Ethnicity Status Research Articles

Oral health inequities over time among older adults of different racial/ethnic backgrounds: a comparative decomposition analysis across Australia and the United States.

Although the prevalence of poor oral health among older populations in Australia and the United States is higher, the contribution of ethnicity status is unknown. We aimed to estimate the contribution of social inequalities in oral health among older populations in Australia and the United States. Cross-sectional study design using data from Australia's National Survey of Adult Oral Health (NSAOH 2004-06 and 2017-18) and the United States' National Health and Nutrition Examination Survey (NHANES 2003-04 and 2011-16). Participants included in the analysis were aged 65 + years. Oaxaca-Blinder type decomposition analysis was used to assess the contribution of demographic (age, sex), socioeconomic position (educational attainment, household income) and dental behaviors (last dental visit) to changes in prevalence of edentulism and non-functional dentition, and mean number of missing teeth by ethnicity status over time in Australia and the United States. The number of participants aged 65 + years who provided clinical and sociodemographic/dental behaviour data was 1043 and 1269 in NSAOH 2004-06 and 2017-18, and 1372 and 1328 in NHANES 2003-04 and 2011-16 respectively. The prevalence of edentulism was from 13 percent (NHANES 2011-16) to 28 percent (NSAOH 2004-06), while the prevalence of non-functional dentition was from 41 percent (NSAOH 2017-18 and NHANES 2011-16) to 61 percent (NHANES 2003-04). The mean number of missing teeth was from 11 (NSAOH 2017-18) to 18 (NHANES 2003-04). The prevalence of edentulism and non-functional dentition, and the mean number of missing teeth were higher among older Australians identifying as White and the opposite results were observed among older Americans identifying as Non-White. For older adults in Australia, risk factors with the greatest impact on oral health outcomes by ethnicity status were educational attainment and household income. For older adults in the United States, the most dominant risk factor for non-optimal oral health outcomes by ethnicity status was last dental visit. There are important policy translation implications from our findings, as they indicate that social and structural systems in Australia and the United States operate differently in the context of oral health over time among culturally diverse older citizens. This information will help inform initiatives that both target effective oral health promotion for older, culturally-diverse populations and provide evidence for the distribution of resources in the public dental health setting for this age group and cultural demographic.

What is inclusion? Children perspective on education at primary schools in rural Afghanistan

Inclusive education remains a distant goal in Afghanistan threatened by issues of discrimination based on gender, disability, ethnicity, cultural beliefs and socioeconomic status. To promote more inclusive practices, we conducted 120 participatory workshops in three rounds, including 1187 volunteer children aged 9 to 12 years old from grades three, four and five in 40 primary rural schools of Badakhshan, Ghazni and Takhar provinces of Afghanistan between 2018 and 2021. Children described inclusion as the combination of allowing all children to access school and to effectively learn. Children were able to meaningfully define the state of education while articulating coherently what motivates them, their teachers, and parents and what actions need to be taken to improve the whole school system. In a political context limiting girls’ education, children voiced their need for a school environment that is enriching, supportive and adapted to their needs and expectations to keep motivated and engaged.

Telomere length and chronotype among women in the California Teachers Study (CTS)

ABSTRACT While links between certain chronotypes and poorer health outcomes have been well established in previous studies, few studies have examined the relationship between chronotype and cellular aging. Using data from the California Teachers Study (CTS), the present study evaluates the relationship between cellular aging and chronobiology through an analysis of leukocyte telomere length (LTL) and chronotype among 817 predominantly postmenopausal women with no history of cancer and occupations not associated with night-shift work. Unconditional logistic regression models were run to estimate odds ratios (ORs) for each chronotype category, adjusted for age, ethnicity, and smoking status. Analyses were then stratified by potential modifiers to assess whether results varied among specific subgroups within the sample. Women who reported being current evening types and evening types from teen years to now were significantly less likely to have short LTL compared to women who reported being current morning types or morning types from teen years to now (OR = 0.72; 95% CI = 0.53-0.98; OR = 0.57; 95% CI = 0.39-0.84). Our results suggest that women with no history of cancer who identify as evening chronotypes may undergo decreased cellular aging compared to women in the same population who identify as morning types. Further studies on populations of postmenopausal women are warranted.

