Racial Groups Research Articles

Peripartum Cardiomyopathy and Social Vulnerability: An Epidemiological Analysis of Mortality Outcomes.

Peripartum cardiomyopathy (PPCM) outcomes have been previously linked to demographic and social factors. The social vulnerability index (SVI) is a measure of social vulnerability in the United States. We explored PPCM disparities and the impact of SVI on PPCM mortality. Mortality from 1999 to 2020, SVI, and demographic data were obtained from CDC databases. County-specific SVI rankings were linked to PPCM age-adjusted mortality rates (AAMRs), allowing for a comparative analysis of AAMRs across both cumulative populations and subpopulations to identify disparities. All US counties were then stratified into low- and high-SVI groups, facilitating comparison of SVI rankings by estimation of excess-deaths per 1 000 000 person-years attributable to greater social vulnerability and rate ratios (RR) through univariable Poisson regression. We identified a total of 1026 deaths related to PPCM between 1999 and 2020. Overall AAMR increased from 0.180 in 1999 to 0.326 in 2020. Black populations (AAMR: 1.081) and Southern US counties (AAMR: 0.444) had the highest AAMRs compared with other racial and US census groups, respectively. Higher SVI accounted for 0.172 excess deaths per 1 000 000 person-years (RR=1.800). Among Black and White populations, higher SVI also accounted for 0.248 and 0.071 excess deaths per 1 000 000 person-years, respectively. Similar impacts of greater social vulnerability were observed when comparing the US census regions (Northeast RR=1.609, Midwest RR=1.819, South RR=1.934, West RR=1.776). PPCM mortality disparities exist across racial and geographic populations in the United States. A greater burden of social vulnerability is associated with higher PPCM mortality on a national level.

Improving racial/ethnic health equity and naloxone access among people at risk for opioid overdose: A simulation modeling analysis of community-based naloxone distribution strategies in Massachusetts, United States.

During the COVID-19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two community-based naloxone expansion strategies, with the objective of identifying approaches that could mitigate mortality and racial and ethnic disparities in OODs. Individual-based simulation model. We measured naloxone availability using naloxone kits per OOD and evaluated scenarios of achieving higher benchmarks for naloxone availability (i.e. 40, 60 and 80 kits per OOD) from 2022 levels (overall: 26.0, White: 28.8, Black: 17.3, Hispanic/Latinx: 18.9). We compared two naloxone distribution strategies: (1) proportional distribution: achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial/ethnic group (at 40 kits per OOD benchmark: overall: 40, White: 44.3, Black: 26.6, Hispanic/Latinx: 29.1), and (2) equity-focused distribution: achieving the benchmark ratio among each racial/ethnic group (at 40 kits per OOD benchmark: 40 for all groups). Massachusetts, United States. People at risk of OOD. Annual number and rate of OODs, total healthcare costs of increasing naloxone availability. Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5% and 7.1% reduction in annual OODs in 2025 among White, Black and Hispanic/Latinx populations, respectively. In contrast, equity-focused distribution achieved a reduction of 5.7%, 11.3% and 10.2% in the respective groups. In all scenarios, the cost per OOD averted was lower than the generally accepted thresholds for cost per life saved. An equity-focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could improve health equity among racial and ethnic groups while potentially improving overall population health at lower healthcare costs per opioid overdose death averted than a proportional distribution strategy.

Expanded Newborn Screening Using Genome Sequencing for Early Actionable Conditions

