Ethnic Subgroups Research Articles

Association between angiotensin-converting enzyme (ACE) gene I/D polymorphism with the risk of knee OA: A systematic review, meta-analysis, and meta-regression.

Previous studies have linked genetics to knee osteoarthritis. Angiotensin-converting enzyme (ACE) gene I/D polymorphism may cause OA. However, evidence remains inconsistent. This study examines knee OA risk and ACE gene I/D polymorphism. We explored Europe PMC, Medline, Scopus, and Cochrane Library using keywords. Three assessment bias factors were assessed using the Newcastle-Ottawa Scale (NOS). Criteria for inclusion: (1) Split the study population into knee OA patients and healthy controls; (2) Analysed the ACE gene I/D polymorphism; (3) Case-control or cross-sectional surveys. Studies with non-knee OA, incomplete data, and no full-text were excluded. The odds ratio (OR) and 95% confidence intervals (95% CI) were calculated using random-effect models. A total of 6 case-control studies consist of 1,226 patients with knee OA and 1,145 healthy subjects as controls were included. Our pooled analysis revealed that a significant association between ACE gene I/D polymorphism and risk of knee OA was only seen in the dominant (DD + ID vs. II) [OR 1.69 (95% CI 1.14 - 2.50), p = 0.009, I2 = 72%], and ID vs. II [OR 1.37 (95% CI 1.01- 1.86), p = 0.04, I2 = 43%] genotype models. Other genotype models, including recessive (DD vs. ID + II), alleles (D vs. I), DD vs. ID, and DD vs. II models did not show a significant association with knee OA risk. Further regression analysis revealed that ethnicity and sex may influence those relationships in several genotype models. Dominant and ID vs. II ACE gene I/D polymorphism models increased knee OA risk significantly. More research with larger samples and different ethnic groups is needed to confirm our findings. After ethnicity subgroup analysis, some genetic models in our study showed significant heterogeneities, and most studies are from Asian countries with Asian populations, with little evidence on Arabs.

Ethnicity data resource in population-wide health records: completeness, coverage and granularity of diversity

Intersectional social determinants including ethnicity are vital in health research. We curated a population-wide data resource of self-identified ethnicity data from over 60 million individuals in England primary care, linking it to hospital records. We assessed ethnicity data in terms of completeness, consistency, and granularity and found one in ten individuals do not have ethnicity information recorded in primary care. By linking to hospital records, ethnicity data were completed for 94% of individuals. By reconciling SNOMED-CT concepts and census-level categories into a consistent hierarchy, we organised more than 250 ethnicity sub-groups including and beyond “White”, “Black”, “Asian”, “Mixed” and “Other, and found them to be distributed in proportions similar to the general population. This large observational dataset presents an algorithmic hierarchy to represent self-identified ethnicity data collected across heterogeneous healthcare settings. Accurate and easily accessible ethnicity data can lead to a better understanding of population diversity, which is important to address disparities and influence policy recommendations that can translate into better, fairer health for all.

Differences in metabolic biomarkers in people with schizophrenia who are of Mexican descent compared to non-Hispanic whites

Metabolic dysfunction is highly prevalent and contributes to premature mortality among people with schizophrenia (PwS), especially in Hispanic/Latino/a/x/e PwS, compared to non-Hispanic White (NHW) PwS. This study evaluated the relative contributions of Mexican descent and schizophrenia diagnosis to metabolic biomarker levels. This cross-sectional study included 115 PwS and 102 non-psychiatric comparison (NC) participants – English-speakers aged 26–66 years, 27% Mexican descent, and 52% women across both groups. Assessments included evaluations of BMI, psychopathology, and fasting metabolic biomarkers. We used ANOVA analyses to compare metabolic outcomes between diagnostic and ethnic subgroups, linear regression models to examine associations between Mexican descent and metabolic outcomes, and Spearman's correlations to examine relationships between metabolic outcomes and illness-related variables in PwS. Mexican PwS had higher hemoglobin A1c levels, insulin resistance, and body mass index than NHW PwS. Mexican descent was associated with higher hemoglobin A1c levels, insulin resistance, body mass index, and leptin levels, controlling for age, sex, depression, education, and smoking. Among Mexican PwS, worse negative symptoms were associated with greater insulin resistance. These findings support the possibility of ethnicity-based differences in metabolic dysregulation, though further investigation is warranted to create targeted health interventions for Hispanic PwS.

