Ethnoracial Groups Research Articles

Lessons learned and future directions: A scoping review of American Indian and Alaska Native participants in the National Drug Abuse Treatment Clinical Trials Network

IntroductionAmerican Indian and Alaska Native (AI/AN) populations are disproportionately affected by substance use disorders (SUDs) and related health disparities in contrast to other ethnoracial groups in the United States. Over the past 20 years, substantial resources have been allocated to the National Institute on Drug Abuse Clinical Trials Network (CTN) to disseminate and implement effective SUD treatments in communities. However, we know little about how these resources have benefitted AI/AN peoples with SUD who arguably experience the greatest burden of SUDs. This review aims to determine lessons learned about AI/AN substance use and treatment outcomes in the CTN and the role of racism and Tribal identity. MethodWe conducted a scoping review informed by the Joanna Briggs framework and PRISMA Extension for Scoping Reviews checklist and explanation. The study team conducted the search strategy within the CTN Dissemination Library and nine additional databases for articles published between 2000 and 2021. The review included studies if they reported results for AI/AN participants. Two reviewers determined study eligibility. ResultsA systematic search yielded 13 empirical articles and six conceptual articles. Themes from the 13 empirical articles included: (1) Tribal Identity: Race, Culture, and Discrimination; (2) Treatment Engagement: Access and Retention; (3) Comorbid Conditions; (4) HIV/Risky Sexual Behaviors; and (5) Dissemination. The most salient theme was Tribal Identity: Race, Culture, and Discrimination, which was present in all articles that included a primary AI/AN sample (k = 8). Themes assessed but not identified for AI/AN peoples were Harm Reduction, Measurement Equivalence, Pharmacotherapy, and Substance Use Outcomes. The conceptual contributions used AI/AN CTN studies as exemplars of community-based and Tribal participatory research (CBPR/TPR). ConclusionCTN studies conducted with AI/AN communities demonstrate culturally congruent methods, including CBPR/TPR strategies; consideration/assessment of cultural identity, racism, and discrimination; and CBPR/TPR informed dissemination plans. Although important efforts are underway to increase AI/AN participation in the CTN, future research would benefit from strategies to increase participation of this population. Such strategies include reporting AI/AN subgroup data; addressing issues of cultural identity and experiences of racism; and adopting an overall effort for research aimed at understanding barriers to treatment access, engagement, utilization, retention, and outcomes for both treatment and research disparities for AI/AN populations.

Exoduster Entrepreneurs: Distinctiveness and Segregation in Minority Communities

Abstract This study examines the creation of Black communities in the context of the Exoduster movement, the first major migration of African Americans out of the southern and border states. We focus initially on Nicodemus, Kansas, a site with well-preserved archival information, and then turn to census microdata on roughly three-hundred African-American communities that emerged in Kansas, Colorado, and Oklahoma between 1880 and 1920. Analysis of these communities informs a general model of minority-majority group relations that is differentiated along two dimensions: spatial segregation and the distinctiveness of business activities. Under conditions of prejudice from the majority ethno-racial group, the model predicts that rates of minority business proprietorship and community growth will increase with segregation and distinctiveness, but that the joint occurrence of these conditions presents an existential threat. We draw conclusions for the trajectories of several well-known Black communities, including Nicodemus, Tulsa, and Langston, Oklahoma.

Neighborhood-level social vulnerability and individual-level cognitive and motor functioning over time in older non-Latino Black and Latino adults.