The feasibility of implementing genome sequencing as an adjunct to traditional newborn screening (NBS) in newborns of different racial and ethnic groups is not well understood. To report interim results of acceptability, feasibility, and outcomes of an ongoing genomic NBS study in a diverse population in New York City within the context of the New York State Department of Health Newborn Screening Program. The Genomic Uniform-screening Against Rare Disease in All Newborns (GUARDIAN) study was a multisite, single-group, prospective, observational investigation of supplemental newborn genome screening with a planned enrollment of 100 000 participants. Parent-reported race and ethnicity were recorded at the time of recruitment. Results of the first 4000 newborns enrolled in 6 New York City hospitals between September 2022 and July 2023 are reported here as part of a prespecified interim analysis. Sequencing of 156 early-onset genetic conditions with established interventions selected by the investigators were screened in all participants and 99 neurodevelopmental disorders associated with seizures were optional. The primary outcome was screen-positive rate. Additional outcomes included enrollment rate and successful completion of sequencing. Over 11 months, 5555 families were approached and 4000 (72.0%) consented to participate. Enrolled participants reflected a diverse group by parent-reported race (American Indian or Alaska Native, 0.5%; Asian, 16.5%; Black, 25.1%; Native Hawaiian or Other Pacific Islander, 0.1%; White, 44.7%; 2 or more races, 13.0%) and ethnicity (Hispanic, 44.0%; not Hispanic, 56.0%). The majority of families consented to screening of both groups of conditions (both groups, 90.6%; disorders with established interventions only, 9.4%). Testing was successfully completed for 99.6% of cases. The screen-positive rate was 3.7%, including treatable conditions that are not currently included in NBS. These interim findings demonstrate the feasibility of targeted interpretation of a predefined set of genes from genome sequencing in a population of different racial and ethnic groups. DNA sequencing offers an additional method to improve screening for conditions already included in NBS and to add those that cannot be readily screened because there is no biomarker currently detectable in dried blood spots. Additional studies are required to understand if these findings are generalizable to populations of different racial and ethnic groups and whether introduction of sequencing leads to changes in management and improved health outcomes. ClinicalTrials.gov Identifier: NCT05990179.

Racial disparities persist in mortality after firearm assault injuries: A national analysis of the Trauma Quality Improvement Program database

ObjectivesIt is unclear whether improvements in the delivery of trauma care over the last decade have diminished racial disparities in mortality after firearm injuries. MethodsThe American College of Surgeons Trauma Quality Improvement Program was queried for patients (≥18 years old) who experienced penetrating firearm assault injuries between 2008 and 2018. Multivariable logistic regression was used to assess the association between mortality and race, controlling for demographics, comorbidities, shock index, injury severity score injury location, and hospital characteristics. ResultsThis retrospective cohort study included 261,116 patients who experienced firearm injuries secondary to assault between 2008 and 2018. Patients most frequently identified as Black (64.1%, n = 167,494), followed by White (16.3%, n = 42,649), Hispanic/Latino (15.7%, n = 41,044), and other racial groups (3.8%, n = 9,929). On multivariable logistic regression, Black patients (odds ratio, 1.53; 95% confidence interval, 1.45–1.62), and Hispanic/Latino patients (odds ratio, 1.11; 95% confidence interval, 1.03–1.19) were more likely to die after a firearm assault injury than White patients. Black patients were more likely to die in the emergency department (62.2%, n = 13,438) compared with White patients (52.7%, n = 2,838), Hispanic/Latino patients (53.0%, n = 2,635), and patients of other races (54.8%, n = 681). Across all years of the study period, Black patients had a greater risk-adjusted mortality rate than White patients and Hispanic/Latino patients. ConclusionSignificant racial disparities in mortality after firearm assault continue to persist. Early death within the emergency department appears to be a significant driver of these persistent disparities.

Interconnectedness of mindfulness facets and their impact on mental health outcomes in Asian American and European American college students: A network approach.

Despite extensive research supporting the effectiveness of mindfulness-based interventions, the understanding of the dynamic connections between various mindfulness facets, particularly across diverse cultures, remained limited. This study aimed to investigate the networks among mindfulness aspects across different cultural backgrounds and their individual associations with mental health and well-being. Using the data collected from 710 undergraduate students in Hawaii (445 Asian Americans, 265 European Americans), we constructed sparse networks for each group to investigate their centrality index. To compare the overall structures of these networks, we utilized permutation-based tests. In addition, we used relative weight analysis to evaluate the distinct contributions of each mindfulness facet to positive and negative mental health outcomes. The results indicated similar trends in both racial groups, emphasizing the importance of specific mindfulness aspects like describing and acting with awareness within the mindfulness construct. However, notable variations were observed, particularly in how observing and nonjudging facets related among Asian Americans. In addition, acting with awareness and nonjudging showed substantial inverse associations with negative mental health outcomes across groups, whereas the observing aspect displayed positive connections with anxiety and stress among Asian Americans. The findings suggest which aspects are fundamental to mindfulness, aiding in a nuanced understanding of the construct. They also emphasize the importance of acknowledging cultural diversity in both mindfulness research and its clinical applications. Practical implications and directions for future research were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing the role of non-state actors in health service delivery and health system resilience in Myanmar