517 - Lebrikizumab demonstrates significant efficacy versus placebo across racial and ethnic subgroups in patients with moderate-to-severe atopic dermatitis

Abstract Introduction/Background The efficacy of monotherapy lebrikizumab to treat moderate-to-severe atopic dermatitis (AD) has been established in phase 3 studies. Disease characteristics and efficacy outcomes may vary among racial and ethnic subgroups. Objectives To report the week 16 efficacy results of lebrikizumab-treated patients by racial and ethnic subgroups from ADvocate1 (NCT04146363) and ADvocate2 (NCT04178967). Methods Eligible patients were randomized 2:1 to receive lebrikizumab or placebo every 2 weeks. Other AD treatments during this induction period were prohibited. The week 16 efficacy endpoints reported here include Investigator’s Global Assessment 0 or 1 with ≥2-point improvement from baseline (IGA 0/1), ≥75% improvement in the Eczema Area and Severity Index from baseline (EASI 75), ≥90% improvement in EASI from baseline (EASI 90), and ≥4-point Pruritus Numeric Rating Scale (NRS) improvement from baseline. Race and ethnicity were self-reported. Data were collected globally. Data were pooled from ADvocate1 (Intent to Treat [ITT]) and ADvocate2 (modified ITT). Subsequent data from patients who received topical or systemic rescue medication or discontinued treatment due to lack of efficacy were imputed as nonresponders. Subsequent data from patients who discontinued treatment for other reasons were set to missing. Missing data were handled with multiple imputation. Logistic regression tested the interaction between the treatment by subgroup. P>0.1 indicated consistent treatment effect of lebrikizumab versus placebo across subgroups. For each outcome, the Cochran-Mantel-Haenszel method evaluated treatment effect within each subgroup after adjusting for stratification factors. Results Most patients (818/851 [96.1%]) were Asian (192 [22.6%]), Black/African American (84 [9.9%]), or White (542 [63.7%]). Due to the low proportion of patients identifying as another racial category (33/851 [3.9%]) including American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, multiple, other, and not reported, only results of Asian, Black/African American, and White subgroups are reported. In patients with completed ethnicity data (N=839), 10.8% (91/839) identified as Hispanic/Latino and 89.2% (748/839) identified as not Hispanic/Latino. At baseline, Asian patients reported a numerically earlier mean age of AD onset (8.3 years) compared to White (16.5 years) and Black/African American (16.9 years) patients. A numerically greater proportion of Asian patients presented with severe (IGA 4) disease at baseline (49.5%) and prior use of systemic treatment for AD (75.5%) compared with White (35.1% and 51.1%, respectively) and Black/African American (33.3% and 36.9%, respectively) patients. At week 16, no significant treatment differences were observed for the proportion of patients achieving or reporting IGA 0/1, EASI 75, EASI 90, or ≥4-point Pruritus NRS improvement across racial or ethnic subgroups (p>0.1). In Asian patients, a higher proportion treated with lebrikizumab vs placebo (p<0.001) achieved or reported IGA 0/1 (25.1%, 4.1%), EASI 75 (45.5%, 8.5%), EASI 90 (26.5%, 4.3%), and Pruritus NRS ≥4-point improvement (36.4%, 5.7%). In Black/African American patients, a greater proportion treated with lebrikizumab versus placebo achieved or reported IGA 0/1 (33.2%, 13.2%) EASI 75 (51.7%, 18.8%), EASI 90 (26.9%, 13.2%), and ≥4-point Pruritus NRS improvement (41.7%, 17.4%). No statistical comparisons were performed due to limited sample size. In White patients treated with lebrikizumab, statistical significance was observed versus placebo (p<0.001) for IGA 0/1 (43.3%, 14.1%), EASI 75 (59.7%, 20.4%), EASI 90 (38.3%, 10.9%), and Pruritus NRS ≥4-point improvement (45.9%, 14.8%). Significant and similar differences with lebrikizumab-treatment versus placebo were observed among IGA 0/1, EASI 75, and ≥4-point Pruritus NRS improvement in Hispanic/Latino (p<0.05) and non-Hispanic/Latino (p<0.001) patients. The proportion of lebrikizumab-treated patients achieving EASI 90 versus placebo was numerically greater in Hispanic/Latino patients (p=0.057) but only reached statistical significance in non-Hispanic/Latino patients (p<0.001). Conclusions In ADvocate1 and ADvocate2, lebrikizumab was effective across racial and ethnic subgroups for the treatment of moderate-to-severe AD after 16 weeks of monotherapy treatment.