Despite known health disparities in cognitive aging, a comprehensive rationale for the increased burden in older minoritized populations including non-Latino Black and Latino adults has yet to be elucidated. While most work has focused on person-specific risk, studies are increasingly assessing neighborhood-level risk. We evaluated multiple aspects of the environmental milieu that may be critical when considering vulnerability to adverse health outcomes. We investigated associations between a Census-tract derived Social Vulnerability Index (SVI) and level of and change in cognitive and motor functioning in 780 older adults (590 non-Latino Black adults, ∼73 years old at baseline; 190 Latinos, ∼70 years old baseline). Total SVI scores (higher = greater neighborhood-level vulnerability) were combined with annual evaluations of cognitive and motor functioning (follow-up ranged from 2 to 18 years). Demographically-adjusted mixed linear regression models tested for associations between SVI and cognitive and motor outcomes in analyses stratified by ethno-racial group. For non-Latino Black participants, higher SVI scores were associated with lower levels of global cognitive and motor functioning-specifically, episodic memory, motor dexterity and gait-as well as longitudinal change in visuospatial abilities and hand strength. For Latinos, higher SVI scores were associated with lower levels of global motor functioning only-specifically, motor dexterity; there were no significant associations between SVI and change in motor functioning. Neighborhood-level social vulnerability is associated with cognitive and motor functioning in non-Latino Black and Latino older adults, although associations appear to contribute to level more so than longitudinal change.

Trapped in a Pathological Paradigm: Critiques of Suicidology Scholarship and Practice

Suicide among Africana youth, ages 10–19, is increasing at a faster rate than all ethnoracial groups in the US. Over four decades, epidemiological data reveal an upward trend in Africana youth suicidal behavior. We contend that the rising rates of Africana youth suicide cannot be effectively addressed because suicidology is trapped in a pathological paradigm based on the imposition of European cultural hegemony. Focusing on Africana youth, two critiques are presented. First, the inefficacy of universalism as a standard in suicidology is delineated. Intrapsychic, individually oriented approaches are overemphasized and a culturally incongruent epistemology undergirds scientific methodologies; thus, advancing culturally dystonic suicide prevention/intervention efforts. Second, the underinvestigated role of contextual oppressive factors in gender disparities discussions, risk factors impacting Africana youth, and the salience of social integration as a protective factor are deconstructed. Recommendations for multidisciplinary training/curricula, collaboration with social justice organizations, and supporting culturally defined and practice-based evidence approaches are outlined.

For Land and Liberty: Black Struggles in Rural Brazil

For Land and Liberty: Black Struggles in Rural Brazil

Preparing Clinicians to Provide Equitable Alzheimer’s Disease (AD) Care: What Continuing Medical Education (CME) Can Achieve (P12-2.003)

<h3>Objective:</h3> To assess the influence of live online CME on clinicians’ (HCPs) awareness of ethnic and racial differences in AD and ability to develop strategies to enhance care access for diverse patients. <h3>Background:</h3> Government agencies and advocacy groups have prioritized reduction of disparities in brain health. HCPs need to recognize the increased risks and burdens associated with AD in various ethno-racial groups and have outreach strategies for diverse underrepresented communities. <h3>Design/Methods:</h3> We partnered with advocacy groups and experts in community-based AD care to produce two 60-minute CME activities, launched 12/16/2021 and 3/2/2022. The activities were on-demand for one year. Experts recorded videos outlining their community-outreach strategy. In addition, HCPs could submit their outreach plans to be reviewed during the second CME activity. Responses to test questions before, immediately post, and 2 months after an activity, along with outreach plans, were analyzed for insights and identification of remaining gaps. Chi-square compared paired responses (pre/post and pre/2 mos, <i>P</i>&lt;0.05). <h3>Results:</h3> As of 10/4/22, 1,893 HCPs participated and 865 identified as treaters seeing 10 patients/week. Post activity, there were marked improvements in awareness of causes of AD care inequities (+37%, <i>P</i>&lt;0.05), genetic predisposition (+46%, <i>P</i>&lt;0.05), and ability to identify tools to evaluate cognitive status (+55%, <i>P</i>&lt;0.05). Reported practice changes included use of assessment tools and strategies to evaluate patients and account for genetic and cultural differences. Six outreach plans were reviewed (communities were rural, urban, and/or low-economic status). Outreach projects included providing culturally appropriate education to communities, hiring a socially sensitive workforce, connecting with churches, and enhancing research diversity. <h3>Conclusions:</h3> Data support the positive impact of live-online CME in preparing HCPs to provide equitable AD care through increased recognition of critical differences in risk among races and ethnic groups and development of outreach strategies to build trust and address barriers to access. <b>Disclosure:</b> Carole Drexel has nothing to disclose. Dr. Wilson has nothing to disclose. Ms. Bixler has nothing to disclose. Goldie S. Byrd has nothing to disclose. Dr. Zwerling has nothing to disclose. Dr. Allen has nothing to disclose. Ms. Lynn has nothing to disclose.