BackgroundDue to the weaknesses of the public health system and its low reach, especially in border areas, provision of health services by non-state actors (NSAs) has historically played an important role in Myanmar. NSAs include local and international NGOs and civil society organisations (CSOs), but also Ethnic Health Organisations (EHOs) in the border areas, as well as the private (for profit) sector. This study aims to understand the changing role of NSAs in the shifting political environment of Myanmar between 2010 and 2022, and to explore their contribution to health system resilience.MethodsOur study includes three main components: a documentary review (n = 22), key informant interviews (KIIs) at central level (n = 14) and two township-level case studies (13 KIIs, 4 FGDs). Mostly qualitative data were collected in 2022 and synthesized, using a health system resilience framework to structure the analysis.ResultsDuring the transition period (2010–2014) and the new political era (2015–2020), while the country gradually transitioned to a democratic system, the government increasingly recognized NSAs. Initially, engagement with NSAs remained focused on disease-specific activities and government oversight was limited, but later it expanded to health system strengthening, including the start of a “convergence” with ethnic health systems. Progress was relatively slow, but defined by a clear vision and plans. The military coup of February 2021 brought a halt to this progress. Collaboration between government and NSAs was interrupted, and NSAs restored previous practices and parallel systems. Initially, most health service provision stopped, but with time coping strategies emerged, which showed the capacity of NSAs to absorb the shocks (focusing on basic services; using informal communication channels; maintaining buffer stocks of supplies) and adapt (changing modes of delivery and supply chains, and adjusting HRH training).ConclusionsThe study highlights the role of NSAs during crises, and provides insights on how the resilience capacities built over time by NSAs to provide services in adverse circumstances have informed the response to the latest crisis. While strategies of absorption and adaptation are noted in the study, we did not identify any transformation strategy – which might indicate the difficulty of NSAs to introduce radical changes when subjected to multiple shocks and a hostile political environment.

Top-down racial biases in size perception: A registered replication and extension of

Biases in the perception and judgment of members of race-based and ethnicity-based minority groups are prevalent, often resulting in detrimental outcomes for these individuals. One such bias is a threat-related stereotype, associating specific race and ethnicity-based social groups with aggressiveness, violence, and criminality. In the US context, Black men are often victims of such bias. Recent evidence suggests that threat-related stereotypes are also linked to biased perceptions, such that perceivers overestimate the body size of Black relative to White men, even in the absence of perceptual differences between them. That is, mere top-down social category information was sufficient to induce perceptual biases in size perception related to threat (Wilson et al., 2017, Study 7). Considering the novelty of this finding and its theoretical importance, we suggested a registered replication of this finding to assess its robustness across laboratories, participants, and social groups. We conducted a direct replication (Study 1, N = 280) of the effect reported by Wilson and colleagues, followed by a conceptual replication (Study 2, N = 280) that tested the generalization of the original findings to another population (Israeli residents) and a different target social group (Muslim Israelis) frequently stereotyped as threatening in this population. Participants did not overestimate the body size of Black or Muslim Israeli targets, pointing to a failed replication of the original effect. These findings suggest that the effects of purely top-down social category information on threat-related perception and judgment are less robust than previously assumed.

From assimilation to alienation: exploring the career trajectories of women of color leaders and the coping strategies used