Stockholm3 validation in a multi-ethnic cohort for prostate cancer (SEPTA) detection: A multicentered, prospective trial.

262 Background: Stockholm3 is a multiparametric blood test incorporating germline risk, proteins and clinical data which improves prostate cancer (PC) risk stratification compared to PSA, however no validation exists in an ethnically diverse population. Methods: SEPTA is a prospective trial (NCT04583072) aimed to validate Stockholm3 in an ethnically diverse cohort of men referred for prostate biopsy at 17 North American sites from 2019 to 2023 (supplemented with bio-banked specimens 2008-2020). The trial had two prespecified primary aims when comparing Stockholm3 (≥15) compared to PSA (≥4 ng/ml): (1) Demonstrate non-inferior sensitivity in detecting clinically significant PC (csPC) (defined as ISUP Gleason Grade group ≥2) compared to PSA (non-inferiority margin of 20%). (2) Prove superior specificity thereby reducing the number of biopsies compared to PSA in men with benign or ISUP 1 biopsies. Both aims were assessed using a one-sided alpha of 0.025. A secondary aim was to evaluate Stockholm3 and PSA across ethnic subgroups. Statistical analysis plans were published before the analysis commenced. Results: The study involved 2,129 biopsied participants, categorized into self-identified groups: African American/Black (24%), White/Caucasian (46%), Hispanic/Latino (14%), and Asian (16%). Median participant age was 63 years. PSA and Stockholm3 median values were 6.1 ng/mL and 17, respectively. A total of 16% underwent MRI-targeted biopsies and 20% had a prior benign biopsy. On either systematic or targeted biopsy, csPC was found in 29%, 14% had ISUP 1 cancer, and 57% benign. The detection rate for csPC across groups were: African American/Black (37%), White/Caucasian (28%), Hispanic/Latino (29%), and Asian (21%). Overall, Stockholm3≥15 showed non-inferior sensitivity compared to PSA≥4 ng/ml (relative sensitivity: 0.95 [95% CI: 0.92-0.99]) and nearly 3 times superior specificity (relative specificity: 2.91 [95% CI: 2.63-3.22]). Results were consistent across ethnic subgroups: non-inferior sensitivity (0.91-0.98) and superior specificity (2.51-4.70). Stockholm3 ≥15 would have reduced benign and ISUP 1 biopsies by 45% overall and between 42-52% across ethnic subgroups compared to PSA ≥4 ng/ml. Stockholm3 exhibited higher AUC (0.82) compared to PSA (0.66), with similar trends in ethnic subgroups. Conclusions: In an ethnically diverse population, Stockholm3 would significantly reduce unnecessary prostate biopsies and diagnosis of ISUP 1 cancer at a similar sensitivity of PSA for detecting clinically significant cancer. Clinical trial information: NCT04583072 . [Table: see text]

Prevalence of Cardiometabolic Diseases Among Racial and Ethnic Subgroups in Adults - Behavioral Risk Factor Surveillance System, United States, 2013-2021.

Although diabetes and cardiovascular disease account for substantial disease prevalence among adults in the United States, their prevalence among racial and ethnic subgroups is inadequately characterized. To fill this gap, CDC described the prevalence of diagnosed cardiometabolic diseases among U.S. adults, by disaggregated racial and ethnic subgroups, among 3,970,904 respondents to the Behavioral Risk Factor Surveillance System during 2013-2021. Prevalence of each disease (diabetes, myocardial infarction, angina or coronary heart disease, and stroke), stratified by race and ethnicity, was based on self-reported diagnosis by a health care professional, adjusting for age, sex, and survey year. Overall, mean respondent age was 47.5 years, and 51.4% of respondents were women. Prevalence of cardiometabolic diseases among disaggregated race and ethnicity subgroups varied considerably. For example, diabetes prevalence within the aggregated non-Hispanic Asian category (11.5%) ranged from 6.3% in the Vietnamese subgroup to 15.2% in the Filipino subgroup. Prevalence of angina or coronary heart disease for the aggregated Hispanic or Latino category (3.8%) ranged from 3.1% in the Cuban subgroup to 6.3% in the Puerto Rican subgroup. Disaggregation of cardiometabolic disease prevalence data by race and ethnicity identified health disparities among subgroups that can be used to better help guide prevention programs and develop culturally relevant interventions.

Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States.

Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals. Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC. Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001). Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.

Daily Moderate-to-Vigorous Activity of Native Hawaiians and Pacific Islanders and Seven Asian Subgroups by Types of Activities, American Time Use Survey, 2010-2019.

The study used the American Time Use Survey data from 2010 to 2019 to compare the daily moderate-to-vigorous activity of Native Hawaiians and Pacific Islanders (NHPI) and seven Asian ethnic subgroups. Adults aged 24 years and older were included. The study analyzed activities from sports and recreation, household activities, and all activities carried out during the day. Outcomes were determined by the completion of 30 min or more of moderate-to-vigorous activity and the type of activity carried out in the day. Significant ethnic differences were observed for sports and recreation but not for household activities and not for all activities carried out during the day. Of the ethnic populations, NHPI were the least active, and Asian Indians and Chinese were the most active. A majority achieved 30 min or more of moderate-to-vigorous activity during the day from all their activities. Physical activity from household activities exceeded physical activity from sports and recreation. The most physically active group was adults over the age of 65 years, perhaps reflecting more time to exercise or greater concerns about their health. For sports and recreation, exercising with someone doubled the minutes of moderate-to-vigorous activity. The results emphasize the importance of activities performed around the household in addition to sports and recreation and the benefit of exercising with someone. Ethnic populations may be receptive to interventions that emphasize activities they are performing in their daily lives.

Limited English Proficiency and Sepsis Mortality by Race and Ethnicity

Patients with limited English proficiency (LEP) face multiple barriers and are at risk for worse health outcomes compared with patients with English proficiency (EP). In sepsis, a major cause of mortality in the US, the association of LEP with health outcomes is not widely explored. To assess the association between LEP and inpatient mortality among patients with sepsis and test the hypothesis that LEP would be associated with higher mortality rates. This retrospective cohort study of hospitalized patients with sepsis included those who met the Centers for Disease Control and Prevention's sepsis criteria, received antibiotics within 24 hours, and were admitted through the emergency department. Data were collected from the electronic medical records of a large New England tertiary care center from January 1, 2016, to December 31, 2019. Data were analyzed from January 8, 2021, to March 2, 2023. Limited English proficiency, gathered via self-reported language preference in electronic medical records. The primary outcome was inpatient mortality. The analysis used multivariable generalized estimating equation models with propensity score adjustment and analysis of covariance to analyze the association between LEP and inpatient mortality due to sepsis. A total of 2709 patients met the inclusion criteria, with a mean (SD) age of 65.0 (16.2) years; 1523 (56.2%) were men and 327 (12.1%) had LEP. Nine patients (0.3%) were American Indian or Alaska Native, 101 (3.7%) were Asian, 314 (11.6%) were Black, 226 (8.3%) were Hispanic, 38 (1.4%) were Native Hawaiian or Other Pacific Islander or of other race or ethnicity, 1968 (72.6%) were White, and 6 (0.2%) were multiracial. Unadjusted mortality included 466 of 2382 patients with EP (19.6%) and 69 of 327 with LEP (21.1%). No significant difference was found in mortality odds for the LEP compared with EP groups (odds ratio [OR], 1.12 [95% CI, 0.88-1.42]). When stratified by race and ethnicity, odds of inpatient mortality for patients with LEP were significantly higher among the non-Hispanic White subgroup (OR, 1.76 [95% CI, 1.41-2.21]). This significant difference was also present in adjusted analyses (adjusted OR, 1.56 [95% CI, 1.02-2.39]). No significant differences were found in inpatient mortality between LEP and EP in the racial and ethnic minority subgroup (OR, 0.99 [95% CI, 0.63-1.58]; adjusted OR, 0.91 [95% CI, 0.56-1.48]). In a large diverse academic medical center, LEP had no significant association overall with sepsis mortality. In a subgroup analysis, LEP was associated with increased mortality among individuals identifying as non-Hispanic White. This finding highlights a potential language-based inequity in sepsis care. Further studies are needed to understand drivers of this inequity, how it may manifest in other diverse health systems, and to inform equitable care models for patients with LEP.

