Hispanic Population Research Articles

Disparate outcomes in Hispanic patients with metabolic dysfunction-associated steatotic liver disease/steatohepatitis and type 2 diabetes: Large cohort study

BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are a growing health burden across a significant portion of the global patient population. However, these conditions seem to have disparate rates and outcomes between different ethnic populations. The combination of MASLD/MASH and type 2 diabetes increases the risk of hepatocellular carcinoma (HCC), and Hispanic patients experience the greatest burden, particularly those in South Texas. AIM To compare outcomes between Hispanic and non-Hispanic patients in the United States, while further focusing on the Hispanic population within Southeast Texas to determine whether the documented disparity in outcomes is a function of geographical circumstance or if there is a more widespread reason that all clinicians must account for in prognostic consideration. METHODS This cohort analysis was conducted with data obtained from TriNetX, LLC (“TriNetX”), a global federated health research network that provides access to deidentified medical records from healthcare organizations worldwide. Two cohort networks were used: University of Texas Medical Branch (UTMB) hospital and the United States national database collective to determine whether disparities were related to geographic regions, like Southeast Texas. RESULTS This study findings revealed Hispanics/Latinos have a statistically significant higher occurrence of HCC, type 2 diabetes mellitus, and liver fibrosis/cirrhosis in both the United States and the UTMB Hispanic/Latino groups. All-cause mortality in Hispanics/Latinos was lower within the United States group and not statistically elevated in the UTMB cohort. CONCLUSION This would appear to support that Hispanic patients in Southeast Texas are not uniquely affected compared to the national Hispanic population.

"God is going to help me get through this": spirituality perspectives from Hispanic adolescent and young adult cancer survivors.

Describe spirituality's role in a sample of Hispanic adolescent and young adult (AYA) cancer survivors. This phenomenology-informed convergent parallel mixed-methods study aimed to explore participants' lived experiences with hope during cancer treatments and cancer survivorship. A purposive sample of Hispanic AYAs who completed cancer treatments 2-5years ago were virtually recruited for participation. Participants completed virtual semi-structured interviews about their experiences with hope during cancer treatments and cancer survivorship and prepared narratives about their experiences. Thematic analyses were iteratively performed across the data set to identify final themes. Ten Hispanic AYA cancer survivors (mean age 30.2, SD = 4.5) years participated in this pilot study. Seven participants (70%) were female, and three participants (30%) were male. Six participants (60%) experienced non-hematologic malignancies, and four participants (40%) experienced hematologic malignancies. Eight (80%) participants' language preference was Spanish, while two (20%) participants' language preference was English. The theme spirituality and subthemes living by faith, god as a resource, and spiritual gratitude were identified as concepts participants linked to their conceptualization of hope during cancer treatment and survivorship. Hope and spirituality may be conceptually linked to coping behaviors among Hispanic AYA cancer survivors. Hope through faith may be a learned spiritual value in Hispanic AYAs and might play a role in their spiritual and cognitive development. Further research is needed to explore the potentially protective value of hope and spirituality for the Hispanic AYA population.

The association of cancer-preventive lifestyle with colonoscopy screening use in border Hispanic adults along the Texas-Mexico border.

The relationship between engaging in two domains of cancer-preventive behaviors, lifestyle behaviors and colonoscopy screening, is unknown in Hispanic adults. Accordingly, the study examined the association between lifestyle and colonoscopy screening in Hispanic adults along the Texas-Mexico border, where there is suboptimal colorectal cancer prevention. Lifestyle behavior adherence and compliance with colonoscopy screening schedules were assessed using 2013-2023 data from the Cameron County Hispanic Cohorta population-based sample of Hispanic adults living along the Texas-Mexico border. The 2018 World Cancer Research Fund scoring system characterized healthy lifestyle engagement. Multivariable logistic regression quantified the association between lifestyle behaviors and colonoscopy screening. Among 914 Hispanic adults, there was a mean adherence score of 2.5 out of 7 for recommended behaviors. Only 33.0% (95% CI 25.64-41.39%) were up-to-date with colonoscopy. Complete adherence to fruit and vegetable (AOR [adjusted odds ratio] 5.2, 95% CI 1.68-16.30; p = 0.004), fiber (AOR 2.2, 95% CI 1.06-4.37; p = 0.04), and ultra-processed foods (AOR 2.8, 95% CI 1.30-6.21; p = 0.01) consumption recommendations were associated with up-to-date colonoscopy screening. Having insurance versus being uninsured (AOR 10.8, 95% CI 3.83-30.62; p < 0.001) and having local medical care versus in Mexico (AOR 7.0, 95% CI 2.26-21.43; p < 0.001) were associated with up-to-date colonoscopy. Adherence to dietary lifestyle recommendations was associated with being up-to-date with colonoscopy screenings. Those with poor dietary behavior are at risk for low-colonoscopy use. Improving lifestyle behaviors may complement colonoscopy promotion interventions. Healthcare accessibility influences up-to-date colonoscopy prevalence. Our findings can inform cancer prevention strategies for the Hispanic population.

