White Women Research Articles

Genetic architecture of oral glucose-stimulated insulin release provides biological insights into type 2 diabetes aetiology

The genetics of β-cell function (BCF) offer valuable insights into the aetiology of type 2 diabetes (T2D)1,2. Previous studies have expanded the catalogue of BCF genetic associations through candidate gene studies3–7, large-scale genome-wide association studies (GWAS) of fasting BCF8,9 or functional islet studies on T2D risk variants10–14. Nonetheless, GWAS focused on BCF traits derived from oral glucose tolerance test (OGTT) data have been limited in sample size15,16 and have often overlooked the potential for related traits to capture distinct genetic features of insulin-producing β-cells17,18. We reasoned that investigating the genetic basis of multiple BCF estimates could provide a broader understanding of β-cell physiology. Here, we aggregate GWAS data of eight OGTT-based BCF traits from ~26,000 individuals of European descent, identifying 55 independent genetic associations at 44 loci. By examining the effects of BCF genetic signals on related phenotypes, we uncover diverse disease mechanisms whereby genetic regulation of BCF may influence T2D risk. Integrating BCF-GWAS data with pancreatic islet transcriptomic and epigenomic datasets reveals 92 candidate effector genes. Gene silencing in β-cell models highlights ACSL1 and FAM46C as key regulators of insulin secretion. Overall, our findings yield insights into the biology of insulin release and the molecular processes linking BCF to T2D risk, shedding light on the heterogeneity of T2D pathophysiology.

Cardiovascular risk according to genetic predisposition to gout, lifestyle and metabolic health across prospective European and Korean cohorts

ObjectiveRecent studies have reported that gout is associated with a risk of cardiovascular disease (CVD) later in life. However, the predictive value of genetic predisposition to gout combined with lifestyle...

Racial Disparities in Receipt of Guideline-Concordant Care in Older Adults With Early Breast Cancer

Racial disparities in receipt of guideline-concordant care (GCC) among older patients with potentially curable breast cancer are understudied. To determine whether rates of GCC, time to treatment initiation, and all-cause mortality in stage I to III breast cancer differ by race among older adults. This cohort study used data from the National Cancer Database and included patients aged 65 years and older with stage I to III breast cancer, diagnosed between 2010 and 2019. Data analysis was conducted between July 2022 to July 2023. Race, defined as non-Hispanic Black or non-Hispanic White. The primary outcome was nonreceipt of GCC, defined using the National Comprehensive Cancer Network guidelines, and all-cause mortality. The secondary outcome was time to treatment initiation. Univariate and multivariate regression analysis were used to determine association between exposure and outcomes. Models for GCC and all-cause mortality included age, stage, receptor status, year of diagnosis, Charlson-Deyo comorbidity index, insurance, health care setting, and neighborhood-level educational attainment and median income. The analytic cohort included 258 531 participants (mean [SD] age, 72.5 [6.0] years), with 25 174 participants who identified as non-Hispanic Black (9.7%) and 233 357 participants who identified as non-Hispanic White (90.3%), diagnosed between 2010 and 2017. A total of 4563 non-Hispanic Black participants (18.1%) and 35 374 non-Hispanic White participants (15.2%) did not receive GCC. Non-Hispanic Black race, compared with non-Hispanic White race, was associated with increased odds of not receiving GCC in the multivariate analysis (adjusted odds ratio [aOR], 1.13; 95% CI, 1.08-1.17; P < .001). Non-Hispanic Black race was associated with 26.1% increased risk of all-cause mortality in the univariate analysis, which decreased to 4.7%, after adjusting for GCC and clinical and sociodemographic factors (adjusted hazard ratio, 1.05; 95% CI, 1.01-1.08; P = .006). Non-Hispanic White race, compared with non-Hispanic Black race, was associated with increased odds of initiating treatment within 30 (OR, 1.65; 95% CI, 1.6-1.69), 60 (OR, 2.11; 95% CI, 2.04-2.18), and 90 (OR, 2.39; 95% CI, 2.27-2.51) days of diagnosis. In this cohort study, non-Hispanic Black race was associated with increased odds of not receiving GCC and less timely treatment initiation. Non-Hispanic Black race was associated with increased all-cause mortality, which was reduced after adjusting for GCC and clinical and sociodemographic factors. These findings suggest that optimizing timely receipt of GCC may represent a modifiable pathway to improving inferior survival outcomes among older non-Hispanic Black patients with breast cancer.