Factor H-related protein 1 in systemic lupus erythematosus.

Factor H (FH) is a major soluble inhibitor of the complement system and part of a family comprising five related proteins (FHRs 1-5). Deficiency of FHR1 was described to be linked to an elevated risk of systemic lupus erythematosus (SLE). As FHR1 can partially antagonize the functionality of FH, an altered FHR1/FH ratio could not only enhance SLE vulnerability but also affect the disease expression. This study focuses on the analysis of FH and FHR1 at a protein level, and the occurrence of anti-FH autoantibodies (anti-FH) in a large cohort of SLE patients to explore their association with disease activity and/or expression. We assessed FH and FHR1 levels in plasma from 378 SLE patients compared to 84 healthy controls (normal human plasma, NHP), and sera from another cohort of 84 healthy individuals (normal human serum, NHS), using RayBio® CFH and CFHR1 ELISA kits. Patients were recruited by the Swiss SLE Cohort Study (SSCS). Unmeasurable FHR1 levels were all confirmed by Western blot, and in a subgroup of patients by PCR. Anti-FH were measured in SLE patients with non-detectable FHR1 levels and matched control patients using Abnova's CFH IgG ELISA kit. Overall, FH and FHR1 levels were significantly higher in healthy controls, but there was no significant difference in FHR1/FH ratios between SLE patients and NHPs. However, SLE patients showed a significantly higher prevalence of undetectable FHR1 compared to all healthy controls (35/378 SLE patients versus 6/168 healthy controls; p= 0.0214, OR=2.751, 95% CI = 1.115 - 8.164), with a consistent trend across all ethnic subgroups. Levels of FH and FHR1, FHR1/FH ratios and absence of FHR1 were not consistently associated with disease activity and/or specific disease manifestations, but absence of FHR1 (primarily equivalent to CFHR1 deficiency) was linked to the presence of anti-FH in SLE patients (p=0.039). Deficiency of FHR1 is associated with a markedly elevated risk of developing SLE. A small proportion of FHR1-deficient SLE patients was found to have autoantibodies against FH but did not show clinical signs of microangiopathy.

Ethnic and socioeconomic inequalities in air pollution exposure: a cross-sectional analysis of nationwide individual-level data from the Netherlands

Air pollution contributes to a large disease burden and some populations are disproportionately exposed. We aimed to evaluate ethnic and socioeconomic differences in exposure to air pollution in the Netherlands. We did a nationwide, cross-sectional analysis of all residents of the Netherlands on Jan 1, 2019. Sociodemographic information was centralised by Statistics Netherlands and mainly originated from the National Population Register, the tax register, and education registers. Concentrations of NO2, PM2·5, PM10, and elemental carbon, modelled by the National Institute for Public Health and the Environment, were linked to the individual-level demographic data. We assessed differences in air pollution exposures across the 40 largest minority ethnic groups. Evaluation of how ethnicity intersected with socioeconomic position in relation to exposures was done for the ten largest ethnic groups, plus Chinese and Indian groups, in both urban and rural areas using multivariable linear regression analyses. The total study population consisted of 17 251 511 individuals. Minority ethnic groups were consistently exposed to higher levels of air pollution than the ethnic Dutch population. The magnitude of inequalities varied between the minority ethnic groups, with 3-44% higher exposures to NO2 and 1-9% higher exposures to PM2·5 compared with the ethnic Dutch group. Average exposures were highest for the lowest socioeconomic group. Ethnic inequalities in exposure remained after adjustment for socioeconomic position and were of similar magnitude in urban and rural areas. The variability in air pollution exposure across ethnic and socioeconomic subgroups in the Netherlands indicates environmental injustice at the intersection of social characteristics. The health consequences of the observed inequalities and the underlying processes driving them warrant further investigation. The Gravitation programme of the Dutch Ministry of Education, Culture, and Science, the Netherlands Organization for Scientific Research, the Netherlands Organisation for Health Research and Development, and Amsterdam University Medical Center.

Nutrition and diet in the general U.S. Asian American population: A scoping review protocol.