Is hyper-selectivity a root of Asian American children's success?

Asian immigrants' children, even those from lower-backgrounds, tend to acquire higher levels of education than other ethnoracial groups, including White natives. Asian culture is often cited as a conventional explanation. The hyper-selectivity hypothesis challenges conventional wisdom by arguing that Asian American culture is an outcome of the community resources associated with hyper-selectivity. In this study, we assess the validity of the hyper-selectivity theory by examining the association between the magnitude of hyper-selectivity measured by the proportion of the BA + degree holders among the 1st generation Asian immigrants across communities and the likelihood of school enrollment for 1.5 and 2nd + generation Asian American children. Our results cast doubt on the hyper-selectivity theory. Asian American children's school enrollment is associated with the magnitude of educational selectivity among Asian immigrants for neither high school nor college. The benefits of hyper-selectivity do not seem to be cross-class or cross Asian ethnic groups. The higher the hyper-selectivity in a community is, the larger the education gap between upper- and lower-background Asian American children. The implications of these findings are discussed.

Pan-African identity, psychological well-being, and mental health among African Americans

ABSTRACT Studies show that racial and ethnic identity can significantly improve mental health and well-being among marginalized ethnoracial groups who experience racism and discrimination. However, the relationships between Pan-African identity, psychological well-being, and mental health have received less attention. Using a national sample of African American adults, I examine whether Pan-African identity impacts psychological well-being and self-rated mental health. The results show that respondents who feel closer towards members of the African diaspora and Black people in Africa and prefer Pan-African labels have better self-rated mental health and higher levels of self-esteem. Moreover, the analysis finds that respondents who prefer Pan-African labels have higher levels of mastery. Although self-esteem explains the self-rated mental health benefits of both Pan-African closeness and Pan-African label preferences, only mastery explains the relationship between Pan-African label preferences and self-rated mental health. This study demonstrates the possible psychological benefits of a globalized identity for marginalized groups in Eurocentric contexts.

The Asian American assimilation paradox

ABSTRACT The fastest growing ethnoracial group in the United States, Asian Americans are the most highly educated, the highest earning, and the most likely to intermarry. Once deemed diseased, morally deviant, unfit for citizenship, and unassimilable, Asian Americans have attained unprecedented racial mobility, now boasting socioeconomic outcomes that surpass those of native-born Whites. Their attainment has led some social scientists to conclude that Asians are rapidly assimilating into American mainstream and remaking it in the process. While Asian American attainment defies theories of racial disadvantage, their experiences with xenophobia, racism, and anti-Asian violence vex theories of assimilation – pointing to an assimilation paradox. At no recent time has the paradox become more apparent than during COVID-19 pandemic. We maintain that the paradox reflects three tensions: the ahistorical nature of sociologists’ research on Asian American assimilation; the tautology of using educational attainment acquired from immigrants’ countries of origin as a measure of structural assimilation in their country of destination; and the disjuncture between the way sociologists normatively measure assimilation and the way ethnoracial minorities experience it. By integrating legacies of exclusion into theories of Asian American assimilation, addressing the tautology, and incorporating a subject-centered approach into empirical measures, we advance theory and research, and reclaim narratives of Asian American assimilation.

Eliciting social stressors, supports, and determinants of health through the DSM-5 cultural formulation interview.

