Magnitude Of Racial Disparities Research Articles

Racial and ethnic disparities in liver transplant access vary within and across transplant referral regions.

Prior studies have demonstrated racial disparities in access to liver transplantation but determinants of these disparities remain poorly understood. We used geographic catchment areas for transplant centers (transplant referral regions, TRRs) to characterize transplant environment contributors to racial and ethnic disparities in liver transplant access. Data were obtained from the Scientific Registry for Transplant Recipients (SRTR) and the National Center for Health Statistics (NCHS) from 2015 to 2021. The primary outcome was the difference in the listing-to-ESLD death ratio (LDR) between Black, Hispanic, and non-Hispanic White patients for each TRR. We accounted for demographics, socioeconomic status, healthcare access, organ availability, and transplant center competition using multivariable linear regression. We examined intra-TRR differences in waitlist composition using Levene's test of variance. Across the 66 included TRRs, Black patients had lower LDRs than White patients in 80% of TRRs, while Hispanic patients had equal or higher LDRs compared to White patients in 56% of TRRs. The majority of variation in racial disparities across TRRs remained unexplained by multivariable models. Disparities were attenuated after excluding patients with HCC-associated mortality. Among the 27 TRRs that contained more than one transplant center, variance across TRRs was statistically significant for Black and Hispanic waitlist composition. We observed substantial geographic variation in the magnitude of racial disparities in liver transplant access across the United States. Findings highlight the need for targeted health equity interventions in regions with high disparities and the development of disparity-sensitive access metrics for transplant centers.

Balancing Equity and HLA Matching in Deceased-Donor Kidney Allocation with Eplet Mismatch

HLA antigen-level matching in US kidney allocation has been de-emphasized due to its role in elevating racial disparities. Molecular matching based on eplets might improve risk stratification compared to antigen matching, but the magnitude of racial disparities in molecular matching is not known. To assign eplets unambiguously, we utilized a cohort of 5193 individuals with high resolution allele-level HLA genotypes from the National Kidney Registry. Using repeated random sampling to simulate donor-recipient genotype pairings based on the ethnic composition of the historical US deceased donor pool, we profiled the percentage of well-matched donors available for candidates by ethnicity. The prevalence of well-matched donors with zero-DR/DQ eplet mismatch was 3-fold less racially disparate for Black and Asian candidates and 2-fold less for Latino candidates compared to zero-ABDR antigen mismatches. Compared to zero-DR antigen mismatch, zero-DR eplet mismatch was 1.33-fold more racially disparate for Asian and 1.28-fold more for Latino, with similar disparity for Black candidates, whereas zero-DQ eplet mismatch reduced disparities, showing 1.26-fold less disparity for Black, 1.14-fold less for Latino, but 1.26-fold higher for Asian candidates. The prevalence of well-matched donors for candidates of different ethnicities varied according to which molecules were chosen to define a low-risk match.

Methodologic considerations in estimating racial disparity of mortality among very preterm infants.

This review explores methodological considerations in estimating racial disparities in mortality among very preterm infants (VPIs). Significant methodological variations are evident across studies, potentially affecting the estimated mortality rates of VPIs across racial groups and influencing the perceived direction and magnitude of racial disparities. Key methodological approaches include the birth-based approach versus the fetuses-at-risk approach, with each offering distinct insights depending on the specific research questions posed. Cohort selection and the decision for crude versus adjusted comparison are also critical elements that shape the outcomes and interpretations of these studies. This review underscores the importance of careful methodological planning and highlights that no single approach is definitively superior; rather, each has its strengths and limitations depending on the research objectives. The findings suggest that adjusting the methodological approach to align with specific research questions and contexts is essential for accurately assessing and addressing racial disparities in neonatal mortality. IMPACT: Elucidates the impact of methodological choices on perceived racial disparities in neonatal mortality. Offers a comprehensive comparison of birth-based vs. fetuses-at-risk approaches in the context of racial disparity research. Provides guidance on the cohort selection and adjustment criteria critical for interpreting studies on racial disparities in very preterm infant mortality.

Quo Vadis Racial Disparities? Trend Analysis of the Participation and Top Achievement in Advanced Placement Computer Science Exams

This study explores the direction and magnitude of racial disparities on three advanced placement (AP) computer science (CS) exams, namely AP CS Principles, AP CS A, and AP CS AB, based on the test scores of more than one million students who have taken AP CS exams between 1997 and 2020. Using Mann–Kendall test and Sen's slope procedures we found that the number of Black, Hispanic, and Native American students in AP CS exams have increased steadily and significantly over years, yet they are still far from reaching parity. Further, our findings suggest that the racial disparities among top achievers are very wide. The results provide educators and researchers support for identifying and quantifying the racial disparities in advanced academic programs and may inform the development of policies, practices, and programs to reduce racial disparities in pre-college CS education and further.

Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999-2020.

Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. Pain-related visits to the ED by Black or White patients. Prescriptions for opioid and non-opioid analgesics. A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.

Race, geography, and risk of breast cancer treatment delays: A population-based study 2004-2015.

Treatment delays affect breast cancer survival and constitute poor-quality care. Black patients experience more treatment delay, but the relationship of geography to these disparities is poorly understood. We studied a population-based, retrospective, observational cohort of patients with breast cancer in North Carolina between 2004 and 2017 from the Cancer Information and Population Health Resource, which links cancer registry and sociodemographic data to multipayer insurance claims. We included patients >18years with Stage I-III breast cancer who received surgery or chemotherapy as their first treatment. Delay was defined as >60days from diagnosis to first treatment. Counties were aggregated into nine Area Health Education Center regions. Race was dichotomized as Black versus non-Black. Among 32,626 patients, 6190 (19.0%) were Black. Black patients were more likely to experience treatment delay >60days (15.0% of Black vs. 8.0% of non-Black). Using race-stratified modified Poisson regression, age-adjusted relative risk of delay in the highest risk region was approximately twice that in the lowest risk region among Black (relative risk, 2.1; 95% CI, 1.6-2.6) and non-Black patients (relative risk, 1.9; 95% CI, 1.5-2.3). Adjustment for clinical and sociodemographic features only slightly attenuated interregion differences. The magnitude of the racial gap in treatment delay varied by region, from 0.0% to 9.4%. Geographic region was significantly associated with risk of treatment delays for both Black and non-Black patients. The magnitude of racial disparities in treatment delay varied markedly between regions. Future studies should consider both high-risk geographic regions and high-risk patient groups for intervention to prevent delays.

It Is Not Just the Southeast-Geographically Pervasive Racial Disparities in Neisseria gonorrhoeae Between Non-Hispanic Black and White US Women.

Racial disparities in female gonorrhea rates are not confined to the Southeast; both relative and absolute disparities are equivalent or larger in areas of the Northeast, Midwest, and West. Background Spatial analyses of gonorrhea morbidity among women often highlight the Southeastern United States but may not provide information on geographic variation in the magnitude of racial disparities; such maps also focus on geographic space, obscuring underlying population characteristics. We created a series of visualizations depicting both county-level racial disparities in female gonorrhea diagnoses and variations in population size. Methods We calculated county- and region-level race-specific relative rates (RelR) and between-race rate differences (RDs) and rate ratios (RRs) comparing gonorrhea case rates in non-Hispanic Black (NHB) versus non-Hispanic White (NHW) women. We then created proportional symbol maps with color representing counties' RelR/RD/RR category and symbol size representing counties' female population. Results Gonorrhea rates among NHB women were highest in the Midwest (718.7/100,000) and West (504.8), rates among NHW women were highest in the West (74.1) and Southeast (72.1). The RDs were highest in the Midwest (654.6 excess cases/100,000) and West (430.7), whereas the RRs were highest in the Northeast (12.4) and Midwest (11.2). Nearly all US counties had NHB female rates ≥3× those in NHW women, with NHB women in most highly populated counties experiencing ≥9-fold difference in gonorrhea rates. Conclusions Racial disparities in gonorrhea were not confined to the Southeast; both relative and absolute disparities were equivalent or larger in magnitude in areas of the Northeast, Midwest, and West. Our findings help counter damaging regional stereotypes, provide evidence to refocus prevention efforts to areas of highest disparities, and suggest a useful template for monitoring racial disparities as an actionable public health metric.

Racial and Treatment Center Differences on Time to Treatment Initiation for Nonsmall Cell Lung Cancer Patients Receiving Radiation Therapy As an Initial Treatment.

Objective:Because time to treatment has been shown to be associated with increase in the risk of death for Non Small Cell Lung Cancer (NSCLC) patients, we examined the prevalence and magnitude of racial disparities in mean time to radiation therapy (TTRT) for Stage I-III non-small cell lung cancer patients across a variety of treatment facilities.Methods:Utilizing the United States National Cancer Database (NCDB), we determined differences in TTRT between different races and different treatment facilities.Results:Concordant with past research, we found that non-White patients and patients treated at academic facilities, regardless of race, have longer mean TTRT, and that racial disparities in TTRT extend across all treatment facilities (all p<0.05).Conclusions:These findings shed light on the potential presence of and impact of structural racism on patients seeking cancer treatment, and the need for further investigation behind the reasonings behind longer TTI for non-White patients. To elucidate the real-world applicability of these results, further investigation into the societal determinants that perpetuate disparity in time to radiation therapy, and potential interventions in the clinical setting to improve cultural and racial sensitivity among healthcare professionals is recommended.