PurposeThis qualitative study explores the career trajectories of women of color (WOC) leaders through the “From Assimilation to Alienation” framework, building upon Thomas et al.’s (2013) “Pet to Threat” work and incorporating intersectionality and the Stereotype Content Model. By examining 71 WOC leaders across various industries and racial groups (Black, East Asian, Latina and South Asian), this study aims to uncover the challenges, coping strategies they employ and the nuanced variations in their career experiences. The findings seek to inform organizational practices and DEI interventions in workplaces and leadership positions by considering the complex interplay of race, gender and stereotypes in corporate environments.Design/methodology/approachThis qualitative study employs an interpretivist paradigm, featuring semi-structured interviews with 71 WOC leaders (18 Black, 18 East Asian, 17 Latina and 18 South Asian) from various industries, including Fortune 10 to 500 companies. Participants were purposively sampled based on leadership roles and racial backgrounds. Virtual interviews lasted approximately 60 min each. Data were analyzed using thematic analysis, focusing on predefined themes from the “From Assimilation to Alienation” framework while allowing for new themes to emerge. This approach enabled the exploration of participants' experiences, challenges and coping strategies within their corporate environments.FindingsThe findings reveal that WOC leaders experience a trajectory “From Assimilation to Alienation,” with nuanced variations across racial groups. Initially, they face tokenism, overlooked competencies and patronization. As they challenge the status quo, they encounter alienation, professional legitimacy challenges and insufficient recognition. Black women leaders face the most adverse experiences, followed by South Asian, Latina and East Asian leaders. Isolation emerges as a persistent theme across racial groups and career tenures. WOC leaders employ coping strategies such as demonstrating high work proficiency, relying on merit, utilizing diplomacy and setting boundaries when facing adversity.Research limitations/implicationsThis study’s limitations include a focus on specific racial groups (Black, East Asian, Latina and South Asian), excluding white women and other diverse groups. It also does not explore intersectionalities such as religion, sexual orientation and age. However, the “From Assimilation to Alienation” framework developed in this study provides a foundation for future research to examine how multiple intersectionalities impact work and leadership experiences across a broader range of diverse groups.Practical implicationsThe findings of this study provide valuable insights into the unique challenges faced by WOC leaders, highlighting the need for organizations to develop targeted interventions that address the “From Assimilation to Alienation” trajectory. Leadership training programs should incorporate modules that raise awareness about the experiences of WOC leaders and provide tools to assess and mitigate the adverse effects of tokenism, isolation and professional legitimacy challenges. These modules should also emphasize the importance of recognizing and rewarding the contributions of WOC leaders. By fostering a deeper understanding of the experiences of this group and providing practical strategies for support and inclusion, organizations can create a more equitable and inclusive leadership landscape that harnesses the full potential of diverse talent.Originality/valueThis study extends the Pet to Threat theory (Thomas et al., 2013) by exploring the “From Assimilation to Alienation” experiences of women of color leaders in corporate environments, integrating intersectionality and the Stereotype Content Model. Examining leaders from four racial groups (Black, East Asian, Latina and South Asian) provides a nuanced understanding of their challenges and coping strategies. The findings offer insights for organizations promoting DEI in leadership, highlighting the need for targeted interventions. This research contributes to the limited literature on career trajectories of this underrepresented group and lays the foundation for future studies on intersectionality of race, gender and leadership in the workplace.

Trust in Health Institutions Across Racial Groups: Implications for Dual Flu-Coronavirus Vaccine Adoption.

This study employs t-tests to compare the means of trust in health institutions, frequency of flu vaccine uptake, and COVID-19 vaccine uptake between individuals who are willing and unwilling to accept the combined vaccine. Additionally, a weighted logistic regression analysis is conducted to predict the likelihood of individuals to receive the combined vaccine, considering key independent and control variables. The t-test results reveal that individuals who are willing to accept the combined vaccine exhibit higher levels of trust in health institutions, more frequent flu vaccine uptake, and higher COVID-19 vaccine uptake. This pattern holds true across all racial groups. The logistic regression analysis demonstrates that trust in health institutions, frequency of flu vaccine uptake, and COVID-19 vaccine uptake significantly predict individuals' willingness to accept the combined vaccine. Partisanship and demographic characteristics also exert influence on vaccine acceptance. Trust in health institutions plays a pivotal role in vaccine acceptance among individuals from all racial groups. Encouraging routine vaccination practices and leveraging existing vaccination campaigns can facilitate the adoption of combined vaccines. It is imperative to address racial disparities and tailor communication strategies to specific demographic groups to enhance vaccine uptake.

Do immigrant women spend more time on unpaid labor? Generational differences by race, ethnicity, and household composition in household work within the United States

ABSTRACT Despite relative progress, it is an overt fact that women still take on the heavier burden of unpaid work in the household compared to men in the United States. Our study expands the horizons of previous studies by looking at women specifically and analyzes how women’s performance of unpaid labor differentiates based on various contexts such as generational status, household composition, race, and ethnicity. Using the pooled cross-sectional data from the 2011-2021 American Time Use Survey (ATUS), we test hypotheses derived from an absolute resources perspective and a structural perspective to examine migrant generational differences among married, cohabiting, and single women as well as investigate the intra-group differences of racial and ethnic groups. From our descriptive analysis and ordinary least squares (OLS) regression analyses, we find support for the structural perspective for housework, as the generational differences remain even after controlling for socioeconomic factors, but only for first-generation married women. However, socioeconomic factors account for the differences between cohabiting or single first-generation women, which is supported by the absolute resources perspective. Our intra-group analysis by racial and ethnic groups yielded similar findings but found that Hispanic and Asian first-generation women take on a larger proportion of housework, relative to later-generation women.