Factors Associated with Influenza Vaccination in a National Veteran Cohort

IntroductionOnly 53% of American adults receive influenza vaccination, and disparities in vaccination exist amongst particular racial and ethnic groups. This study determines how race, ethnicity, sex, and rurality are associated with influenza vaccination adherence in a national Veteran Health Affairs Administration (VHA) cohort. MethodsWe examined differences in documented influenza vaccinations for the 2019-2020 influenza season among VHA patients in a retrospective cohort study using VHA administrative electronic health record data. We used logistic regression to model receipt of influenza vaccination in association with race, ethnicity, sex, and rurality while controlling for clinical diagnoses, demographics, and ambulatory care utilization. We also stratified the models by sex and rurality. ResultsAmong 5,943,918 veterans, 48.6% received influenza vaccination. Unadjusted comparisons showed those who were vaccinated were more likely to be white, male sex, and older. Similar proportions of unvaccinated and unvaccinated veterans were from rural settings. In adjusted models, Black race was most strongly associated with decreased vaccination (AOR=0.69, [0.69-0.70]), and American Indian/Alaskan Native race also had reduced odds of vaccination (AOR=0.94 [0.92-0.95]) compared to White race. Female veterans had increased odds of vaccination (AOR=1.20; [1.19-1.20]) compared to men. Rurality (AOR=0.97 [0.96-0.97]) was associated with a small decreased odds of vaccination compared to urban. In stratified models, Black veterans were less likely to receive influenza vaccination regardless of sex and rurality compared to White veterans. American Indian/Alaska Native female veterans had equal odds of vaccination as compared to White female veterans, while American Indian/Alaska Native male veterans had reduced odds of vaccination compared to White male veterans. ConclusionsDuring the 2019-2020 influenza season, Black and American Indian/Alaskan Native veterans had lower odds of vaccination. Despite the VHA's universal approach to healthcare, racial disparities still exist in preventive care.

The impact of oncology nutrition services on weight change among patients with head and neck or pancreatic cancers.

86 Background: Weight loss is prevalent among cancer patients and correlates with lower health-related quality of life and overall survival rates. Individuals diagnosed with head and neck (HN) and pancreatic cancers face a heightened risk of weight loss due to tumor location and treatment-related side effects. Although guidelines advocate early interventions such as referral to a dietitian for tailored nutritional support, the precise impact of oncology nutrition services (ONS) on weight loss remains unclear. In this study, we investigated the longitudinal association between weight change and ONS among patients diagnosed with HN or pancreatic cancers. Methods: A retrospective chart review was conducted for patients diagnosed with HN or pancreatic cancers visited between January 2019 and December 2023. Inclusion criteria encompassed patients who had weight measurements taken within 30 days of their cancer diagnosis. Patient demographics, clinical characteristics, all recorded body weights, and receipt of ONS were extracted from electronic health records. Weight change (%) from the baseline was calculated at each measurement by subtracting the initial weight value. A mixed-effects model was employed to evaluate the impact of ONS on weight change, with time to weight measurement and ONS serving as interaction terms, after adjusting for demographics and clinical characteristics. Results: A cohort of 1305 patients was identified, predominantly comprising males (n=1014, 63%) and individuals of White race (n=1358, 85%), with a diverse ethnic distribution (Hispanic: n=620, 39%). Of these patients, 947 (73%) received ONS at any point following cancer diagnosis. Significant weight loss over time was noted among all patients (-0.53% per 6 months, p&lt;0.001). Baseline weight, sex, ethnicity, receipt of percutaneous endoscopic gastrostomy, total parenteral nutrition, radiation, chemotherapy, and ONS were significantly associated with weight loss. Following adjustment for the covariates, patients receiving ONS showed significantly less weight loss compared to those without ONS (-0.06% [95% confidence interval (CI): -0.10, -0.03] vs. -0.04% [95% CI: -0.38, -0.23] per 6 months, p&lt;0.001). Conclusions: The findings indicate that ONS plays a significant role in attenuating weight loss among patients diagnosed with HN or pancreatic cancer, irrespective of baseline demographics or clinical status. While the magnitude of weight change may appear modest, its implications are substantial long term. Early referrals to ONS should be recommended for HN or pancreatic cancer patients to mitigate weight loss.