Proportional Trends in Pediatric Opioid Prescribing Between 2005 and 2016 by Age Group, Sex, Ethnicity, Race, Language, and Payer Status from a Large Children’s Hospital in the Southwest United States

Background/Objectives: Prescription opioid use before adulthood is typically effective for acute pain control and is also associated with adverse short- and long-term consequences. Methods: This study examined pediatric opioid prescribing trends over time across different age groups (early childhood, school age, adolescence, young adult) and sociodemographic subgroups (sex, ethnicity, race, language, payer type) from 2005 to 2016. Results: Utilizing 42,020 first outpatient opioid prescriptions for youth aged 0–21 years from a large US children’s hospital, this research found notable trends and disparities. Prescription rates increased by 35% from 2005–2007 to 2008–2010, then decreased by 14% from 2008–2010 to 2011–2013, and decreased again by 22% from 2011–2013 to 2014–2016. Chi-squared tests indicated significant changes in prescription rates across all sociodemographic subgroups, though only age group, ethnicity, and payer type (i.e., the party responsible for payment for hospital services) had changes with non-negligible effect sizes (Cramer’s V). Specifically, age group showed small to medium effects (V = 0.16), while ethnicity and payer demonstrated small effects (V = 0.10 each). This study highlights variations in opioid prescribing trends, particularly among different age groups, ethnicities, and payer statuses up to 2016. Conclusions: These findings reveal differing trends in pediatric opioid prescribing during the peak of the opioid epidemic, highlighting the importance of considering age and sociodemographic variables for understanding prescribing patterns fully and raising potential concerns about inequities in pain management. Future studies should explore similar trends from 2016 onward.

Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study.

Urbanicity is a well-established risk factor for psychosis. Our recent multi-national study found an association between urbanicity and clinical psychosis in Northern Europe but not in Southern Europe. In this study, we hypothesized that the effect of current urbanicity on variation of schizotypy would be greater in North-western Europe countries than in Southern Europe ones. We recruited 1080 individuals representative of the populations aged 18-64 of 14 different sites within 5 countries, classified as either North-western Europe (England, France, and The Netherlands) with Southern Europe (Spain and Italy). Our main outcome was schizotypy, assessed through the Structured Interview for Schizotypy-Revised. Our main exposure was current urbanicity, operationalized as local population density. A priori confounders were age, sex, ethnic minority status, childhood maltreatment, and social capital. Schizotypy variation was assessed using multi-level regression analysis. To test the differential effect of urbanicity between North-western and Southern European, we added an interaction term between population density and region of recruitment. Population density was associated with schizotypy (β = 0.248,95%CI = 0.122-0.375;p < 0.001). The addition of the interaction term improved the model fit (likelihood test ratio:χ2 = 6.85; p = 0.009). The effect of urbanicity on schizotypy was substantially stronger in North-western Europe (β = 0.620,95%CI = 0.362-0.877;p < 0.001) compared with Southern Europe (β = 0.190,95%CI = 0.083-0.297;p = 0.001). The association between urbanicity and both subclinical schizotypy and clinical psychosis, rather than being universal, is context-specific. Considering that urbanization is a rapid and global process, further research is needed to disentangle the specific factors underlying this relationship.