As recognition of the importance of social determinants of mental health has increased, the limitations of clinical competence-enhancing interventions that do not emphasize this approach have emerged. The Cultural Formulation Interview (CFI) is a cultural competence intervention that emerges from a confluence of social medicine and medical anthropology traditions. Limited research has examined how patients respond to CFI questions on social-structural aspects of illness and care to assess whether the CFI adequately elicits information on social determinants of mental health. Patients' responses during a first intake appointment to three CFI questions on social stressors, supports, or barriers to care from 27 patient-clinician dyads are analyzed through qualitative content analysis. The data come from a hyper-diverse clinical setting in Queens, New York, where no ethnoracial group has a majority and all patient-clinician dyads reflect cross-cultural interactions. At least one social determinant was coded in 89 of all cases, and nearly 44% included themes related to multiple determinants of health. The most-commonly coded theme was social relationships (n = 21), followed by financial instability (n = 7), stigma (n = 5), housing instability (n = 2), and poor access to healthcare, involvement in the criminal justice system, employment instability, area-level poverty, and immigration policies (n = 1 each). Our work shows that social determinants of mental health can be elicited through the CFI. Future work should examine how this information is included in clinicians' formulations and whether the cultural formulation approach would benefit from additional revision to facilitate assessment of socio-structural factors.

All-cause and cause-specific mortality rates after severe extremity injuries among previously deployed active duty service members.

Previous research has shown that active duty military personnel who sustain extremity injuries while in service are at elevated risk for serious physical and psychological health issues that could affect their long-term functioning and quality of life yet longer-term mortality has not been studied in this population. To determine whether rates of all-cause and cause-specific mortality are elevated for active duty U.S. service members who sustained traumatic limb injuries in service, compared to the broader population of deploying service members. To assess differences in mortality rates between service members with traumatic limb injuries that did versus did not result in amputation. Retrospective cohort study; archival Department of Defense deployment, personnel, medical, and death records were combined and analyzed. Standardized mortality ratios (SMR) adjusted for age, sex, and ethnoracial group, along with associated 95% confidence intervals (CIs), were calculated to directly compare all-cause and cause-specific mortality rates in each of the two injury groups to rates in the total study population. Not applicable. Service members who deployed in support of the global war on terror between 2001 and 2016 were eligible for inclusion; the final sample included 1,875,206 individuals surveilled through 2019. Not applicable. All-cause and cause-specific mortality rates. Overall, the number of deaths was over three times higher than expected among service members with amputations (SMR=3.01; CI: 2.36-3.65), and nearly two times higher among those with serious limb injuries not resulting in amputation (SMR=1.72; CI: 1.54-1.90) when compared to the larger study population. Rates for both internal and external causes of death were significantly elevated among those with limb injuries. Long-term mortality rates are elevated among service members with traumatic limb injuries, though mortality patterns may differ based on whether the injury results in amputation. Although further research into causal mechanisms is needed, these results may inform the development of interventions to improve long-term health outcomes among injured military personnel.

Racial microaggressions and major discriminatory events explain ethnoracial differences in psychotic experiences.

Few empirical studies have examined whether exposure to major racial discrimination explains ethnoracial disparities in psychosis outcomes and none to our knowledge have done so in the U.S. or have examined the role of other forms of racism such as racial microaggressions. The present study examined ethnoracial differences in self-reported psychotic experiences (PE) among 955 college students in an urban environment in the Northeastern U.S., and the degree to which major experiences of racial discrimination and racial microaggressions explains ethnoracial differences in PE. Mean scores on self-report inventories of PE and distressing PE (i.e., Prodromal Questionnaire (PQ)), major experiences of racial discrimination (EOD), and racial and ethnic microaggressions (REMS) were compared across 4 ethnoracial groups (White, Black, Asian, and Latina/o). Results from parallel mediation linear regression models adjusted for immigrant status, age, gender, and family poverty using the Hayes PROCESS application indicated ethnoracial differences in PE were explained independently by both forms of racism. Specifically, Black young people reported higher mean levels of PE, and distressing PE than both White and Latina/o people and the difference in PE between Black and White and Black and Latino/a young people was significantly explained by both greater exposure to racial microaggressions and major racial discriminatory experiences among Black people. This study re-emphasizes the explanatory role of racism, in its multiple forms, for psychosis risk among Black young populations in the US. Anti-racism interventions at both structural and interpersonal levels are necessary components of public health efforts to improve mental health in Black populations.

