pregnancy. Cumulative evidence also suggests that the risk of cardiometabolic diseases including T2D, hypertension, and CVD events after GDM varies by race and ethnicity. However, whether the risk is higher in certain racial and ethnic groups and whether the pattern may vary by the postpartum cardiometabolic outcome of interest remain unclear. The underlying mechanisms linking GDM and subsequent T2D and CVD are complex, often involving multiple pathways and their interactions, with the specific mechanisms varying by individuals of different racial and ethnic backgrounds. Diabetes and CVD risk screening among individuals with GDM should be initiated early during postpartum and continue, if possible, frequently. Unfortunately, adherence to postpartum glucose testing with either obstetrician or primary care providers remained poor among individuals with GDM. A life-course perspective may provide critical information to address clinical and public health gaps in postpartum screening and interventions for preventing T2D and CVD risks in individuals with GDM. Future research investigating the racial- and ethnic-specific risk of progression from GDM to cardiometabolic diseases and the role of multi-domain factors including lifestyle, biological, and socio-contextual factors are warranted to inform tailored and culture-appropriate interventions for high-risk subpopulations. Further, examining the barriers to postpartum glucose testing among individuals with GDM is crucial for the effective prevention of cardiometabolic diseases and for enhancing life-long health.

Percentage mammographic density or absolute breast density for risk stratification in breast screening: Possible implications for socioeconomic health disparity.

Obesity levels and mortality from breast cancer are higher in more deprived areas of the UK, despite lower breast cancer incidence. Supplemental imaging for women with dense breasts has been proposed as a potential improvement to screening, but it is not clear how stratification by percentage mammographic density (%MD) would be reflected across socioeconomic groups. This study aims to clarify the associations between breast composition (dense and fatty tissue) and socioeconomic status in a multi-ethnic screening population. Demographic characteristics were collected for 62,913 participants in a UK breast screening programme (age, ethnicity, Index of Multiple Deprivation (IMD)). Automated mammographic measurements were derived: dense volume (DV), non-dense volume (NDV) and percent density (%MD). Correlations between deprivation and mammographic composition were examined before and after adjustment for age, ethnicity and NDV, using non-dense breast volume as a proxy for body mass index (BMI). There was negligible correlation between deprivation and DV (r = 0.017; P < 0.001 in all cases), but NDV increased with increasing deprivation (Pearson r = 0.101). Correlations were weaker in the Asian and Chinese ethnic groups. %MD decreased with deprivation (r = -0.094) and adjustment for ethnicity did not alter the association between %MD and IMD (relative change, most to least deprived quintile IMD: 1.18; 95% confidence interval: 1.16, 1.21). Deprivation-related differences in %MD in the screening population are largely explained by differences in breast fat volume (NDV) which reflects BMI. Women in more deprived areas, where obesity and breast cancer mortality rates are higher, have increased breast adiposity and may miss out on risk-adapted screening if stratification is based solely on %MD or BIRADS classification.

Prolonged Boarding and Racial Discrimination and Dissatisfaction Among Emergency Department Patients

Emergency department (ED) boarding times have increased rapidly, but their health equity outcomes are unknown. To investigate whether prolonged ED boarding is associated with increased perceived racial discrimination and dissatisfaction and whether associations vary between patients from marginalized racial and ethnic groups vs non-Hispanic White patients. This is a cross-sectional study of hospitalized adults who boarded in the ED during internal medicine admissions at a large, urban hospital in Boston, Massachusetts, from June 2023 to January 2024. Equal proportions of non-Hispanic White patients and patients from marginalized racial and ethnic groups (American Indian or Alaska Native, Hispanic, non-Hispanic Black and/or African American, and multiracial) were selected randomly. The duration of ED boarding was categorized as less than 4 hours (reference), 4 to less than 24 hours, and 24 or more hours. Primary outcomes were odds of reporting (1) discrimination via the Discrimination in Medical Settings scale, and (2) dissatisfaction via the adapted Picker Patient Experience-15 questionnaire. Marginalized race and ethnicity was tested as an effect modifier. Multivariable logistic regression models adjusted for patient age, sex, language, and insurance payer. Of 598 patients approached, 527 were enrolled, and 525 completed the surveys (response rate, 87.8%). The mean age (SD) was 60.6 (18.7) years, 300 patients (57.1%) were female, 246 patients (47.3%) identified as non-Hispanic White, and 274 (52.7%) were from a marginalized racial or ethnic group. In total, 135 (25.7%) boarded less than 4 hours (reference), 202 (38.5%) boarded 4 to less than 24 hours, and 188 (35.8%) boarded 24 hours or longer. Compared with less than 4 hours, boarding 24 hours or longer was associated with increased perceived discrimination (odds ratio [OR], 1.84; 95% CI, 1.14-2.99; P = .01). An increased association was observed in the subgroup of patients from racial and ethnic marginalized groups (OR, 2.36; 95% CI, 1.20-4.65; P = .01); effect modification was not significant (P for interaction, .10). For all patients, boarding 24 hours or longer was associated with increased dissatisfaction with care (OR, 1.77; 95% CI, 1.03-3.06; P = .04); effect modification was not significant (P for interaction, .80). In this cross-sectional study, hospitalized patients who boarded in the ED 24 hours or longer reported more discrimination and dissatisfaction with care, which may disproportionately affect patients from marginalized racial and ethnic groups. As ED boarding times increase nationally, it is critical to recognize their potential to exacerbate health inequities and to respond with equity-focused solutions.