Non-arteritic anterior ischemic optic neuropathy in Black patients

Prior studies have shown that non-arteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared to those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black NAION patients compared to White patients. Retrospective cross-sectional study METHODS: Self-reported race was collected from all NAION patients seen between 2014-2022 from a single US neuro-ophthalmology service. All Black NAION patients and a randomly selected sample of White NAION patients were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures. We included 32 Black NAION patients (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to <3 months: OR 4.07, P = 0.03; 6 to <12 months: OR 6.05, P = 0.007). Chronic kidney disease (OR 7.53, P = 0.003) and hemodialysis (OR 13.69, P = 0.02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to <0.25: OR 2.83, P = 0.09; 0.25 to <0.35: OR 0.56, P = 0.46; ≥0.35: OR 0.66, P = 0.44). Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black NAION patients were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White NAION patients, suggesting that the underlying proposed compartment mechanism is the same between races.

Patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015.

Understanding factors associated with opioid dispensing in cancer patients is important for developing tailored guidelines and ensuring equitable access to pain management. We examined patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015. We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare claims. We included the most common cancer types among patients aged 66-95 years. Opioids dispensed within 30 days before and 120 days after cancer diagnosis were assessed. We used logistic regression models to examine trends, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) for opioid dispensing, considering patient demographics, geography, cancer stage, comorbidities, and treatment options. Models were stratified by sex. A total of 211,759 cancer patients aged 66-95 years were included in the study. For cancers combined, non-Hispanic Black men had a significantly lower odds of receiving opioids during the 120 days post-diagnosis (aOR = 0.89, 95% CI = 0.84-0.94) compared to non-Hispanic White men. Factors such as pre-diagnosis opioid dispensing, age, geography, cancer stage, comorbidities, and type of cancer treatment were associated with opioid dispensing during the 120 days post-diagnosis. Surgery had the strongest association, with men undergoing surgery being 4.4 times more likely to receive opioids within 120 days post-diagnosis (aOR = 4.41, 95% CI = 4.23-4.60), while women had an odds ratio of 2.72 (95% CI = 2.62-2.83). Chemotherapy and radiotherapy were also positively associated with opioid dispensing, with less pronounced estimates. We observed significant variations in opioid dispensing among cancer patients aged 66-95 years across cancer types and demographic and clinical factors.

What about sex, race(ism), and social determinants of health in neonatal outcomes?