Analysis of Alzheimer's Disease-Related Mortality Rates Among the Elderly Populations Across the United States: An Analysis of Demographic and Regional Disparities from 1999 to 2020.

Alzheimer's Disease (AD) is the leading cause of dementia and a significant public health concern, characterized by high incidence, mortality, and economic burden. This study analyzes the mortality patterns and demographic disparities in Alzheimer's disease-related deaths among the elderly population in the United States from 1999 through 2020. Alzheimer's disease mortality data for individuals 65 and older were obtained from the CDC WONDER database, utilizing ICD-10 codes G30.0, G30.1, G30.8, and G30.9 for identification. Demographic and regional variables included age, gender, race/ethnicity, place of death, urban- rural status, and geographic region. Crude death rates (CR) and age-adjusted mortality rates (AAMR) per 100,000 individuals were calculated. Joinpoint Regression Program 5.0.2 was used to analyze trends, calculating Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs). From 1999 to 2020, 1,852,432 deaths were attributed to AD among individuals aged 65 and older. The AAMR increased from 128.8 in 1999 to 254.3 in 2020, with an AAPC of 2.99% (95% CI = 2.61-3.48). The age-adjusted mortality rate (AAMR) was higher in females (218.5) than in males (163.5). Among racial and ethnic groups, non-Hispanic whites had the highest AAMR, followed by Non-Hispanic Blacks and Hispanics. Regionally, the West reported the highest AAMR, while the Northeast recorded the lowest. Most deaths occurred in nursing homes (57.3%), with a significant portion also occurring at decedents' homes (22.4%). AD mortality rates in the U.S. have risen significantly, with notable disparities across age, gender, race, and geographic regions. These findings highlight the need for targeted interventions and research to address the growing burden of AD, particularly among the most affected demographic groups.

Epidemiological profile of patients hospitalized with Crohn’s disease due to severe acute respiratory infection during the COVID-19 pandemic: a 2-year report from Brazil

Background and aimsThe novel coronavirus-induced severe acute respiratory syndrome (COVID-19) led to one of the most significant global pandemics of the 21st century, causing substantial challenges for healthcare systems worldwide, including those in Brazil. This study aimed to investigate the demographic and clinical profiles of hospitalized patients in Brazil who had both COVID-19 and Crohn’s disease (CD) over a 2-year period.MethodsAn epidemiological analysis was conducted using data from Open-Data-SUS. The study focused on describing the demographic characteristics, clinical manifestations, comorbidities, and hospitalization details of patients afflicted with severe acute respiratory syndrome due to COVID-19 and CD, with the aim of predicting mortality risk.ResultsThe states of São Paulo, Paraná, and Minas Gerais accounted for 50% of the reported COVID-19 cases. The most affected racial group consisted of individuals who self-declared as mixed race. Common comorbidities included heart disease, diabetes mellitus, and obesity. The age group most affected was 25 to 60 years old, particularly among hospitalized patients with both CD and COVID-19 who ultimately succumbed to the illness. A multivariable analysis was conducted to identify the following significant risk factors for death: (a) the presence of neurological disorder (OR = 6.716; 95% CI = 1.954–23.078), (b) the need for intensive care (OR = 3.348; 95% CI = 1.770–6.335), and (c) the need for invasive mechanical ventilation (OR = 59.017; 95% CI = 19.796–175.944).ConclusionThere was no discernible gender-based prevalence among hospitalized patients with CD and COVID-19; however, individuals of mixed race were disproportionately affected. The 25 to 60 age group emerged as the most vulnerable demographic group, with high risks of hospitalization and mortality. Moreover, the study highlights the potential for COVID-19 to induce systemic pathologies that may result in long-term degenerative effects and sequelae.

An Immediate but Fleeting Interest in MPH Programs After the Onset of COVID-19: An Interrupted Time-Series Analysis.