The impact of race, ethnicity, and socioeconomic status on fertility-sparing management of early-stage cervical cancer

The impact of race, ethnicity, and socioeconomic status on fertility-sparing management of early-stage cervical cancer

Aging with CF: Characteristics of people with CF aged 40 and older in the United States

We conducted a descriptive analysis of people with CF 40 years of age and older using CF Foundation Patient Registry data from 2022 to provide a current estimate of the population size and characteristics. We summarized demographic details including biological sex, race, ethnicity, insurance and employment status. Clinical data including body mass index, lung function, respiratory infections, hospitalization rates, prevalence of CF-related complications and CF therapy prescriptions were collated. A total of 5,243 individuals aged 40 years or older contributed data to the CFFPR: 2,687 (51 %) people aged 40–49 years; 1,410 (27 %) people aged 50–59 years; and 1,146 (22 %) people aged 60 years or older. The ≥60 year old group have unique characteristics compared to younger individuals, with later diagnosis of CF and greater proportion of females (58 %). These results highlight heterogeneity in the older CF adult population and the need to develop and individualize CF care practices.

Trends in Location of Death for Individuals With Primary Bone Tumors in the United States.

Given the significant morbidity and mortality associated with primary bone cancer, provision of high-quality end-of-life care concordant with patient preferences is critical. This study aimed to evaluate trends in use of dedicated end-of-life care settings and investigate sociodemographic disparities in location of death among individuals with primary bone cancer. A retrospective, population-based review of patients who died of primary bone cancer-related causes was performed using the Underlying Cause of Death public use record from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) database for the years 2003 through 2019. A total of 24,557 patients were included. Over the study period, the proportion of primary bone cancer-related deaths occurring at home and in hospice increased, whereas those occurring in hospital, nursing home, and outpatient medical facility/emergency department settings decreased. Several sociodemographic factors were found to be associated with location of death, including age, marital status, and level of education. Moreover, patients of racial and ethnic minority groups were at significantly lower risk of experiencing death at home or in outpatient medical facility/emergency department settings relative to a hospital compared with White patients. Although rates of in-hospital death from primary bone cancer are decreasing, marked racial and ethnic disparities in use of dedicated end-of-life care settings exist. These gaps must be addressed to ensure all patients with primary bone cancer have equitable access to high-quality end-of-life care regardless of racial, ethnic, or socioeconomic status. [Orthopedics. 202x;4x(x):xx-xx.].

Associations of psychotic symptom dimensions with clinical and developmental variables in twin and general clinical samples.

Positive, negative and disorganised psychotic symptom dimensions are associated with clinical and developmental variables, but differing definitions complicate interpretation. Additionally, some variables have had little investigation. To investigate associations of psychotic symptom dimensions with clinical and developmental variables, and familial aggregation of symptom dimensions, in multiple samples employing the same definitions. We investigated associations between lifetime symptom dimensions and clinical and developmental variables in two twin and two general psychosis samples. Dimension symptom scores and most other variables were from the Operational Criteria Checklist. We used logistic regression in generalised linear mixed models for combined sample analysis (n = 875 probands). We also investigated correlations of dimensions within monozygotic (MZ) twin pairs concordant for psychosis (n = 96 pairs). Higher symptom scores on all three dimensions were associated with poor premorbid social adjustment, never marrying/cohabiting and earlier age at onset, and with a chronic course, most strongly for the negative dimension. The positive dimension was also associated with Black and minority ethnicity and lifetime cannabis use; the negative dimension with male gender; and the disorganised dimension with gradual onset, lower premorbid IQ and substantial within twin-pair correlation. In secondary analysis, disorganised symptoms in MZ twin probands were associated with lower premorbid IQ in their co-twins. These results confirm associations that dimensions share in common and strengthen the evidence for distinct associations of co-occurring positive symptoms with ethnic minority status, negative symptoms with male gender and disorganised symptoms with substantial familial influences, which may overlap with influences on premorbid IQ.

Social Determinants of Successful Smoking Cessation: An Eight-Year Analysis of Population Assessment of Tobacco and Health (PATH) Data.

Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. This study aimed to examine differences in smoking cessation rates among daily smokers based on race, ethnicity, and socioeconomic status (SES) using data from the Population Assessment of Tobacco and Health (PATH) study, spanning waves 1 to 6 (eight years). Longitudinal data from PATH were analyzed, focusing on baseline daily cigarette smokers followed over an eight-year period to assess cessation outcomes. SES was measured by education and poverty status. Successful smoking cessation was defined as sustained abstinence from cigarettes for 12 months or more at the final wave. Logistic regression models identified predictors of successful cessation, adjusting for potential confounders, including age, nicotine dependence, and access to cessation resources. The analysis revealed significant disparities in cessation success across racial, ethnic, and SES groups. Smokers living in poverty and those with lower educational attainment were less likely to achieve cessation success than their counterparts. Race (Black) and ethnicity (Latino) were also significantly associated with lower cessation success. This study highlights the social determinants of smoking cessation success among U.S. adult smokers, with lower success rates observed among those in poverty and with less educational attainment. These findings emphasize the need for targeted interventions that address the unique barriers to cessation faced by low-SES groups. Public health strategies should prioritize equitable access to cessation resources and culturally tailored interventions to reduce these disparities and improve cessation outcomes among all smokers.

Nutrient intake of young South African adults from the baseline of the African-PREDICT cohort study.

This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study according to ethnicity and socioeconomic status (SES). Cross-sectional analysis of baseline nutrient intakes in the African-PREDICT study. North West Province, South Africa. Black and white adults (n=1153), aged 20-30 years, were classified into three SES groups. Dietary data were collected using three multiple-pass 24-hour dietary recalls. Among all participants, over 70% failed to meet the Estimated Energy Requirements and the Estimated Average Requirements (EAR) for 17 of the 19 reported micronutrients. Across SES groups, more than 50% of participants consistently did not meet the EAR for calcium, magnesium, folate, pantothenic acid, and biotin, as well as vitamins A, C, D, and E. Participants' distribution by nutrient pattern tertiles showed high adherence to two patterns: one rich in animal protein and saturated fat, and the other in magnesium, potassium, calcium, phosphorus, and fiber. This was seen only in white participants and high SES. Black participants and low SES showed higher adherence to a plant protein, B-vitamins, zinc, and iron nutrient pattern. The dietary intake of young adults in this study was restricted, with none of the groups meeting nutrient requirements for essential nutrients. Further research is needed to establish a direct link between nutrient patterns and the early detection and identification of cardiovascular diseases and hypertension.

Ethnic minorities who complete cardiac rehabilitation achieve equivalent functional capacity outcomes after cardiac rehabilitation but only half complete

Abstract Background Cardiac rehabilitation (CR) reduces the risk of death and repeat cardiac events and improves multiple patient outcomes. Ethnic minority backgrounds experience significant health disparities, often due to lack of fluency in dominant language and higher rates of cardiovascular disease risk factors. Despite these issues, outcomes for ethnic minorities from CR are rarely differentiated and participation in CR programs infrequently reported. Purpose To compare participation in and exercise outcomes from CR programs for patients from ethnic minorities versus the majority. Methods A secondary analysis from a national CR audit including 2335 CR participants. Ethnic minority was defined as having poor English language fluency requiring an interpreter for CR assessment. Functional capacity was assessed using 6-minute walk test (6MWT) or metabolic equivalent of tasks (METs). Binary logistic regression model was created to identify independent predictors of completion, accounting for baseline variables. Multiple linear regression models were used to determine if ethnic minority status was an independent predictor of change in 6MWT and METs after adjusting for baseline characteristics. Results Of the 2335 participants, 326 (14%) were from ethnic minorities. The mean age was 66.3±12.4 years and 70% males. There were no differences between minority and majority groups in relation to baseline characteristics. The most common referral diagnosis was myocardial infarction (27%), angina (25%), other – arrhythmias, cardiac devices, valve diseases/procedures (24%), and cardiac surgery (24%). Ethnic minorities were half as likely to complete CR (OR 0.49, 95% CI 0.38, 0.65) adjusted for age, sex, diagnosis, minority status, smoking, referral site and wait time (Table 1). Other factors that increase completion likelihood included all other cardiac diagnoses (compared to myocardial infarction as reference) and non-smokers, whereas major referral centre and female sex negatively impacted completion. Patients from ethnic minority backgrounds had less functional capacity at CR entry compared to the majority (379.9±118 versus 430.7±103 metres, p&amp;lt;0.001), though METs were comparable (6.69±2.73 versus 6.46±2.28 mg/kg/min, p=0.69). However, improvements were equivalent for 6MWT: minority 71.03±58.57 versus majority 71.37±61.16 (p=0.96), and for METs: minority 3.01±1.66 versus majority 3.13±1.74 mg/kg/min (p=0.77). Ethnic minority status was not an independent predictor of change in 6MWT and METs after accounting for age, sex, diagnosis, smoking, referral site, and wait time. Conclusion For patients from ethnic minority groups who completed CR, exercise/functional capacity outcomes were equivalent to majority participants, however less than one-in-two completed. CR programs should consider the needs of ethnic minority groups, particularly in relation to language and tailor content and delivery to promote participation and ensure more equitable access.