Asian American populations face unique structural/social inequities contributing to poor diet quality and health disparities. The current body of literature on diet and food consumption of Asian Americans mainly focuses on the health of Filipino and East Asian Americans, or those with pre-existing non-communicable diseases. The aim of this review is to comprehensively compile all available literature on nutrition and dietary consumption among the general population in Asian American ethnic subgroups, highlight any disparities and research gaps, and suggest further research action. With guidance from a research librarian, we enumerated and searched key terms related to diet, food, nutrition, and Asian Americans in PubMed/MEDLINE, Food Science Collection (CABI Digital Library), CINAHL (EBSCO), Scopus, Food Science and Technology Abstracts (Web of Science), and Biological & Agricultural Index Plus (EBSCO) in accordance with PRISMA-S guidelines. An article will be included if it was published in the English language; is a peer-reviewed research manuscript or published in grey literature from 2000 to present; and describes what food groups and macronutrients healthy non-institutionalized Asian Americans in the U.S. are eating. An article will be excluded if it contains only research conducted outside of the U.S.; combines Asian Americans with Native Hawaiian and Pacific Islanders; and had no explicit focus on Asian American nutrition and dietary consumption. Two or more reviewers will participate in the study screening and selection process. We will record article characteristics, diet outcomes, and recommendations from final included articles using a data extraction table and prepare a summary narrative with key findings. Results will be disseminated through a peer-reviewed manuscript. The findings from this review can have broad implications for designing and implementing nutrition-focused initiatives that will appropriately reflect and address the needs as well as norms and values of each distinct Asian American ethnic subgroup.

Guarding the boundaries of belonging: the Church of Sweden, Gypsy mission and social care in the 1910s–40s

ABSTRACT Historically, social welfare providers have defined social and ethnic minorities such as ‘vagrants’ and Romani people as non-deserving and thus excluded them from their work. Gradually during the nineteenth century, however, Christian actors and organizations across Europe were among the first to recognize Romani groups as legitimate targets of relief. The operations required boundary changes where previously undeserving categories were transferred to deserving, thus becoming legitimate targets of relief. The article discusses the Church of Sweden’s social care for minorities, with a special focus on Romani groups from the 1910s to the 1940s. At that point, Protestant social work was permeated by conservative paternalism and focused on changing the individual through interventions defined as help-to-self-help, rather than challenging the unjust social structures in Swedish society. However, welfare measures were enacted differently depending on the majority/minority position of the individual; the recognition or rejection of minority rights affected the distribution and content of Lutheran social welfare. Examining church-led or church-endorsed activities, the contribution sheds light on the differentiation of social and ethnic subgroups and brings nuance to a field that has overlooked the Swedish state church as a welfare provider in the twentieth century. The instances of intersection between and sometimes confusion of social and ethnic boundaries serve as examples of the historicity of such boundaries and churchmen’s contribution to establishing these.

RACIAL AND ETHNIC DIVERSITY IN FAMILY CARE INTERVENTIONS: A CALL FOR ACTION

Abstract In the United States, women are disproportionately represented as family caregivers and racial and ethnic minority families experience the challenges of caregiving at greater rates, such as poorer health and psychological distress. Recent research results demonstrate the effectiveness of family care interventions through improvements for caregiver depression, anxiety, and caregiver knowledge; yet most of these programs were developed for and evaluated with White families. The extent to which caregiver support interventions attend to racial and ethnic diversity is inadequate. Limited understanding of intervention results by racial and ethnic subgroups may ultimately further exacerbate disparities across groups by limiting our ability to account for any differences in treatment outcomes. Advances in research on caregiver interventions warrant an examination of the degree to which gender and/or racial differences are considered in the field of caregiver intervention research. Using a combined theoretical lens of symbolic internationalism and gender role theory, we argue for the development of care programs for racially and ethnically diverse family care perspectives. Thus, we conducted a systematic review of caregiver interventions and further explored whether common evidence-based care interventions are efficacious with non-White populations. Additionally, we emphasize the importance of developing targeted intervention programs by reviewing the impact of recently develop programs for specific target populations. This work underscores the gap in current family care interventions and identifies the need for evidence-based family care programs for diverse populations. Our systematic review will further our understanding about disparities in intervention outcomes to develop culturally appropriate interventions.