The relationship between the onset of the COVID-19 pandemic and interest in master of public health (MPH) programs is unknown. We examined trends in MPH application rates for 31 MPH concentrations and specifically for the MPH concentration in epidemiology and differences by race and ethnicity before and after the onset of the COVID-19 pandemic. We constructed a quasi-experimental design to examine trends in MPH application rates from academic years 2015-2016 through 2022-2023 by using Centralized Application Service for Schools and Programs of Public Health data. We used an interrupted time-series analysis to test whether application rates surged after the pandemic's onset (academic years 2019-2020 through 2020-2021) and whether this increase persisted during the pandemic (academic years 2020-2021 through 2022-2023). We fit models for the overall sample, a combined racially and ethnically minoritized sample, each racial and ethnic group separately, and a non-US citizen sample. The pandemic's onset correlated with an immediate increase in application rates across most samples: overall (38%) and among American Indian/Alaska Native/Native Hawaiian/Pacific Islander (91%), Asian (35%), Black (42%), Hispanic (60%), multiracial (30%), racially and ethnically minoritized (44%), and White (53%) samples. However, this trend was not sustained; application rate trends during the pandemic were significantly lower than prepandemic trends. Application rate trends for all MPH concentrations and the MPH in epidemiology concentration among non-US citizens were significantly higher during the pandemic than prepandemic. Our results highlight the need for innovative strategies to sustain MPH degree interest and a diverse applicant pool.

Prevalence of Unrecognized Cognitive Impairment in Federally Qualified Health Centers

There is a need for early and equitable detection of cognitive impairment among older adults. To examine the prevalence of unrecognized cognitive impairment among older adults receiving primary care from federally qualified health centers (FQHCs). This cross-sectional study was conducted at 5 FQHCs providing primary care in Indianapolis, Indiana, between 2021 and 2023. Participants were adults aged 65 years and older, without a diagnosis of mild cognitive impairment (MCI), dementia, or severe mental illness. Data analysis was performed from September 2023 to April 2024. The primary outcome was a diagnosis of dementia or MCI, as determined by an interdisciplinary clinical team using data from structured patient and study partner interviews, medical record reviews, and a detailed cognitive assessment, including neuropsychological testing. Differences between participants determined to have normal cognition, MCI, and dementia were assessed statistically using analysis of variance for continuous variables, χ2 or Fisher exact tests for categorical variables, or Fisher exact test alone when expected cell counts were 5 or less. A total of 844 eligible individuals were consecutively approached, 294 consented to participate, and 204 completed the study (mean [SD] age, 70.0 [5.1] years; 127 women [62.3%]). One hundred eight participants (52.9%) were African American, 5 (2.5%) were Hispanic, 199 (97.5%) were not Hispanic, and 90 (44.1%) were White. The mean (SD) duration of education was 13.1 (2.6) years, and the mean (SD) Area Deprivation Index score was 78.3 (19.9), indicating a high level of neighborhood disadvantage. In total, 127 patients (62.3%) met the diagnostic criteria for MCI, 25 (12.3%) had dementia, and 52 (25.5%) had no cognitive impairment. Compared with non-Hispanic White individuals and after adjusting for age, sex, and education level, African American individuals were more than twice as likely to have MCI or dementia (odds ratio, 2.73; 95% CI, 1.38-5.53; P = .02). This cross-sectional study found that unrecognized cognitive impairment is ubiquitous among older adults from underrepresented, minoritized racial and ethnic groups and those who are socially vulnerable receiving primary care from FQHCs. To overcome the disparity in early detection of cognitive impairment, timely, equitable, scalable, and sustainable detection approaches need to be developed.

Impact of Race, Ethnicity, Insurance, and Procedural Timing on Sterilization Method.