Diabetes worsens the adverse association between myocardial diffuse fibrosis and left ventricular strain

Abstract Background Heart failure is a common cardiovascular complication to diabetes. Increased fibrosis of the myocardium has been suggested to be a mechanism, however, no convincing clinical evidence has so far been presented. A better understanding of how myocardial tissue characteristics influence functional aberration in diabetes could aid diagnosis, risk assessment and guide treatment. Native T1 is a CMR marker of diffuse fibrosis with diagnostic and prognostic value (1,2), and feature tracking (CMR-FT) strain is a sensitive measure of myocardial systolic function. In this study, we evaluated the association of CMR markers of fibrosis with markers of systolic function in individuals with and without diabetes. Purpose To understand the relationship between native T1 and myocardial strain and how diabetes may affect this. Methods Participants from the UK Biobank population imaging study were included. Left ventricular global longitudinal strain (GLS) was derived using a semi-automated batch processing software tool. Native T1 was derived from segmentation of the entire short axis slice using an automated quality control tool, excluding scans with predicted dice score of &amp;lt;0.7. Multivariable linear models were used with the strain metrics as the outcome variable and native T1 and diabetes as the exposure variables. These models were adjusted for age, sex, BMI, ethnicity, smoking and alcohol status, prevalent hypertension hypercholesterolaemia and coronary artery disease. The effect of interaction between diabetes and native T1 on GLS was examined by introducing an interaction term. Results In total 41,533 participants were included, of which 1957 had diabetes – see Table 1 for baseline characteristics. The average GLS measured for those with diabetes was -17% and was -18% for those without. The average native T1 in those with diabetes was 935ms and 933ms for those without on the background of greater prevalence of cardiovascular risk factors in those with diabetes. In model adjusted for all relevant co-variates, individuals with diabetes had worse GLS measured compared to those without diabetes (β-coefficient: 0.51, p value &amp;lt;0.001). Increasing fibrosis (native T1) was associated with worsening GLS (β-coefficient: 0.005, p value &amp;lt;0.001) in all participants. However, in those with diabetes, increasing native T1 was associated with a greater decline in GLS compared to those without diabetes (interaction term β-coefficient: 0.005, p value &amp;lt;0.001), with a relative impairment seen within normal ranges for native T1 - see Figure 1. Conclusion(s) This is the largest study of its kind to demonstrate a dose dependent relationship between increasing native T1, representing potential myocardial fibrosis, and myocardial strain, representing cardiac dysfunction. Our findings indicate that increased fibrosis alone does not explain the higher risk of HF in diabetes, other mechanisms, perhaps intracellular, might be at play.