Bridging the Digital Divide: The Role of Online Education in Promoting Equity

This qualitative case study examines the impact of online education in Smith County (a pseudonym), a rural area in the southwestern United States characterized by economic challenges and a large Hispanic population. This study aimed to identify the barriers to and facilitators of educational equity in digital environments. A purposive sampling was utilized to select participants who could provide rich, in-depth insights into the impact of online education within Smith County. In-depth interviews were conducted and focus groups held with students, teachers, and administrators within Smith County. Data analysis was conducted through an iterative process of coding and thematic analysis. The study was informed by the theoretical framework of digital divide and culturally responsive pedagogy. This study delved into the nuanced challenges faced by this community, including technological access, digital literacy, and socio-economic factors. The analysis also explored the pedagogical approaches and support systems that contribute to effective online learning experiences within this rural area. The findings revealed a complex interplay of factors affecting online education engagement and success, highlighting the critical role of tailored support services, culturally responsive teaching, and community partnerships to enhance educational outcomes. The study underscores the importance of understanding local contexts and learner needs in designing and implementing online education programs that specifically address equity. Major conclusions point toward the need for comprehensive strategies that go beyond providing internet access, emphasizing the creation of inclusive, supportive online learning communities. This research contributes to the discourse on educational equity in the digital age, offering insights for educators, policymakers, and online education providers seeking to improve access and outcomes for all learners.

Apoptosis Pathway-Associated Proteins Are Frequently Expressed in Melanoma: A Study of 32 Cases With Focus on Acral Lentiginous Melanoma.

Acral lentiginous melanoma (ALM) is an aggressive type of cutaneous melanoma (CM) that arises on palms, soles, and nail units. ALM is rare in White population, but it is relatively more frequent in dark-skinned populations. There is an unmet need to develop new personalized and more effective treatments strategies for ALM. Increased expression of antiapoptotic proteins (ie, BCL2, MCL1) has been shown to contribute to tumorigenesis and therapeutic resistance in multiple tumor types and has been observed in a subset of ALM and mucosal melanoma cell lines in vivo and in vitro. However, little is known about their expression and clinical significance in patients with ALM. Thus, we assessed protein expression of BCL2, MCL1, BIM, and BRAF V600E by immunohistochemistry in 32 melanoma samples from White and Hispanic populations, including ALM and non-ALM (NALM). BCL2, MCL1, and BIM were expressed in both ALM and NALM tumors, and no significant differences in expression of any of these proteins were detected between the groups, in our relatively small cohort. There were no significant associations between protein expression and BRAF V600E status, overall survival, or ethnicity. In summary, ALM and NALM demonstrate frequent expressions of apoptosis-related proteins BCL2, MCL1, and BIM. Our findings suggest that patients with melanoma, including ALM, may be potential candidates for apoptosis-directed therapies.

A Latent Profile Analysis of COVID-19 and Influenza Vaccine Hesitancy among Economically Marginalized Hispanic Mothers of Children under Five Years of Age in the US.