Objective: This study aims to determine if race, ethnicity, insurance status, or procedural timing is associated with type of sterilization procedure. Methods: A retrospective cohort study was performed. The study population included women who underwent elective sterilization at one institution from January 2010 to December 2020. The medical record was reviewed to obtain age, race, ethnicity, procedure type and timing, and insurance status. Race and ethnicity groups included were Asian, non-Hispanic Black, Hispanic, or non-Hispanic White. Timing was divided into peripartum (at the time of cesarean section or before discharge after vaginal delivery) and interval procedures. Multivariate logistic regression was performed to assess the association of procedure type with race, ethnicity, insurance status, and timing. In addition, a sensitivity analysis was performed for procedures after January 1, 2016, to determine if the associations with the above categories differed. Results: A sample of 2,041 individuals received sterilization procedures, and 1,115 were included in the analysis: 70% (782) of sterilizations were performed during the peripartum period, and 60% (670) of women had public insurance. On multivariate analysis, both non-Hispanic Black (odds ratio [OR] 0.54 95% confidence interval [CI] 0.32-0.89) and Asian (OR 0.23 95% CI 0.06-0.72) individuals were less likely to have salpingectomy (SL) when compared with non-Hispanic White individuals. On sensitivity analysis for procedures after January 1, 2016, non-Hispanic Black (OR 0.31 95% CI 0.17-0.56), Hispanic (OR 0.31 95% CI 0.14-0.66), and Asian (OR 95% CI 0.04-0.54) individuals were less likely to have when compared with non-Hispanic White individuals. Conclusion: Tubal ligation is more frequently performed in our health system, and we identified critical disparities in performance of SL for sterilization.

Challenging the use of the overall adverse childhood experiences (ACEs) score: Comparing total ACEs, maltreatment, and household dysfunction on mental health problems among White, African American, and Native American women under correctional control.

Adverse childhood experiences (ACEs) have been consistently linked to mental health problems. There have been recent conceptual and empirical critiques that suggest maltreatment and household dysfunction to not be combined to create a composite ACE score. Women in correctional custody demonstrate disproportionately high ACE levels and greater mental health problems as to racial minorities. The present study compared the effects of varying operationalizations of the ACEs measure on women's mental health stratified across race using a sample of White, African American, and Native American women in correctional custody in Oklahoma. The cross-sectional study administered a paper-and-pencil survey to 494 women. Structural equation modeling was used to test hypotheses. Maltreatment was a significant predictor of women's mental health across all racial groups but demonstrated the strongest effect among African American inmates. Household dysfunction was not a significant predictor of mental health for any racial group. When comparing the maltreatment-only model to the maltreatment and household dysfunction model, and the overall ACE score model, there was little explained variance lost. These findings indicate that maltreatment demonstrates unique associations with women's mental health and may be the driving force behind the relationship between ACEs and adult mental health among women within correctional custody. Researchers are advised to not use the overall ACE score and instead break down the measure into the maltreatment and household dysfunction subscales. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparing Black and White Patients in Treatment of Advanced Prostate Cancer and Survival in an Equal Access Health System.

Racial disparities in prostate cancer treatment and survival in the U.S. have been attributed to differences in access to care and medical insurance. We aimed to compare treatment and survival of advanced prostate cancers between White and Black men in the equal access Military Health System (MHS). We accessed the MilCanEpi database to study a cohort of non-Hispanic White and Black men diagnosed with stage III or IV prostate cancer between 1998 and 2014 in the MHS. The racial groups were compared in receiving curative treatment of radical prostatectomy (RP) only, RP with (neo)adjuvant radiation or hormone therapy, radiation only, or combination radiation and hormone therapy; and overall survival using multivariable regression models. The study included 1476 White and 531 Black men. Overall, there was no racial difference in receiving any curative treatment (AOR = 0.85, 95% CI = 0.67, 1.08 for Black vs. White). By treatment type, Black men were statistically as likely to receive RP only (AOR = 0.87, 95% CI = 0.67, 1.14), radiation only (AOR = 0.81, 95% CI = 0.49, 1.34), or combination radiation and hormone therapy (AOR = 1.12, 95% CI = 0.71, 1.78) but statistically less likely to receive RP with (neo)adjuvant treatment (AOR = 0.56, 95% CI = 0.37, 0.86) relative to no curative treatment compared to White men. The difference in RP with (neo)adjuvant treatment was also statistically significant among patients with stage III tumors, but not stage IV. Survival was similar overall (AHR = 1.12, 95% CI = 0.88, 1.42 for Black vs. White) and when evaluated by tumor stage. In the MHS, the overall likelihood to receive any treatment for advanced prostate cancers and survival was similar between races, which might result from universal health care. Racial differences in receipt of RP with (neo)adjuvant treatment, especially for patients with stage III prostate cancer, may be related to factors other than access to care and warrants further research.

From worries to resilience: a qualitative study of the psychosocial experiences of diverse adolescents and young adults with heart failure and their caregivers.