Social inequalities in cancer incidence, survival and mortality: An umbrella review

Abstract Background An increasing number of systematic reviews investigating differences in cancer burden by social factors such as race, ethnicity, and socioeconomic status have been published in recent years. Our study aims to evaluate the strength and quality of evidence from systematic reviews investigating associations between social factors and cancer incidence, survival, and mortality to help policy-makers reduce existing social inequalities in the burden of cancer. Methods Our study is a pre-registered umbrella review (PROSPERO; CRD42024552884). We systematically searched Medline, Scopus, Web of Science, CINAHL, PsycINFO, the Cochrane Library, the JBI EBP database, and Epistemonikos without date restrictions for published systematic reviews with or without meta-analyses on June 17, 2024. The search identified 15,542 records, which were reduced to 7,421 after deduplication. We are currently screening studies to include systematic reviews of cohort or case-control studies that examined associations between one or more social factors (gender, race/ethnicity, education, occupation, socioeconomic status, place of residence, religion, social capital) and cancer outcomes. Study screening, data extraction, and quality appraisal will be done in duplicate using pre-piloted forms. The strength of evidence of reported associations between social factors and cancer outcomes will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Before data synthesis, we will assess the degree of overlap between primary studies in the eligible reviews by creating citation matrices and calculating corrected covered area indices. Following this, we will narratively summarize associations (for systematic reviews without meta-analyses) and pool the risk estimates for individual social factors and cancer outcomes (for reviews with meta-analyses) using random-effects meta-analysis models. We will have preliminary results ready by November 2024. Key messages • Our umbrella review aims to evaluate the strength and quality of evidence from systematic reviews which have examined social inequalities in cancer incidence, survival, and mortality. • This high-level evidence synthesis can help policy-makers better plan and target interventions to reduce the existing social inequalities in the burden of cancer.

Atrial Fibrillation in young patients: Insights from the National Inpatient Sample

Abstract Background The burden of atrial fibrillation (AF) in young patients is not well characterized. We aimed to study trends in AF burden and management over time in patients aged 18-45 years. Methods We conducted a retrospective analysis of all primary AF hospitalizations in patients 18-45 years of age using the United States National Inpatient Sample (NIS) data from 01/01/2008 to 12/31/2019. We collected data on clinical and socioeconomic features including demographics, comorbidities, ZIP Code income, resource utilization, and various clinical outcomes. Quartile classification of the median household income of the zip code of the patient’s residence was used to classify socioeconomic status. Results The rate of AF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p&amp;lt;0.001) (Figure 1). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in black patients compared to other ethnicities (20.4 for black vs. 15.6 for white vs. 8.5 Hispanic per 100,000) (Figure 2). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p&amp;lt;0.001), and the utilization of catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p&amp;lt;0.001) (Figure 1). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p &amp;lt;0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3%) and catheter ablation (6.1% vs. 3.3%, p &amp;lt;0.001) compared to black patients. Patients in the highest socioeconomic status quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p&amp;lt;0.001) and catheter ablation (8.0% vs. 3.7%, p&amp;lt;0.001) compared to patients in the lowest socioeconomic status quartile. Conclusions We found significant differences in inpatient AF burden across different patient populations. We identified differences in inpatient AF management based on sex, ethnicity, and socioeconomic status. Further research is needed to better understand these differences, their impact on clinical outcomes, and strategies to improve healthcare disparities.

Longitudinal association between nonstandard work schedule and depressive symptoms

Abstract Background Nonstandard work schedules (NSWSs) have been linked to increased risk of depression, but the evidence is mostly from cross-sectional studies and data on the risk distribution across various groups is lacking. We examined the impact of different NSWSs on depressive symptoms and assessed effect modification by sex, ethnicity, and immigrant status. Methods We used five waves of longitudinal data from the Understanding Society, the UK Household Longitudinal Study, which were collected biennially from 2010/11 to 2018/19. The study sample comprised 11371 employed workers aged 16 to 58 years in 2010/11. Generalised estimating equation with logistic regression was used to assess crude and adjusted effects of NSWS types (work time arrangement, work hours, and weekend working) on depressive symptoms. Independent correlation was specified in all the models. Complete-case and multiple imputation analyses were performed. Results After adjusting for confounders, only weekend work was associated with depressive symptoms. Workers who worked most/all (OR 1.24; 95%CI 1.13 - 1.37) or some (OR 1.10; 95%CI 1.02 - 1.18) weekends had a higher risk of depressive symptoms than workers who did not work on weekends. Ethnicity modified the association between work hours and depressive symptoms, indicating a higher risk among White workers working &amp;gt; 40 hours/week (OR 1.10; 95%CI 1.02 - 1.20) and Asian workers working &amp;lt;35 hours/week (OR 1.72; 95%CI 1.32 - 2.25) compared to White workers working 35-40 hours/week. No effect modification by sex or immigrant status was observed. The results were the same as those obtained from the imputation model. Conclusions Weekend work, long work hours (for White workers), or working &amp;lt; 35 hours/week (for Asian workers) were associated with increased risk of depressive symptoms. These findings indicate the need to review the working conditions of workers exposed to NSWSs, especially those working on weekends and Asian workers who work part-time. Key messages • Weekend work schedule is associated with an increased risk of depressive symptoms among employed workers in the UK. • The effect of work hours on depressive symptoms varies by ethnicity.