Rates of COVID-19 and influenza vaccine coverage among Hispanic young children continue to be low in comparison to other racial and ethnic groups in the United States. This study utilized a person-centered approach to understand COVID-19 and influenza vaccination hesitancy for young children under the age of five among 309 economically marginalized Hispanic mothers. Drawing on the cultural health belief model, in 2022, following FDA approval of the COVID-19 vaccine for young children, a latent profile analysis was conducted from which three profiles emerged. The Low Acculturation group (Profile 1), was notable for lower acculturation, moderate cultural medical mistrust, lower access to vaccines, and higher financial security. Compared to Profile 1, the two remaining profiles had higher acculturation and lower levels of financial security, but differed in that the High Acculturation group (Profile 2) had higher vaccine accessibility and the Moderate Acculturation group (Profile 3) had higher cultural medical mistrust. Relative to other profiles, Low Acculturation mothers were more likely to plan to vaccinate their child against current and seasonal COVID-19 and seasonal influenza, report that their child's health provider recommended the COVID-19 shot and reported lower COVID-19 and influenza vaccine mistrust. However, they also reported lower vaccine accessibility and moderate levels of cultural medical mistrust. The study highlights the importance of developing person-centered public health strategies that draw on Hispanic cultural values and consider diversity within lower income Hispanic populations to increase future pediatric COVID-19 and flu vaccination coverage among young Hispanic children.

Evaluating bias and noise induced by the U.S. Census Bureau's privacy protection methods.

The U.S. Census Bureau faces a difficult trade-off between the accuracy of Census statistics and the protection of individual information. We conduct an independent evaluation of bias and noise induced by the Bureau's two main disclosure avoidance systems: the TopDown algorithm used for the 2020 Census and the swapping algorithm implemented for the three previous Censuses. Our evaluation leverages the Noisy Measurement File (NMF) as well as two independent runs of the TopDown algorithm applied to the 2010 decennial Census. We find that the NMF contains too much noise to be directly useful without measurement error modeling, especially for Hispanic and multiracial populations. TopDown's postprocessing reduces the NMF noise and produces data whose accuracy is similar to that of swapping. While the estimated errors for both TopDown and swapping algorithms are generally no greater than other sources of Census error, they can be relatively substantial for geographies with small total populations.

Abstract PO5-09-09: Incidence of Breast Cancer in Hispanic Women Across the US: A Focus on Texas

Abstract Introduction Breast cancer (BC) is one of the most common cancers affecting the female population in the United States, particularly among the Hispanic community. According to the CDC, the incidence rate of new breast cancer cases in Hispanic women is 95.6 per 100,000 annually, and the mortality rate is 13.7 per 100,000 women annually. Texas is home to one of the largest Hispanic communities in the US. By analyzing the prevalence, mortality, and access to healthcare services in Texas, we can shed light on the unique aspects of breast cancer within the Hispanic population. Overall, this study will provide valuable insights and identify potential avenues for reducing disparities and improving healthcare outcomes for Hispanic women affected by breast cancer. Materials and methods This study used comparative data from State Cancer Profiles on the CDC and NIH databases. The database was used to generate an overall comparison of breast cancer in Hispanic women across different US states. Comparison factors analyzed include incidence, mortality, insurance, and screening efforts. Significant differences were noted especially in Texas. Graphs and quantitative data for comparison factors were generated. This data is from 2015-2019 unless noted. Results The incidence of breast cancer in Hispanic women in Texas (TX) is 93.5 (Age-Adjusted Incidence Rate-cases per 100,000) with a CI of (92.2-94.8). The incidence of BC in Hispanic women in the US averages 99.0 with a CI of 98.7-99.9. From the incidence data, Hispanic women in Texas have a lower overall incidence of BC compared to the rest of the Hispanic females in the US. When analyzing the mortality rate, Hispanic women in TX have an Age-Adjusted Death Rate (deaths per 100,000) of 15.2 (CI of 14.7-15.8). In the US, Hispanic women have an Age-Adjusted Death Rate (deaths per 100,000) of 13.0 (CI of 13.4-13.9). To analyze preventative measures, a graph reporting mammogram use in 2020 by state was gathered. In TX 2020, the estimated age-adjusted prevalence of mammograms among Hispanic females from 50-74 years old was 75.0% (CI of 67.0%-81.7%). Nationally, the age-adjusted prevalence among Hispanic females 50-74 years who reported mammogram screening in 2 years was 79.7% (CI of 76.6 – 82.4). As for Texas insurance rates in 2020, Hispanic women under 65 years old, 27.4 % reported being uninsured. In comparison, other ethnicities such as African American (non-Hispanic) women, 16.5% reported to be uninsured, and white (non-Hispanic) women in Texas 11.8 % reported to be uninsured. Additionally, to further analyze if the lack of preventative measures was causing women to have a higher mortality rate, the instance of late-stage diagnosis of BC in Texan Hispanic women was analyzed. The age-adjusted incidence rate of late-stage breast cancer in Hispanic women was reported to be 33.4 (CI of 32.6-34.2) and the national incidence of late-stage BC in Hispanic women is 35.0 (CI of 35.1-35.8). Conclusion Even with Texas having one of the largest Hispanic communities, Hispanic women with breast cancer in Texas are faced with obstacles that lead to an increase in their mortality rate. As seen in the results, Hispanic women have less incidence of BC (including late stage) than their equivalent across the US but Hispanic women in TX have higher mortality rates in comparison. This is additionally accompanied by a decrease in insured women and a decrease in the utilization of cancer screenings. Lack of access to affordable healthcare and lack of regulatory cancer screenings cause Hispanic women to meet their premature death. Further analysis of the effects of affordable health care or further molecular investigation of this population is encouraged to research to fully conclude the reason behind this population's disparities. Citation Format: Catalina Esguerra, Kemely Santos Barbosa, Roy Khalife, Anthony Magliocco. Incidence of Breast Cancer in Hispanic Women Across the US: A Focus on Texas [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-09-09.