Despite advances in treatment and outcomes for paediatric heart failure, both physical and psychosocial comorbidities remain notable among this patient population. We aimed to qualitatively describe the psychosocial experiences of adolescent and young adults with heart failure and their caregivers' perceptions, with specific focus on personal challenges, worries, coping skills, and resilience. Structured, in-depth interviews were performed with 16 adolescent and young adults with heart failure and 14 of their caregivers. Interviews were recorded and transcribed. Content analysis was performed, and themes were generated. Transcripts were coded by independent reviewers. Ten (63%) adolescent and young adults with heart failure identified as male and six (37.5%) patients self-identified with a racial or ethnic minority group. Adolescent and young adults with heart failure generally perceived their overall illness experience more positively and less burdensome than their caregivers. Some adolescent and young adults noted specific worries related to surgeries, admissions, major complications, death, and prognostic/treatment uncertainty, while caregivers perceived their adolescent and young adult's greatest worries to be around major complications and death. Adolescent and young adults and their caregivers were able to define and reflect on adolescent and young adult experiences of resilience, with many adolescent and young adults expressing a sense of optimism and gratitude as it relates to their medical journey. This study is the first of its kind to qualitatively describe the psychosocial experiences of a racially and socioeconomically diverse sample of adolescent and young adults with heart failure, as well as their caregivers' perceptions of patient experiences. Findings underscore the importance of identifying distress and fostering resilient processes and outcomes in young people with advanced heart disease.

Mortality trends, gender, and racial disparities in older adults due to abdominal aortic aneurysm: A nationwide cross-sectional analysis

Abdominal aortic aneurysms (AAAs) are a significant vascular pathology in older adults, often asymptomatic but with high mortality upon rupture. Despite advancements in diagnostic imaging and surgical interventions, AAAs remain a public health concern. This research letter analyzed CDC WONDER data on AAA-related deaths (ICD-10 I71.3 and I71.4) among US adults aged 65+ from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, gender, age group, race/ethnicity, geography, and urbanization status. Between 1999 and 2020, there were 180,037 reported deaths in older adults due to AAA. The overall AAMR decreased from 32.6 to 13.2 per 100,000, with a significant decline from 2014 to 2020 (APC: −1.66; 95% CI: −2.48 to −0.48). Older men had a significantly higher AAMR than older women (31.2 vs. 12). Among racial and ethnic groups, Non-Hispanic (NH) Whites had the highest AAMR at 21.7, followed by NH American Indian or Alaska Native (14.5), NH Black (12.6), NH Asian or Pacific Islander (10.1), and Hispanic populations (8.4). Additionally, non-metropolitan areas exhibited higher AAMRs compared to metropolitan areas (23.9 vs. 18.7). While mortality rates have declined, disparities remain, with higher rates among older men, NH Whites, and non-metropolitan residents, highlighting the need for targeted and equitable interventions.

The structured assessment of violence risk in youth demonstrates measurement invariance between Black and White justice-referred youths.

Identification and implementation of effective methods for reducing racial/ethnic bias and disparities in legal settings are paramount in the United States and other countries. One procedure originally thought to reduce bias in legal decisions is the use of risk assessment instruments, which is now being heavily scrutinized. Measurement invariance, a latent trait technique, is a robust method for assessing one form of bias. Measurement invariance involves determining whether risk items in an instrument appear to be functioning the same between racial or other groups. Thus, the present study examined measurement invariance of the Structured Assessment of Violence Risk in Youth (SAVRY) between non-Latino Black and White youths to examine racial bias. We expected the SAVRY to be invariant (lacking measurement bias) between Black and White youths. The sample included 687 Black and 361 White youths, and the study used a large, multistate data set of SAVRYs conducted by probation officers. We conducted measurement invariance testing in a series of hierarchical steps including testing configural and scalar invariance. The SAVRY demonstrated scalar invariance (equal thresholds for ratings from "low" to "moderate" and "moderate" to "high") for all items except one-community disorganization. The findings lend further credibility to the SAVRY, and the structured professional judgment approach, as a method to assess violence risk and case planning needs among youths involved in the legal system. These findings provide more confidence that significant differences in SAVRY risk level or items between Black and White youths are not based in measurement bias, with the exception of the community disorganization item. Potential fixes discussed include eliminating or deemphasizing this item in final risk level ratings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).