Neonatal outcomes encompass a range of outcome measures, including mortality rates, physical and mental health morbidities, and long-term neurodevelopmental statistics. These outcomes are influenced by non-modifiable factors, such as sex and race, and modifiable factors, such as social determinants of health and racism. There is a known bias toward worse outcomes for male infants in terms of preterm birth, low birth weight, and mortality, with several biological and physiological factors contributing to these sex-related differences. In relation to racial disparities, wherein race is a social construct, maternal and infant healthcare continues to lag behind for minority populations compared with the white population, despite advances in medical care. Infants born to Black women have higher infant mortality rates and lower birth weights than infants of white women. These differences can be largely attributed to social and environmental factors, rather than racial and ethnic differences. Furthermore, we emphasize the role of social determinants of health in neonatal outcomes. Factors such as economic stability, education access and quality, healthcare access and quality, the physical neighborhood environment, and the social and community context all contribute to these outcomes. Overall, this article highlights the complex interactions between sex, race(ism), and social determinants of health in neonatal outcomes. It underscores the need for a comprehensive understanding of these factors to improve maternal-neonatal care and reduce disparities in outcomes. Healthcare providers, policymakers, and communities need to work together to combat these complex issues and improve neonatal outcomes for all infants, while understanding the complex interplay between sex, racism, and/or social determinants of health.

Molecular correlates of social adversity in breast cancer.

48 Background: Neighborhood disadvantage (ND) is associated with shorter breast cancer (BCa) survival independent of individual, tumor, and treatment factors, suggesting more aggressive tumor biology in women from disadvantaged neighborhoods. This study evaluates how differential DNA methylation (DNAm), gene expression, and biologic pathways are wired with each other to delineate the regulatory landscape of ND on BCa. Methods: We leveraged 55 geocoded ER+/HER2- BCa samples from Hispanic White women enrolled in a prospective genomic-epidemiologic cohort study. Objective ND was evaluated using the Area Deprivation Index (ADI) and subjective ND was evaluated using the patient-reported Neighborhood Social Environment Adversity Survey and the Everyday Expanded Discrimination Survey. We analyzed the association between ND and (1) DNAm, (2) RNA transcription and miRNAs, and (3) blood concentration levels of DNAm co-factors (B12 and folate) from the same patient. To evaluate how the DNAm/expressed pathways are wired with each other to delineate the regulatory landscape of ND in these tumors, we performed correlation analyses among CpGs, genes, and miRNAs in the same topologically associated domain (TAD). We used Spearman correlation as our metric and adjusted the resulting p-values to FDR values. Results: The cohort was divided into low ND (ADI&lt;5; 31%) and a high ND (ADI&gt;=5; 69%). There were no significant differences between groups by age, race/ethnicity, genetic ancestry, BMI, smoking/alcohol, subtype, stage, or OncotypeDX scores. We discovered that high ND exhibits epigenetic deregulation of immune pathways, consistent with our findings of lower circulating B12 in high ND, suggesting activation of immune pathways through reduced systemic availability of methyl donors. RNA-seq identified higher tumor infiltration of immune cells in patients from high ND (e.g., Interferon alpha and gamma responses and inflammatory responses) consistent with aggressive biology. Estrogen response genes were downregulated suggesting that patients from high ND may develop estrogen-resistant tumors. Higher subjective ND scores discovered epigenetic changes on cell adhesion and calcium signaling genes, along with gene expression of E2F targets and cell cycle’s G2M checkpoint, indicative of a more proliferative/stemness signature. TAD analysis discovered significant developmental, immune, and signaling pathways when correlating DNAm with gene expression (e.g., estrogen response and EMT). Conclusions: In this multi-omic matched cohort, we discovered differentially methylated/expressed pathways, consistent with aggressive biology, wired with each other to identify a novel regulatory landscape of ND on BCa. These findings can inform interventions such as improved access to healthy nutrition (B12) in ND/food deserts or targeted stress-reduction interventions based on our survey findings to ultimately reverse aggressive tumor biology and reduce BCa disparities by ND.

Diagnostic evaluation for abnormal uterine bleeding at emergency departments in the United States.