Abstract PO4-04-13: Impact of dose reduction of CDK4/6 inhibitors on progression-free survival in Mexican patients with hormone receptor-positive, HER2-negative metastatic breast cancer: a retrospective single-center study

Abstract Background Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) have been demonstrated to prolong survival in women with hormone receptor-positive, HER-2 negative, metastatic breast cancer. However, these treatments often require dose adjustments due to adverse effects, resulting in a reduction in 30-50% of cases. There is evidence suggesting a relationship between dose intensity and progression-free survival (PFS), but data in the Hispanic population are limited. Therefore, the objective of the study was to explore the association between dose reduction of CDK4/6/i inhibitors and PFS in patients with metastatic breast cancer. Methods We conducted a retrospective single-center study involving patients diagnosed with hormone receptor-positive, HER-2 negative metastatic breast cancer (MBC) between 2020 and 2023. Eligible patients were those who received at least one cycle of palbociclib, abemaciclib, or ribociclib and had a follow-up period of more than three months since the initiation of CDK4/6 inhibitor (CDK4/6i) treatment. Patient data were collected from electronic medical records. We analyzed demographic and clinicopathological characteristics and estimated the PFS in patients who had any dose reduction within the first 12 weeks compared to those who did not, using Kaplan-Meier plots and compared the differences in survival using the log-rank test. A Cox regression analysis was performed to estimate survival hazard ratios (HR). Results Among 41 patients, the mean age at CDK4/6i initiation was 61.0 years (SD 12.9), 22 (53.7%) were postmenopausal at diagnosis, 25 (61%) had recurrent disease, and 22 (53.7%) were receiving CDK4/6i in the first-line setting. Bone metastases were present in 30 (73.2%), and visceral metastases in 22 (53.7%). Regarding type of CDK4/6i, 33 (80.5%) received palbociclib, 7 (17.1%) ribociclib, and 1 (2.4%) abemaciclib. At 12 weeks, 12 patients (29.3%) had a dose reduction (Table 1). With a median follow-up since CDK4/6i initiation of 407 days (95% confidence interval (CI) 272-542), 19 events were recorded, with a median PFS of 12.6 months (95% CI 8.0-17.3) for the overall population. Median PFS was 9.7 months (95% CI 0.6-18.8) in patients who had a dose reduction at 12 weeks and 35.2 months (95% CI 0-72.2) in those who did not (p=0.014). The univariate Cox proportional hazard model showed that dose reduction was associated with a worse PFS (hazard ratio 3.1; 95% CI: 1.20–7.80, p = 0.0019) Conclusion In this cohort of Mexican patients with hormone receptor-positive, HER2-negative metastatic breast cancer we found that dose reduction of CDK4/6 inhibitors within the first 12 weeks of treatment was associated with worse PFS. Given the retrospective nature of this analysis, we believe that these findings should be replicated in prospective studies. Table. Patient characteristics Citation Format: Andres Meraz-Brenez, Alejandro Aranda-Gutierrez, Hector Raul Gonzalez-Sanchez, Bertha Alejandra Martinez-Cannon, Leonardo Verduzco-Rodriguez, Haydee Cristina Verduzco-Aguirre. Impact of dose reduction of CDK4/6 inhibitors on progression-free survival in Mexican patients with hormone receptor-positive, HER2-negative metastatic breast cancer: a retrospective single-center study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-04-13.