Examining the relationship between contested edges and intergroup crime dynamics

The measurement of spatial patterns across urban areas is paramount in answering questions related to the dynamics of social phenomenon. Scholars have measured the layout of cities, land use, infrastructure, and other features of the built environment that may correlate with a number of social processes. Recently, several studies have posited the idea of a contested boundary as a way to measure where and to what extent intergroup conflict may occur. Contested boundaries are conceptualized as interstitial zones that separate communities of contrasting ethno-racial composition – areas where there is no clear majority group that makes up the population. Previous studies have successfully demonstrated the utility of this approach yet have largely based their work on the analysis of areas, potentially masking the local heterogeneity of incident locations in relation to surrounding neighborhoods. Using the City of Cincinnati as a case study, we reconceptualize contested areas as contested edges and determine whether the edges separating racially distinct neighborhoods are associated with a higher rate of interracial crime. Our results lend support for the use of an edge-based approach to evaluate urban social patterns and highlight the importance of accounting for local spatial heterogeneity when assessing ethno-racial group interaction.

Racial and ethnic differences in neuropsychiatric symptoms and progression to incident cognitive impairment among community-dwelling participants.

Neuropsychiatric symptoms (NPS) are a risk factor for dementia; however, their prevalence and severity among ethnoracial groups are poorly understood. We used data from the National Alzheimer's Coordinating Center (NACC) (n=6958; ≥50 years old). Cognitively normal participants at baseline, without any NPS or dementia diagnosis, had at least one follow-up. Survival analyses assessed the hazard ratio for 12 NPS models and progression to cognitive impairment. Propensity score weighting (PSW) matched participants on age, sex, education, and race/ethnicity. All 12 NPS were significantly associated with progression to cognitive impairment. In the PSW models, comparedtowhites,Black/African Americans were more likely to progress to cognitive impairment across all 12 NPS models, followed by Hispanic, and then Asian participants. PSW minimized selection bias to provide robust risk estimates. There is a higher risk of progressing to cognitive impairment for ethnoracial groups with NPS. Tailored screening of NPS and cognitive impairment should incorporate patient and caregiver reports.

TDP-43 Pathology in the Setting of Intermediate and High Alzheimer's Disease Neuropathologic Changes: A Preliminary Evaluation Across Ethnoracial Groups.

Transactive Response DNA Binding Protein 43 kDa (TDP-43) pathology is frequently found in cases with Alzheimer's disease (AD). TDP-43 pathology is associated with hippocampal atrophy and greater AD severity denoted by cognition and clinical representation. Current TDP-43 pathology studies are predominantly based on non-Hispanic White cohorts. We sought to evaluate the presence of TDP-43 pathology across ethnoracial groups utilizing the National Alzheimer's Coordinating Center; a database containing data from over 29 institutions across the United States. Cases (N = 1135: Hispanics/Latinos = 29, African Americans/Black Americans = 51, Asians/Asian Americans = 10, American Indians/Alaskan Natives = 2, non-Hispanic White = 1043) with intermediate/high AD having data on TDP-43 pathology in the amygdala, hippocampus, entorhinal cortex, and neocortex were included. TDP-43 pathology frequency in each neuroanatomic region among ethnoracial groups were compared using generalized linear mixed effects models with center as a random effect adjusting for age at death, education, and gender. Although groups were imbalanced, there was no significant difference across ethnoracial groups based on TDP-43 pathology (p = 0.84). With respect to neuroanatomical regions evaluated, there were no significant differences across ethnoracial groups (p-values > 0.06). There were also no significant differences for age at death and gender ratios across ethnoracial groups based on TDP-43 pathology. Although not statistically significant, TDP-43 pathology was present less often in Hispanic/Latinos (34%) when compared to non-Hispanic Whites (46%). While this is a preliminary evaluation, it highlights the need for diverse cohorts and on TDP-43 pathology research across ethnoracial groups. This is the first study to our knowledge having a focus on the neuroanatomical distribution of TDP-43 deposits in Hispanic/Latino decedents with AD.