269 Background: Uterine cancer is the most common gynecologic malignancy in the U.S. with well-documented racial disparity in stage at diagnosis (more advanced stage among Black women). As there is no routine screening for uterine cancer, timely and proper evaluation of relevant symptoms is important for early diagnosis. Abnormal uterine bleeding (AUB) is a prominent symptom of uterine cancer, yet data on the quality of care around AUB evaluation are sparse, especially among patients presenting to the emergency departments (ED) who are particularly at risk for delayed diagnosis due to lack of access to primary care. This study aimed to examine the pattern of diagnostic evaluation for AUB in a national sample of women seeking care at EDs and potential racial and ethnic differences. Methods: Using the 2014-2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) data, we identified 7,900,653 (weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB. The primary outcomes were whether an ultrasound was performed/ordered at the ED visit and whether a referral/return to a physician or clinic for follow-up consultation was recommended. Multivariable logistic regressions were fit to assess the association of race and ethnicity with these diagnostic evaluations, while accounting for other characteristics of the ED visit (e.g. patient age, comorbidities, involvement of a consulting physician, type of insurance, geographic region, and metropolitan area location). All analyses accounted for the NHAMCS complex sample design and sampling weight to generate nationally representative estimates. Results: Non-Hispanic Black women were less likely than non-Hispanic White women to receive or have an ultrasound ordered (34.9% vs 42.5%, P = 0.004), which remained statistically significant after adjusting for other characteristics of the visit in multivariable analysis (adjusted OR = 0.58, 95% CI 0.36-0.92). Multivariable analysis also showed a lower likelihood of non-Hispanic Black women receiving referral or recommendation for follow-up consultation, compared to non-Hispanic White women (adjusted OR = 0.54, 95% CI 0.31-0.94). Hispanic women did not differ significantly from non-Hispanic White women in these measures. Perimenopausal age (45-54 years) and location in a non-metropolitan area were associated with a lower likelihood of having an ultrasound performed/ordered or a referral/follow-up consultation recommended. Involvement of a consulting physician at the ED visit increased the likelihood of having an ultrasound performed/ordered while reducing the likelihood of referral/recommendation for follow-up consultation. Conclusions: There is racial disparity in the diagnostic evaluation of AUB among women seeking care at EDs. Future efforts to improve care quality and equity in this area may help reduce disparities in early diagnosis of uterine cancer.

Race, Ethnicity, and Gender Representation Among US Academic Spine Surgeons.

Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States. In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons. Fellowship-trained orthopaedic spine surgeons (professor, associate professor, and assistant professor) who graduated residency between 1990 and 2022 were included. Race, sex, academic rank, residency year of graduation, and H-Index scores were recorded using publicly available information from faculty profile pages and the Doximity database. Four hundred fifty-two spine faculty were included in the analysis: 95.1% men and 4.84% women. Across race and ethnicity, 315 surgeons (69.7%) were White, 111 (24.6%) Asian, 15 (3.32%) Black or African American, and 11 (2.43%) Hispanic or Latino or of Spanish origin. Of the 101 professor-level surgeons, 3 (2.97%) were Black men. Among female professors, none were Black, Asian, or Hispanic/Latino. No Hispanic or Latino female professors, associate professors, or assistant professors were identified. The sex and race/ethnicity demographics that have increased in percentage over time include White women (0.92% to 6.08%), Asian men (11.0% to 26.5%), Asian women (0% to 1.66%), and Hispanic/Latino men (1.83% to 3.87%). The surgeon demographic groups that demonstrated minimal fluctuations over time included Black men, Black women, and Hispanic/Latino women. Our findings demonstrate that underrepresentation among academic spine surgeons remains an ongoing challenge that warrants increased attention. Enhancing the representation of Black and Hispanic men, as well as Black, Asian, and Hispanic women, in spine surgery requires a deliberate effort at every level of orthopaedic training.

Evaluating the Regional and Demographic Variations in Dementia-Related Mortality Trends in the United States: 1999 to 2020.