Impact of Obesity on Midurethral Sling Failure in a Highly Hispanic Population.

Mixed data exist in the literature regarding the impact of obesity on midurethral sling (MUS) failure rates. The aim of this study was to evaluate the impact of obesity and Hispanic ethnicity on MUS failure. This was a retrospective cohort study of females who underwent MUS surgery, alone or with concomitant prolapse repair, with at least 1 year of follow-up. Body mass index (BMI) classes were categorized as normal (<25 kg/m2), overweight (25-29.9 kg/m2), obese (30-39.9 kg/m2), and severe obesity (≥40 kg/m2). The primary outcome was MUS failure, defined as a composite of subjectively unchanged or worsened symptoms or need for additional procedures. Secondary outcomes included risk factors related to MUS failure and the effect of ethnicity on MUS failure rates. A total of 322 women were included for analysis. The mean age was 52.3 years. Increasing BMI was associated with higher MUS failure, with multivariate logistic regression showing a 5% increased risk for each 1 kg/m2 BMI increase. Failure rates were significantly different between normal BMI and severe obesity (16.7% vs 36.4%, P = 0.04). After adjusting for other variables, transobturator slings had a higher risk of failure compared with retropubic slings, whereas surgeon training and patient ethnicity did not affect failure rates. We found that increasing BMI was associated with higher MUS failures, with significantly higher failure rates in the severely obese population. Although MUS remains the standard of care for treatment of SUI, based on our findings, counseling should be individualized to the patient, taking into account each patient's unique characteristics.

Racial and Ethnic Disparities in Initiation of Direct Oral Anticoagulants Among Medicare Beneficiaries

The influence of race and ethnicity on initiation of direct oral anticoagulants (DOACs) is relatively understudied in Medicare data. To investigate disparities in the initiation of DOACs compared with warfarin by race, ethnicity, and social vulnerability. This retrospective cohort study used a 50% sample of Medicare fee-for-service data from January 1, 2010, to December 31, 2019 (mean patient enrollment duration, 7.7 years). Analysis took place between January 2023 and February 2024. A cohort of older adults (aged ≥65 years) with atrial fibrillation who newly initiated warfarin or DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) was identified. Patients were classified as non-Hispanic White, non-Hispanic Black, and Hispanic. The likelihood of starting use of DOACs compared with warfarin was modeled, adjusting for race, ethnicity, age, sex, county-level social vulnerability, and other clinical factors. Among 950 698 anticoagulation initiations, consisting of 680 974 DOAC users and 269 724 warfarin users (mean [SD] age, 78.5 [7.6] years; 52.6% female), 5.2% were Black, 4.3% were Hispanic, and 86.7% were White. During the 10-year study period, DOAC use increased for all demographic groups. After adjustment, compared with White patients, Black patients were 23% less likely (adjusted odds ratio [AOR, 0.77; 95% CI, 0.75-0.79) and Hispanic patients were 13% less likely (AOR, 0.87; 95% CI, 0.85-0.89) to initiate DOAC use. Disparities in DOAC initiation were greatest among Black patients in the earlier years but attenuated during the study period. For instance, in 2010, the OR of Black patients initiating DOACs was 0.54 (95% CI, 0.50-0.57), attenuating linearly over time to 0.69 by 2013 (95% CI, 0.65-0.74) and 0.83 (95% CI, 0.78-0.89) by 2017. By 2019, these differences became nonsignificant (OR, 1.08; 95% CI, 0.99-1.18). In this cohort study of Medicare patients with atrial fibrillation, Black and Hispanic patients were less likely to initiate DOACs for atrial fibrillation, although these differences diminished over time. Identifying the factors behind these early disparities is crucial for ensuring equitable access to novel therapies as they emerge for Black and Hispanic populations.

Ethnicity-Based Variations in Focal Adhesion Kinase Signaling in Glioblastoma Gene Expression: A Study of the Puerto Rican Hispanic Population.