The impact of ethnicity on clinical outcomes in patients with heart failure and atrial fibrillation

Abstract Introduction Heart failure (HF) and atrial fibrillation (AF) are increasingly prevalent and associated with substantial morbidity (1,2). When HF and AF co-exist, the outcome profile is significantly worse than for either condition in isolation (3). Ethnic background is known to influence disease outcomes and treatment efficacy (4), but there is limited knowledge about how HF, AF and ethnicity interact on mortality and hospital admission. Purpose This study aims to address the null hypothesis of no difference in death and cardiovascular events comparing non-white and white patients with HF and concomitant AF, and assess the differential impact of ethnicity in patients with these conditions. Methods Individual patient data were obtained from 12 randomized controlled trials (RCTs) in patients with HF. RCT data were harmonised and meta-analysed to investigate the interaction of baseline heart rhythm (sinus rhythm versus atrial fibrillation) and ethnicity (non-white versus white). The primary outcome of all-cause mortality and secondary outcome of cardiovascular (CV)-related mortality were analysed using adjusted Cox regression models and propensity-score matching. Results 16,713 HF patients were included of which 1,899 (11%) were non-white, median age 66 (interquartile range [IQR] 57-73) and 4,703 (28%) women. During median follow-up of 1.4 years (IQR 0.8-2.3), death occurred in 394 (21%) non-white patients and 2,142 (15%) white patients; adjusted hazard ratio (HR) 1.36, 95% CI 1.20-1.54; p&amp;lt;0.001. The impact of ethnicity was greater in patients with coexisting HF and AF (non-white versus white HR 2.05; 95% CI 1.55-2.70; p&amp;lt;0.001), than in those with HF in sinus rhythm (non-white versus white HR 1.24; 95% CI 1.08-1.41; p=0.002). A significant interaction was evident between ethnicity and rhythm status for all-cause mortality (p=0.003), with similar findings using propensity-score matching (Figure 1). An exploratory analysis of beta-blockers versus placebo demonstrated divergent efficacy with respect to mortality for non-white (HR 1.00, 95% CI 0.79-1.27; p=0.99) and white patients (HR 0.70, 95% CI 0.63-0.78; p&amp;lt;0.001); p-interaction=0.008 (Figure 2). For cardiovascular hospitalisation, the non-white cohort also had higher rates, with greatest disparity in patients with combined HF and AF (non-white versus white HR 1.80, 95% CI 1.63-2.37; p&amp;lt;0.001) compared to HF in sinus rhythm (non-white versus white HR 1.23, 95% CI 1.11-1.36; p&amp;lt;0.001); p-interaction=0.012 in propensity-matching. Conclusion Non-white patients with HF suffer from substantially higher rates of death and hospitalisation than corresponding white patients, with the presence of comorbid AF significantly worsening this ethnicity-related disparity. In those with HF in sinus rhythm, beta blockers were found to be significantly less effective at reducing mortality in non-white patients.Figure 1 Figure 2

Differing needs for Advance Care Planning in the Veterans Health Administration: use of latent class analysis to identify subgroups to enhance Advance Care Planning via Group Visits for veterans

BackgroundAdvance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings.MethodsWe conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group.ResultsAnalysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans.ConclusionGreater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates.