Dementia, a term for a range of cognitive impairments impacting memory, thinking, and social abilities, represents a formidable challenge to healthcare systems worldwide. Analysing the temporal trends in dementia-related mortality among individuals, identifying the populations at high risk, and guiding the implementation of tailored interventions to address the escalating effects of dementia on public health. Data from CDC WONDER database was examined from 1999 to 2020 for the four causes of dementia mortality: unspecified dementia (F03), Alzheimer's disease (G30), vascular dementia (F01), and other degenerative diseases of nervous system not elsewhere classified (G31). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by geographic region, year, age groups, sex, and race/ethnicity. A total of 4,077,973 reported deaths were related to dementia from 1999 to 2020 in the United States. The greatest proportion of deaths was associated with Alzheimer's disease (45.9%), followed by unspecified dementia (43.8%). Very low proportion of deaths were associated with vascular dementia (4.9%) or other neurodegenerative diseases (5.3%). The AAMR increased in two distinct periods: a steep incline from 1999 to 2010 (APC: 6.95, 95% CI: 6.00-7.90), followed by a modest incline till 2020 (APC: 1.41, 95% CI: 0.80-2.04). Overall, females had a higher AAMR than males. AAMRs were highest among NH Whites patients and lowest in NH Asians or Pacific Islanders. A significant geographical difference was also observed among different US census regions. Nearly equal AAMRs were seen in non-metropolitan areas and metropolitan areas. States with AAMRs in the top 90th percentile included South Carolina, North Carolina, Maine, Tennessee, Georgia, and Alabama while states with AAMRs in the bottom 10th percentile included South Dakota, Florida, Hawaii, New Jersey, District of Columbia, and New York (33.1). Individuals aged above 85 had the highest AAMRs. Most deaths occurred in nursing homes and least in hospice facilities. The dementia related deaths are continuously increasing. Highest AAMRs were observed among the NH White people, females, and in the southern areas of the United States. People aged 85+ were most affected. To stop the rising death rates, targeted interventions and awareness are required for both prevention and treatment of dementia.

Modernizing Multiple Myeloma Clinical Trial Eligibility to Improve Equity and Inclusivity by Hematological Parameters

In the U.S., Black people experience multiple myeloma (MM) at a frequency that is more than double that of White people and experience much higher rates of mortality. Despite bearing a disproportionate impact of both MM incidence and mortality, Black patients are significantly underrepresented in most MM clinical trials. This is in part because Black patients experience a higher prevalence of hemoglobinopathies and Duffy-null phenotype, which affect hemoglobin and neutrophil levels, respectively, potentially excluding patients from clinical trials. The Multiple Myeloma Research Foundation (MMRF) has convened a series of Health Equity Summits that include a focus on creating inclusive clinical trials for MM. The present paper, an output of the most recent workshop, focuses on the role of laboratory reference ranges as a barrier to clinical trial participation and offers tangible steps to improve the enrollment of a diverse and representative population.

Associations of Everyday Discrimination With Insomnia and Short Sleep Duration Among Older Women.

Discrimination may contribute to sleep health disparities among women, yet limited research has investigated the association between discrimination and insomnia with short sleep. Among a racially and ethnically diverse sample of women (N=25 920; mean age, 72.2±6.1 years), we investigated the relationship of discrimination with insomnia symptoms and sleep duration. Poisson models with robust variance were fit to examine discrimination with insomnia, sleep duration (short <7 hours or long >9 hours versus recommended 7-9 hours), and insomnia short sleep phenotype adjusted for covariates. Insomnia symptoms, short and long sleep, and high discrimination were reported by 53%, 11%, 15%, and 40% of women, respectively. Women reporting high versus low discrimination were more likely to report insomnia, short sleep, and insomnia short sleep phenotype (insomnia: adjusted prevalence ratio, 1.15 [95% CI, 1.13-1.18]; short sleep: adjusted prevalence ratio, 1.24 [95% CI, 1.16-1.34]; insomnia short sleep phenotype: adjusted prevalence ratio, 1.45 [95% CI, 1.31-1.61]). In exploratory analyses, the association between discrimination and insomnia symptoms was present among Asian and White women, whereas the association between discrimination and sleep duration was among Hispanic (long sleep) and White (short sleep) women. Further, the association between discrimination and insomnia symptoms was more pronounced among those with less than a bachelor's degree, whereas women with a bachelor's degree or higher were less vulnerable to the association between discrimination and long sleep. Discrimination was associated with insomnia and short sleep, a more severe phenotype for adverse cardiovascular health. Discrimination may be a target for reducing sleep problems among older women.