Glioblastoma (GBM), an aggressive form of brain cancer, has a higher incidence in non-Hispanics when compared to the US Hispanic population. Using data from RT-PCR analysis of 21 GBM tissue from Hispanic patients in Puerto Rico, we identified significant correlations in the gene expression of focal adhesion kinase and proline-rich tyrosine kinase (PTK2 and PTK2B) with NGFR (nerve growth factor receptor), PDGFRB (platelet-derived growth factor receptor B), EGFR (epithelial growth factor receptor), and CXCR1 (C-X-C motif chemokine receptor 1). This study further explores these correlations found in gene expression while accounting for sex and ethnicity. Statistically significant (p < 0.05) correlations with an r value > ±0.7 were subsequently contrasted with mRNA expression data acquired from cBioPortal for 323 GBM specimens. Significant correlations in Puerto Rican male patients were found between PTK2 and PTK2B, NGFR, PDGFRB, EGFR, and CXCR1, which did not arise in non-Hispanic male patient data. The data for Puerto Rican female patients showed correlations in PTK2 with PTK2B, NGFR, PDGFRB, and EGFR, all of which did not appear in the data for non-Hispanic female patients. The data acquired from cBioPortal for non-Puerto Rican Hispanic patients supported the correlations found in the Puerto Rican population for both sexes. Our findings reveal distinct correlations in gene expression patterns, particularly involving PTK2, PTK2B, NGFR, PDGFRB, and EGFR among Puerto Rican Hispanic patients when compared to non-Hispanic counterparts.

Environmental Pollutant Risk Factors for Worse COVID-19 Related Clinical Outcomes in Predominately Hispanic and Latino Populations

BackgroundPer- and poly-fluorinated compounds (PFAS) and heavy metals constitute two classes of environmental exposures with known immunotoxicant effects. In this pilot study, we aimed to evaluate the impact of exposure to heavy metals and PFAS on COVID-19 severity. We hypothesized that elevated plasma-PFAS concentrations and urinary heavy metal concentrations would be associated with increased odds of ICU admission in COVID-19 hospitalized individuals. MethodsUsing the University of Southern California Clinical Translational Sciences Institute (SC-CTSI) biorepository of hospitalized COVID-19 patients, urinary concentrations of 15 heavy metals and urinary creatinine were measured in n=101 patients and plasma concentrations of 13 PFAS were measured in n=126 patients. COVID-19 severity was determined based on whether a patient was admitted to the ICU during hospitalization. Associations of metals and PFAS with ICU admission were assessed using logistic regression models, controlling for age, sex, ethnicity, smoking status, and for metals, urinary dilution. ResultsThe average age of patients was 55±14.2 years. Among SC-CTSI participants with urinary measurement of heavy metals and blood measures of PFAS, 54.5% (n=61) and 54.8% (n=80) were admitted to the ICU, respectively. For heavy metals, we observed higher levels of Cd, Cr, and Cu in ICU patients. The strongest associations were with Cadmium (Cd). After accounting for covariates, each 1 SD increase in Cd resulted in a 2.00 (95% CI: 1.10-3.60; p=0.03) times higher odds of admission to the ICU. When including only Hispanic or Latino participants, the effect estimates between cadmium and ICU admission remained similar. Results for PFAS were less consistent, with perfluorodecanesulfonic acid (PFDS) exhibiting a positive but non-significant association with ICU admission (Odds ratio, 95% CI: 1.50, 0.97-2.20) and perfluorodecanoic acid (PFDA) exhibiting a negative association with ICU admission (0.53, 0.31-0.88). ConclusionsThis study supports the hypothesis that environmental exposures may impact COVID-19 severity.

Rural-Urban Stroke Mortality Gaps in the United States

IntroductionDisparities in stroke outcomes, influenced by the use of systemic thrombolysis, endovascular therapies, and rehabilitation services, have been identified. Our study assesses these disparities in mortality after stroke between rural and urban areas across the United States (US). MethodsWe analyzed the CDC data on deaths attributed to cerebrovascular disease from 1999-2020. Data was categorized into rural and urban regions for comparative purposes. Age-adjusted mortality rates (AAMR) were computed using the direct method, allowing us to examine the ratios of rural to urban deaths for the cumulative population and among demographic subpopulations. Linear regression models were used to assess temporal changes in mortality ratios over the study period, yielding beta-coefficients (β). ResultsThere was a total of 628,309 stroke deaths in rural regions and 2,556,293 stroke deaths within urban regions. There were 1.13 rural deaths for each one urban death per 100,000 population in 1999 and 1.07 in 2020 (β=-0.001, ptrend=0.41). The rural-urban mortality ratio in Hispanic populations decreased from 1.32 rural deaths for each urban death per 100,000 population in 1999 to 0.85 in 2020 (β=-0.011, ptrend<0.001). For non-Hispanic populations, mortality remained stagnant with 1.12 rural deaths for each urban death per 100,000 population in 1999 and 1.07 in 2020 (β=-0.001, ptrend=0.543). Regionally, the Southern US exhibited the highest disparity with a urban-rural mortality ratio of 1.19, followed by the Northeast (1.13), Midwest (1.04), and West (1.01). ConclusionsOur findings depict marked disparities in stroke mortality between rural and urban regions, emphasizing the importance of targeted interventions to mitigate stroke-related disparities.