EXPERIENCES AND SUPPORTIVE CARE NEEDS OF LATINX MILLENNIAL CAREGIVERS

Abstract Latinx millennial caregivers are the largest ethnic minority subgroup within the millennial caregiving cohort. Due to age and life stage, members of this understudied group must often manage the competing priorities of career, family, and caregiving. Layered with these challenges are the experiences of being part of a minority group in the United States, with systemic barriers impacting access to healthcare, insurance, a safe built environment, and educational opportunities. The purpose of this qualitative descriptive study was to explore the experiences and needs of Latinx millennial caregivers. Participants were recruited locally and nationally using recruitment flyers and social media advertising. Data were collected from 29 participants using five focus group interviews and one individual interview. Data analysis using interpretive thematic analysis and inductive coding occurred. Twenty female and nine male Latinx millennial caregivers participated in the focus groups. Two meta-themes threaded throughout the analysis included the Latinx experience (immigrant background, Latinx culture, and navigating barriers as a minoritized individual) and being a super-caregiver. Main themes were identified: family well-being, occupational and financial well-being, social support dynamics, challenges and rewards of family caregiving, and coping strategies. Family and community were emphasized in all main themes. In this study, the importance of family and community relationships motivated caregiving and were areas where support was needed for Latinx millennial caregivers. Interventions and clinical support for these caregivers is needed that addresses their cultural background, the value of family and community, and the barriers they experience to accessing care and support.

Underrepresentation of Hispanics in clinical trials for liver cancer in the United States over the past 20 years.

Accurate representation of racial and ethnic population subgroups in clinical trials is fundamental to ensure universal effectiveness of new therapies as well as to decrease disparities in oncology care. To determine whether Hispanic people are underrepresented in Phase I and II clinical trials for liver cancer in the United States. A database search was performed in clinicaltrials.gov for interventional liver cancer studies based only in the US with reported results from September 1, 2002, to February 1, 2023. A total of 37 trials with 963 total patients met inclusion criteria and were included for further analysis. Proportion of total patients by race/ethnicity was calculated for non-Hispanic white, non-Hispanic black, Asian, Hispanic, and American Indian/Alaska Native subpopulations. The age-adjusted incidence rates of liver and intrahepatic bile duct were acquired from the National Cancer Institute, Surveillance, Epidemiology, and End Results Program. Liver cancer incidence rates (per 100,000 people) were highest in Indians/Alaska Native people (18.8 cases) followed by Hispanic people (15.1 cases), then Asian people (12.5 cases), then non-Hispanic black people (11 cases), and non-Hispanic white people (7.5 cases). From a total of 91 phase I or II clinical trials for liver cancer in the US, 41% reported race/ethnicity enrollment data; among these, 62.8% of patients were non-Hispanic White, 15.9% were non-Hispanic black, 8.8% were Hispanic, 12.7% Asian, and 0.5% American Indian/Alaska Native. Less than half of phase I or II clinical trials for liver cancer in the US in the last 20 years reported race/ethnicity data to clinicaltrials.gov. Compared to the relative incidence rate of liver cancer, non-Hispanic black people and Hispanic people are underrepresented in these clinical trials.

Racial discrimination and mental health in the context of anti-Asian xenophobia: An intersecting approach of race, ethnicity, nativity, and socioeconomic status

The COVID-19 pandemic, polarized politics, and heightened stigma and discrimination are salient drivers for negative mental health outcomes, particularly among marginalized racial and ethnic minoritized groups. Intersectionality of race, ethnicity, foreign-born status, and educational attainment may distinctively shape an individual's experience of discrimination and mental health during such unprecedented time. The present study examines the differential associations of racial discrimination and mental health based on an individual's race, ethnicity, foreign-born status, and educational attainment during the COVID-19 pandemic. Analyses were based on a nationally representative sample of U.S. adults collected between October and November 2021 (n = 6276). We utilized multivariable linear regressions to identify the multiplicative effects of race, ethnic, foreign-born status and self-reported racial discrimination on mental health, stratified by educational attainment. Among individuals with lower educational attainment, associations between racial discrimination and poor mental health were stronger among Asians (US-born: β = −2.07, p = 0.03; foreign-born: β = −3.18, p = 0.02) and US-born multiracial individuals (β = −1.96, p = 0.02) than their White counterparts. Among individuals with higher educational attainment, foreign-born Hispanics (β = − 3.66, p < 0.001) and US-born Asians (β = −2.07, p = 0.01) reported worst mental health when exposed to racial discrimination out of all other racial, ethnic and foreign-born groups. Our results suggest that association of racial discrimination and mental health varies across racial, ethnic, foreign-born, and education subgroups. Using an intersectional approach to address the widening inequities in racial discrimination and mental health during the COVID-19 pandemic contextualizes unique experience of discrimination and provides crucial insight on the patterns of mental health among marginalized groups.

Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity - United States, 2020-2021.

Although breastfeeding is the ideal source of nutrition for most infants, racial and ethnic disparities exist in its initiation. Surveillance rates based on aggregated data can challenge the understanding and monitoring of effective, culturally appropriate interventions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups. We examined differences in breastfeeding initiation rates by disaggregation of data to finer subgroups of race and ethnicity. We analyzed births from January 1, 2020, through December 31, 2021, in 48 states and the District of Columbia by using National Vital Statistics System birth certificate data. Data indicate whether an infant received any breast milk during birth hospitalization and include self-reported maternal race and ethnicity. Cross-tabulations of race and ethnicity by breastfeeding initiation were calculated and compared across aggregated and disaggregated categories. The overall prevalence of breastfeeding initiation was 84.0%, ranging from 74.5% (mothers identifying as Black) to 94.0% (mothers identifying as Japanese). The aggregated prevalence of breastfeeding initiation among mothers identifying as Hispanic was 86.8%; disaggregated estimates by Hispanic origin ranged from 82.2% (Puerto Rican) to 90.9% (Cuban). Substantial variation in the prevalence of breastfeeding initiation across disaggregated racial or ethnic categories exists. Disaggregation of racial and ethnic data unmasked differences that could reflect variations in cultural practices or systemic barriers to breastfeeding. Understanding why these differences exist could guide public health practitioners' efforts to improve and tailor breastfeeding support.

Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study

ObjectivesTo better characterise the Awarding Gap (AG) between black, Asian and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority...

National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020

Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention. To evaluate 21-year trends in racial and ethnic differences in utilization of guideline-recommended pharmacological medications and lifestyle modifications among US adults with ASCVD. This cross-sectional study includes data from the National Health and Nutrition Examination Survey between 1999 and 2020. Eligible participants were adults aged 18 years or older with a history of ASCVD. Data were analyzed between March 2022 and May 2023. Self-reported race and ethnicity. Rates and racial and ethnic differences in the use of guideline-recommended pharmacological medications and lifestyle modifications. The study included 5218 adults with a history of ASCVD (mean [SD] age, 65.5 [13.2] years, 2148 women [weighted average, 44.2%]), among whom 1170 (11.6%) were Black, 930 (7.7%) were Hispanic or Latino, and 3118 (80.7%) were White in the weighted sample. Between 1999 and 2020, there was a significant increase in total cholesterol control and statin use in all racial and ethnic subgroups, and in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) utilization in non-Hispanic White individuals and Hispanic and Latino individuals (Hispanic and Latino individuals: 17.12 percentage points; 95% CI, 0.37-37.88 percentage points; P = .046; non-Hispanic White individuals: 12.14 percentage points; 95% CI, 6.08-18.20 percentage points; P < .001), as well as smoking cessation within the Hispanic and Latino population (-27.13 percentage points; 95% CI, -43.14 to -11.12 percentage points; P = .002). During the same period, the difference in smoking cessation between Hispanic and Latino individuals and White individuals was reduced (-24.85 percentage points; 95% CI, -38.19 to -11.51 percentage points; P < .001), but racial and ethnic differences for other metrics did not change significantly. Notably, substantial gaps persisted between current care and optimal care throughout the 2 decades of data analyzed. In the period of 2017 to 2020, optimal regimens were observed in 47.4% (95% CI, 39.3%-55.4%), 48.7% (95% CI, 36.7%-60.6%), and 53.0% (95% CI, 45.6%-60.4%) of Black, Hispanic and Latino, and White individuals, respectively. In this cross-sectional study of US adults with ASCVD, significant disparities persisted between current care and optimal care, surpassing any differences observed among demographic groups. These findings highlight the critical need for sustained efforts to bridge these gaps and achieve better outcomes for all patients, regardless of their racial and ethnic backgrounds.