Perceived Community Control in Adults with Acute Low Back Pain: A Community-Based Study.

Low back pain (LBP) is the leading cause of disability for individuals and societies globally. Prior investigations have predominantly centered around biological and psychological factors. Addressing social determinants is critical for enhancing the effectiveness and equity of pain interventions. We aimed to characterize social factors, sleep, and pain among adults with acute LBP, focusing on perceived community control. A community-based sample of adults with acute LBP was recruited from two cities in North Carolina, United States, and followed up at 3 months. We used descriptive statistics to characterize social factors, sleep, and pain, overall and by levels of perceived community control. In total, 110/131 enrolled participants had data on perceived community control (lower scores indicate higher control). Overall, the median perceived community control was 14 (interquartile range [IQR] = 11, 15). People with high perceived community control also had, on average, higher perceived individual control, better-perceived neighborhood walkability, lower number of sites with bothersome comorbid pain, and higher sleep quality. A higher proportion of participants with high perceived community control were of male sex, White race, and had a higher socioeconomic position. Community control and related constructs may be further explored in future intervention development as potentially modifiable social factors that may reduce pain burden.

Reflections on Reproductive Justice in the United States from 1989 to 2024

In 1994, Women of African Descent for Reproductive Justice came together to give voice and vision to the term Reproductive Justice (RJ) and its principles in anticipation of the International Conference on Population and Development and in response to the reproductive rights movement in the United States that white and wealthy women dominated at that time. As a nurse who has worked on the front lines, sidelines, and behind the scenes over the three decades since that auspicious gathering, this article relays some of my professional experiences as they relate to what I believe are among the most pressing issues we face as a global community and as nurses striving to manifest the principles of RJ. The article ends with a call to action for nurses, as there is no time to waste.

Sleep Health Disparity and Race/Ethnicity, Socioeconomic Status, and Gender: A Systematic Review

Despite improvement in US healthcare, racial and ethnic minorities have experienced health disparities including sleep health disparities. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three electronic databases (PubMed, Embase, Web of Science) from the earliest available date to September 2023 using the keywords sleep inequity, gender, race, and socioeconomic status. Studies published in languages other than English were excluded. Meta analysis, case reports, and editorials were also excluded. Medical Subject Headings (MeSH) of the National Library of Medicine and Keywords were used to search PubMed, Embase, and Web of Science. We also searched the reference lists of the selected articles. Using the search strategy, we identified 52 articles. After excluding 11 duplicate studies, we screened 41 articles. The studies not relevant to our search were further excluded and we finally assessed 16 full-text articles. Twelve of the 16 studies were cross sectional and 4 were prospective studies. Compared to Whites, increased prevalence of shorter sleep duration was found among people of diverse racial background. Similarly, individuals with lower socioeconomic status have been shown to have a disproportionate increase in insufficient sleep (1.62 times). Additionally, compared to White women, Black women were more likely to report short sleep (37% vs. 27%) and were less likely to obtain the recommended amount of sleep (52% vs. 64%). This review demonstrates disparities in sleep based on race/ethnicity as well as the effect of gender and socioeconomic status on the quality of sleep.

Disparities in Alcohol Treatment Use at the Intersection of Race, Ethnicity, Gender, and Insurance.