Intersecting Inequalities in Access to Justice for Trans and Non-binary Sex Workers in Canada

IntroductionIn the context of renewed debate about Canada’s “end demand” sex work laws, we took an intersectional approach to characterize experiences with the criminal legal system and perceived access to justice among transgender (trans) and nonbinary sex workers in Canada.MethodsThe Trans PULSE Canada community-based study collected multimode survey data in fall 2019. Data were cross-stratified by lifetime sex work and sex assigned at birth, ethnoracial group, or household income. Age adjustment did not meaningfully impact results.ResultsOf 2012 included participants (median age = 30, 66.5% assigned female at birth, 48.9% non-binary), 280 (16.1%) had ever done sex work. While access to justice was limited for trans and non-binary people overall, sex workers were more likely to anticipate (72.1% vs. 50.5%) and experience (43.2% vs. 15.7%) police mistreatment. In the previous 5 years, sex workers were more likely to experience violence for any reason (61.4% vs. 27.4% of other participants) or due to being trans or non-binary (41.4% vs. 14.0%), and to have avoided calling 911 for police (51.4% vs. 18.1%). Few sex workers trusted that they would be treated fairly by police if they experienced physical (10.8% vs. 34.9%) or sexual (4.7% vs. 20.6%) violence. Intersectional inequalities included that sex workers assigned male at birth and street-based workers were most likely to have experienced gender-based violence, and that Indigenous and racialized sex workers reported higher levels of police mistreatment and 911 avoidance.ConclusionsOverall, trans and non-binary people in Canada reported high levels of violence and limited access to justice. Sex workers faced large inequities in these outcomes, which were exacerbated for transfeminine, Indigenous, racialized, and street-based workers.Policy ImplicationsThese findings challenge the notion that Canadian sex work laws protect sex workers and highlight the limitations of formal legal protections for trans people. These inequities must be addressed in sex work legal reform efforts.

Predictors of housing instability and stability among Housing First participants: A 24-month study

ABSTRACT This study examined the characteristics of people who experienced housing instability and stability after 24 months of being enrolled in Housing First (HF). A companion study addresses the same objective using qualitative methods. A sequential logistic regression was conducted to determine predictors of unstable and stable housing at 24 months of enrollment in HF in a randomized trial. We applied the Gelberg-Andersen. Behavioral Model for Vulnerable Populations to identify and group predictor variables. Thirty-one percent of the HF participants (N = 302/977) met the study criteria for housing instability (i.e. stably housed for less than 90% of last six months). Residence in Winnipeg, longer accumulated lifetime homelessness, and higher levels of substance use predicted unstable housing. Residence in Toronto and Montreal, older age, being in an ethno-racial minority group (other than Indigenous), higher income, higher perceived housing quality, and having a family physician predicted stable housing. The findings of the study have implications for strengthening HF supports to better address the needs of HF participants who may be at risk of housing instability.

A Qualitative Examination of Knowledge, Experiences, and Considerations of PET Brain Scan Participation Among Older Black and Latino Adults.

Biological biomarkers yielded from positron emission tomography (PET) brain scans serve as a pathway to understanding Alzheimer's disease pathology. PET brain scan data remain limited for populations traditionally under-included in aging research. The purpose of this qualitative study was to examine participant-identified barriers to PET brain scan consent and characterize participant-informed elements of educational materials needed to facilitate PET brain scan participation among older Black and Latino adults. Participants (N = 31) were older adults (mean age = 71 years) who self-identified as either non-Latino Black (n = 15) or Latino (n = 16). Each participant took part in a one-time, in-depth individual interview. Researchers analyzed data guided by a Grounded Theory Approach with both Open Coding and Constant Comparative Coding. Four overarching themes emerged across all participants: 1) knowledge limitations; 2) requirements for consent; 3) motivators for participation; and 4) social networks. Within the four themes, there were differences based on participant ethnoracial group. For example, for Theme Three, older Black adults indicated that they would expect compensation for PET brain scan participation. Conversely, older Latinos stated that they would appreciate, but not anticipate, a financial incentive. All participants stressed the importance of written educational materials with subsequent verbal discussions with studystaff. Findings inform the development and implementation of scientifically-relevant and culturally-cognizant engagement approaches, educational materials, and recruitment strategies to increase PET brain scan participation by diverse older adults.