Bioanthropological and Biomechanical Perspectives on Skeletal Senescence Variation: A Literature Review

Background: Senescence is the deterioration of the body’s biological and physiological function throughout later life. Senescent populations are more prone to diseases, though other than osteoporosis, skeletal senescence is a less discussed topic in Indonesia. Furthermore, a global and national increase in the aging population showed that they will be a major group in society, thus raising the urgency to review this matter. This study aims to comprehend the physiological and biomechanical mechanisms of skeletal senescence, as well as senescent variations in a certain sex or population affinity. Literature Review: Age-related skeletal cellular death and imbalance contribute to bone damage in elders. Senescence also affects skeletal biomechanics, expressed in increased bone porosity and brittleness. Stresses in aged bone risk straining above its elastic limit and causing fractures due to its inability to tolerate stresses. The loss of sex hormones is related to skeletal senescence, especially in females, though the effects of testosterone on skeletal senescence are underresearched. Dietary change, estrogen replacement therapy, and calcitonin consumption are effective measures in reducing the effects of osteoporosis. Variations were found in the bone aging process in different populations, especially regarding bone mineral density loss in white, African-American, Asian, and Hispanic populations. Summary: Specific population-based healthcare services in geriatrics and gerontology are highly suggested to ensure inclusive healthcare for every aged individual. Due to the minimum data about bone aging in Indonesia (other than osteoporosis), the authors encourage data procurement on local populations to create more suitable medical guidelines for elders in Indonesia.

A Longitudinal Analysis of Mortality Related to Chronic Viral Hepatitis and Hepatocellular Carcinoma in the United States

(1) Background: Hepatocellular carcinoma (HCC) contributes to the significant burden of cancer mortality in the United States (US). Despite highly efficacious antivirals, chronic viral hepatitis (CVH) remains an important cause of HCC. With advancements in therapeutic modalities, along with the aging of the population, we aimed to assess the contribution of CVH in HCC-related mortality in the US between 1999–2020. (2) Methods: We queried all deaths related to CVH and HCC in the multiple-causes-of-death files from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database between 1999–2020. Using the direct method of standardization, we adjusted all mortality information for age and compared the age-adjusted mortality rates (AAMRs) across demographic populations and by percentile rankings of social vulnerability. Temporal shifts in mortality were quantified using log-linear regression models. (3) Results: A total of 35,030 deaths were identified between 1999–2020. The overall crude mortality increased from 0.27 in 1999 to 8.32 in 2016, followed by a slight reduction to 7.04 in 2020. The cumulative AAMR during the study period was 4.43 (95% CI, 4.39–4.48). Males (AAMR 7.70) had higher mortality rates compared to females (AAMR 1.44). Mortality was higher among Hispanic populations (AAMR 6.72) compared to non-Hispanic populations (AAMR 4.18). Higher mortality was observed in US counties categorized as the most socially vulnerable (AAMR 5.20) compared to counties that are the least socially vulnerable (AAMR 2.53), with social vulnerability accounting for 2.67 excess deaths per 1,000,000 person-years. (4) Conclusions: Our epidemiological analysis revealed an overall increase in CVH-related HCC mortality between 1999–2008, followed by a stagnation period until 2020. CVH-related HCC mortality disproportionately affected males, Hispanic populations, and Black/African American populations, Western US regions, and socially vulnerable counties. These insights can help aid in the development of strategies to target vulnerable patients, focus on preventive efforts, and allocate resources to decrease HCC-related mortality.