Effect of Whole Blood Dietary Mineral Concentrations on Erythrocytes: Selenium, Manganese, and Chromium: NHANES Data.

Selenium (Se), Manganese (Mn), and Chromium (Cr) are dietary minerals ingested from specific grains, vegetables, and animal meats. Prior research showed that these minerals affect animal erythrocyte health but have unknown effects on human red blood cells (RBCs) and hematology. This study evaluated the effects of these dietary minerals on RBC count, hematocrit, and hemoglobin. We conducted a cross-sectional analysis of 23,844 American participants from the 2015-2016 and 2017-2020 National Health and Nutrition Examination Survey. We evaluated sex, age, ethnicity, education, income, and smoking status as covariates. Linear regression analyses were conducted to evaluate the effect of Cr, Se, and Mn on RBC count, hematocrit, and hemoglobin levels. We employed subpopulation-exclusion regressions further to explore the distinct effects of mineral elevation and deficiency. Additional analyses were performed to examine the relationship between Mn and RBC hemoglobin, RBC distribution width, transferrin receptor concentrations, transferrin saturation, and serum iron levels to support the interpretation of our findings. Optimizable ensemble machine learning models were used to corroborate regression results. Adjusting for covariates, Cr was inversely associated with RBC count (Exp(b) = 0.954), hemoglobin (Exp(b) = 0.868), and hematocrit (Exp(b) = 0.668). Conversely, Se was positively associated with RBC count (Exp(b) = 1.003), hemoglobin (Exp(b) = 1.012), and hematocrit (Exp(b) = 1.032). Mn was positively associated with RBC count (Exp(b) = 1.020) but inversely associated with hemoglobin (Exp(b) = 0.945) and hematocrit (Exp(b) = 0.891). Cr was harmful to RBC health in all subpopulations, whereas Se was protective. Mn appears to contribute to the development of microcytic anemia, but only in subjects with clinically elevated Mn levels. Thus, excessive consumption of foods and supplements rich in Cr and Mn may harm human erythrocyte health and hematology.

Socioeconomic Determinants of Health and Reflux Management: Insights from a Tertiary Medical Center.

To assess the correlation of social determinants of health (SDOH) with the general care patterns related to gastroesophageal reflux disease and laryngopharyngeal reflux. Determine correlation of SDOH on utilization rates for medication, reflux testing and surgical intervention for patients diagnosed with reflux. Describe overall care patterns for gastroesophageal reflux disease care at a tertiary academic facility. Retrospective chart review. Patient demographics (age, sex, race, ethnicity, and insurance status) were extracted for adults diagnosed with reflux between 2009 and 2019. Odds ratios (ORs) for the associations between sociodemographic factors and reflux treatment pathways were determined by chi-square analyses. A total of 143,786 patients were evaluated during the study period with a diagnosis code of reflux. A subgroup of 40,754 patients had objective reflux testing including Bravo, dual pH-impedance, manometry, esophagogastroduodenoscopy (EGD) and esophagram, but no significant difference in utilization rates was found. A total of 239 patients who failed medical management underwent fundoplication. White (OR 2.43, 95% confidence interval [CI] 1.56-3.70) and female (OR 1.37, 95% CI 1.05-1.79) patients were more likely to undergo fundoplication than Black (OR 0.42, 95% CI 0.25-0.70) and male (OR 0.72, 95% CI 0.55-0.95) patients. Patients with private insurance (OR 1.58, 95% CI 1.23-2.04) were more likely to undergo fundoplication than those with public insurance (OR 0.65, 95% CI 0.50-0.84). Male patients were less likely to undergo fundoplication (OR 0.69, 95% CI 0.49-0.98) among patients evaluated for reflux with EGD. SDOH correlate with patterns of reflux evaluation and management at our tertiary care center. IV Laryngoscope, 2024.