Treatment for alcohol use disorder (AUD) has the potential to improve health and quality of life. Little is known about disparities in AUD treatment utilization at the intersection of race and gender. We examined disparities in AUD treatment utilization among those diagnosed with AUD in a community sample, by race, ethnicity, and gender, and whether disparities varied by insurance. We also examined whether criminal legal history and socioeconomic status moderated disparities in treatment. We used data from the nationally representative 2017 to 2019 National Survey on Drug Use and Health, the most recent 3-year period available. The analytic sample included noninstitutionalized adults aged 18 to 64 who met criteria for past year AUD and identified as White, Black, or Latinx (n = 7782). We examined disparities in AUD treatment utilization by race, ethnicity, and gender subgroup and by insurance status, estimating weighted logistic regressions, and adjusting for indicators of clinical need in concordance with the Institute of Medicine definition of healthcare disparity. Only 5.4% of adults with AUD in the United States utilized AUD treatment in the past year. AUD treatment utilization did not significantly differ between White males and other racial, ethnic, and gender groups; however, we did identify disparities among Medicaid enrollees and those who were uninsured. Among Medicaid enrollees, Latinx females (3.2%) had lower treatment utilization than White males (9.3%, P < .05). Among uninsured individuals, Latinx males (1.8%) had lower treatment utilization than White males (6.2%, P < .05). AUD treatment utilization was extremely low among adults in the United States aged 18 to 64 who met criteria for AUD. Ethnic and gender disparities in treatment utilization were revealed when examining differences in AUD treatment utilization by insurance status. Strategies for improving access to AUD treatment that address structural barriers to care are needed and should consider targeted approaches for Medicaid enrollees and those uninsured.

Cystic Fibrosis: A Review of Current Knowledge, Treatment Methods and Diagnostics

Introduction: Cystic fibrosis (CF) is an autosomal recessive genetic disease caused by a mutation in the CFTR gene. Characteristic symptoms include persistent lung infection, pancreatic insufficiency, and elevated sweat chloride, although many patients have mild or atypical symptoms. Diagnosis of CF is based primarily on the detection of genetic and/or functional abnormalities in the CFTR gene. Treatment includes pancreatic enzyme replacement therapy, mucolytic drugs, respiratory physiotherapy, and antibiotic therapy. Purpose of the work: This study aims to review and characterize the clinical and pathophysiological aspects of cystic fibrosis. Materials and methods: A comprehensive analysis of research papers available on PubMed, Google Scholar, Web of Science, Embase and Scopus was undertaken using the searchterms encompassing the following keywords: Cystic fibrosis, CFTR, Chloride Channels, Lung Inflammation, Diagnosis, Gene therapy, Treatment. Results: Cystic fibrosis is the most common, multisystem, life-threatening recessive disease in the white race. Although many organs are affected, the leading cause of morbidity and mortality is lung disease. Treatment requires pharmacotherapy, extensive physiotherapy, and nutritional support. In recent years, there has been significant progress in the diagnosis and treatment of cystic fibrosis, and the average survival has increased from a few to almost 50 years.

White by Force and the Racialized State of Exception

White identity is forged through violence. The moment that whites aspired to be white, they set themselves up for immediate, inevitable failure: they try to inhabit an identity of superiority that cannot exist, and this sets them into a perpetual identity crisis, an existential emergency that threatens who they are and who they think they want to be. The ensuing identity formation—white by force—comprises an entire set of strategies, tactics, institutions, and structures meant to prop up an inherently failure-based identity and to do so through brutality, resentment, anger, contrived fear, and murder. Such an identity impacts everyone, including white people themselves, in devastating ways. In what following article, I will put forward a theoretical model called “White by Force and the Racialized State of Exception”, conceptualizing key aspects of this model to provide an emerging vocabulary for studying, discussing, and dismantling white identity, violence, authoritarianism, racism, and the existential crises that we are all facing. Our discourse around race and racism, since the Civil Rights Era, needs new language from which to diagnose an inherently violent identity formation that ultimately benefits no one, especially not people of color or white people from lower socioeconomic strata.