Social Context and Early Disposition Departures: An Examination of Disparity in Immigration Sentencing Across U.S. District Courts

In the 1990s, the United States Attorneys’ Offices implemented programs to make sentencing for immigration offenses more efficient by designating a number of “Fast-Track” districts. In 2012, these programs were expanded to all federal districts. Using data from multiple sources including federal sentencing data from 2015 to 2016 and community-level variables from the American Community Survey, this study examines how individual and district-level characteristics affect receipt and magnitude of early disposition departures. Findings suggest Hispanic population, Republican Control, and original fast-track district predict early disposition departure receipt and sentence length. District-level characteristics can influence when and how these departures are used.

Bridging Health Disparities: Examination of Healthcare Utilization and Care in the U.S. Hispanic Community

Conducted by the 501(c)-3 nonprofit, International Collegiate Health Initiative (ICHI), this study focuses on the significant role of economic factors in healthcare usage within the Hispanic community in the United States. Particularly highlighting the challenges posed by low socioeconomic status, insurance coverage gaps, and geographical barriers that limit access to essential healthcare services and affect the quality of care received by this demographic.The study found low socioeconomic status as a major barrier to adequate healthcare among the Hispanic population. This economic constraint is intricately linked to limited access to healthcare resources, notably in health education and preventive care (Escobedo et al., 2023). The findings emphasize the strong connection between lower socioeconomic status and significantly reduced opportunities for accessing essential medical care. Furthermore, with 12% of Latinos lacking access to insurance, the results show a substantial disparity in health insurance coverage within the Hispanic community. The lack of sufficient insurance coverage leads to a reluctance to seek medical care due to cost concerns (De Jesus &amp; Xiao, 2014). This gap is especially concerning, as it prevents patients from seeking healthcare services in a timely and prompt manner. Additionally, geographical barriers are shown to significantly restrict healthcare access. Around 22% of Hispanics encounter obstacles in reaching healthcare services due to factors such as long travel distances to clinics and inadequate transportation (Oh et al., 2018). These factors demonstrate the need to provide economic support to underserved communities in order to produce greater healthcare outcomes in underserved communities. Effective intervention in these areas is crucial for breaking the cycle of healthcare disparities and ensuring sustainable health improvements for the Hispanic community.

Arrhythmias and ion channelopathies causing sudden cardiac death in Hispanic/Latino and Indigenous populations.

The limited literature and increasing interest in studies on cardiac electrophysiology, explicitly focusing on cardiac ion channelopathies and sudden cardiac death in diverse populations, has prompted a comprehensive examination of existing research. Our review specifically targets Hispanic/Latino and Indigenous populations, which are often underrepresented in healthcare studies. This review encompasses investigations into genetic variants, epidemiology, etiologies, and clinical risk factors associated with arrhythmias in these demographic groups. The review explores the Hispanic paradox, a phenomenon linking healthcare outcomes to socioeconomic factors within Hispanic communities in the United States. Furthermore, it discusses studies exemplifying this observation in the context of arrhythmias and ion channelopathies in Hispanic populations. Current research also sheds light on disparities in overall healthcare quality in Indigenous populations. The available yet limited literature underscores the pressing need for more extensive and comprehensive research on cardiac ion channelopathies in Hispanic/Latino and Indigenous populations. Specifically, additional studies are essential to fully characterize pathogenic genetic variants, identify population-specific risk factors, and address health disparities to enhance the detection, prevention, and management of arrhythmias and sudden cardiac death in these demographic groups.

Implementing Strategies to Recruit and Retain a Diverse Sample of Heart Failure Patients.

Introduction: The increased prevalence, severity, and mortality of heart disease and specifically heart failure among Hispanic and Black populations are a concern for clinicians and researchers. Additionally, patients of poor socioeconomic status also have worse outcomes for cardiovascular disease. To address disparities, it is necessary to address the persistent lack of representation in clinical research of diverse populations, including the Hispanic and Black populations and individuals who are of low socioeconomic status. Method: This study was a pilot randomized trial of a medication adherence intervention for heart failure patients conducted at a safety net hospital and affiliated pharmacy with a diverse patient population. Using an evidence-based multifactorial approach, this investigation implemented and adapted best practices to support the inclusion of Hispanic, Black, and socioeconomically diverse participants. Results: A total of 40 participants were recruited, 58% were Hispanic, 38% Black, and 5% White. A total of 40% reported the need for socioeconomic assistance. At 30 days after discharge, follow-up data were obtained for 37 of 40 (93%) of participants either by interview, electronic record, or both. Conclusion: Findings suggest that a combination of strategies used in this trial can be applied to recruit and retain ethnically and socioeconomically diverse participants.