Waiting-List and early posttransplant prognosis among ethnoracial groups: Data from the organ procurement and transplantation network.

Racial/ethnic disparity in waiting-list mortality among candidates listed for kidney transplantation (KT) in the United States remains unclear. We aimed to assess racial/ethnic disparity in waiting-list prognosis among patients listed for KT in the United States in the current era. We compared waiting-list and early posttransplant in-hospital mortality or primary nonfunction (PNF) among adult (age ≥18 years) white, black, Hispanic, and Asian patients listed for only KT in the United States between July 1, 2004 and March 31, 2020. Of the 516,451 participants, 45.6%, 29.8%, 17.5%, and 7.1% were white, black, Hispanic, and Asian, respectively. Mortality on the 3-year waiting list (including patients who were removed for deterioration) was 23.2%, 16.6%, 16.2%, and 13.8% in white, black, Hispanic, and Asian patients, respectively. The cumulative incidence of posttransplant in-hospital death or PNF after KT was 3.3%, 2.5%, 2.4%, and 2.2% in black, white, Hispanic, and Asian patients,respectively. White candidates had the highest mortality risk on the waiting list or of becoming too sick for a transplant, while black (adjusted hazard ratio, [95% confidence interval, CI], 0.67 [0.66-0.68]), Hispanic (0.59 [0.58-0.60]), and Asian (0.54 [0.52-0.55]) candidates had a lower risk. Black KT recipients (odds ratio, [95% CI] 1.29 [1.21-1.38]) had a higher risk of PNF or death before discharge than white patients. After controlling confounders, black recipients (0.99 [0.92-1.07]) had a similar higher risk of posttransplant in-hospital mortality or PNF as white patients than Hispanic and Asian counterparts. Despite having a better socioeconomic status and being allocated better kidneys, white patients had the worst prognosis during the waiting periods. Black recipients and white recipients have higher posttransplant in-hospital mortality or PNF.

Transgender Adults From Minoritized Ethnoracial Groups in the U.S. Report Greater Subjective Cognitive Decline.

Investigate subjective cognitive decline (SCD) among 4 study groups consisting of cisgender and transgender adults who are from minoritized ethnoracial groups (i.e., minoritized ethnoracial transgender, minoritized ethnoracial cisgender) and White cisgender and transgender adults aged 45+ (i.e., White transgender, White cisgender) to determine the odds of SCD by group and to test for group differences. Data from the 2015-2020 Behavioral Risk Factor Surveillance System were used in a modified case-control approach to perform an intercategorical intersectional study. Each transgender participant was matched to 2 cisgender men and 2 cisgender women, on state, ethnoracial identity, and age. Multivariable logistic regressions modeled SCD odds by group and post hoc contrasts estimated pairwise odds ratios comparing the SCD odds for each combination of groups. SCD prevalence was highest among minoritized ethnoracial transgender (21.6%), followed by White transgender (15.0%), minoritized ethnoracial cisgender (12.0%), and White cisgender (9.0%). After accounting for age, education, and survey year, the odds of SCD were higher in minoritized ethnoracial transgender when compared to White cisgender (adjusted odds ratio [aOR] = 2.51, 95% confidence interval [CI]: 1.59-3.96) and minoritized ethnoracial cisgender (aOR = 1.89, 95% CI: 1.16-3.09). The odds of SCD were higher in White transgender compared to White cisgender (aOR = 1.66, 95% CI: 1.20-2.30). When considering the intersection of transgender and ethnoracial identities, we found that transgender adults from minoritized ethnoracial groups reported higher odds of SCD when compared to cisgender adults from minoritized ethnoracial groups. Additional studies are needed to understand the relationship between racialized and gendered inequities in cognitive impairment and how specific mechanisms of systemic transphobia and racism may contribute to this inequity.