Differences in Racial Disparities in Firearm Homicide across Cities: The Role of Racial Residential Segregation and Gaps in Structural Disadvantage

Background/PurposeLittle research has characterized racial differences in firearm homicide at the city level. In this study, we explicitly model trends from 2000 to 2017 in the gap in homicide rates between the Black and White populations of 275 U.S. cities. MethodsWe used latent trajectory analysis and latent multi-trajectory analysis to identify distinct groups of cities with similar trends over time in: (a) Black and White firearm homicide rates; and (b) the ratio of the Black to White firearm homicide rates. We used a hierarchical, random effects model to examine the impact of racial segregation and racial gaps in structural disadvantage on the extent of the racial disparity in firearm homicide in each city. ResultsWe found that racial residential segregation predicts differences between cities in the magnitude of racial disparities in firearm homicide rates. ConclusionReducing racial disparities in firearm homicide may require programs and policies that specifically address the adverse consequences of racial segregation.

Abstract 037: The U.S. Food and Drug Administration’s Metformin Label Change Reduces Racial Disparity in Metformin Use by Increasing Its Use Among Black Patients With Type 2 Diabetes and Moderately Impaired Kidney Function

Introduction: Historically, metformin was contraindicated in people with type 2 diabetes (T2D) and kidney disease due to concerns of lactic acidosis. The U.S. Food and Drug Administration (FDA) recently changed metformin label from serum creatinine (sCr)-based to estimated glomerular filtration (eGFR)-based indication, expanding its use for people with eGFR≥30 mL/min/1.73 m 2 . The purpose of our study is to assess the effects of the label change on metformin use among people with T2D, stratified by race and eGFR. Hypothesis: Because sCr levels are higher in blacks than in whites at the same level of eGFR, we hypothesized that the label change increases metformin use in people with T2D and kidney disease and magnitude of increase is greater in blacks than in whites. Methods: One-year period prevalence cohort was created for each of before and after the FDA’s label change (April 8, 2016) in Johns Hopkins Medicine, including people with T2D and eGFR≥30 mL/min/1.73 m 2 . We estimated the prevalence of metformin use in each cohort, stratified by eGFR within each race. Results: Mean age of study population (N=15,880) was 61 years, 52% were women, 48% were black, mean eGFR was 81 mL/min/1.73 m 2 , and mean HbA1c was 7.8%. Before the label change, blacks with eGFR 30-44 mL/min/1.73 m 2 were less likely to use metformin compared to whites, controlling for age, sex, eGFR, and HbA1c (odds ratio [OR]=0.49 [95% confidence interval: 0.37-0.65]). The label change did not increase metformin use among whites across all categories of eGFR, whereas it increased metformin use from 26.1% to 32.6% (P=0.03) among blacks with eGFR 30-44 ml/min/1.73 m 2 ( Figure ). As a result, magnitude of racial disparity in metformin use after the label change was attenuated (OR=0.75 [0.57-0.99]). Conclusions: The recent eGFR-based metformin label change increased its use in black people with T2D and moderately impaired kidney function, with reducing racial disparity of metformin use. Further studies to assess impact of metformin label change with longer study period are warranted.

Race, Socioeconomic Status, and Age: Exploring Intersections in Preterm Birth Disparities among Teen Mothers.

Few studies have examined disparities in adverse birth outcomes and compared contributing socioeconomic factors specifically between African-American and White teen mothers. This study examined intersections between neighborhood socioeconomic status (as defined by census-tract median household income), maternal age, and racial disparities in preterm birth (PTB) outcomes between African-American and White teen mothers in North Carolina. Using a linked dataset with state birth record data and socioeconomic information from the 2010 US Census, disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariate and multilevel analyses. African-American teens had significantly greater odds of PTB outcomes than White teens (OR = 1.38, 95% CI 1.21, 1.56). Racial disparities in PTB rates significantly varied by neighborhood income; PTB rates were 2.1 times higher for African-American teens in higher income neighborhoods compared to White teens in similar neighborhoods. Disparities in PTB did not vary significantly between teens younger than age 17 and teens ages 17-19, although the magnitude of racial disparities was larger between younger African-American and White teens. These results justify further investigations using intersectional frameworks to test the effects of racial status, neighborhood socioeconomic factors, and maternal age on birth outcome disparities among infants born to teen mothers.

Telephone Surveys Underestimate Cigarette Smoking among African-Americans

Background: This study tested the hypothesis that data from random digit-dial telephone surveys underestimate the prevalence of cigarette smoking among African-American adults.Method: A novel, community-sampling method was used to obtain a statewide, random sample of N = 2118 California (CA) African-American/Black adults, surveyed door-to-door. This Black community sample was compared to the Blacks in the CA Health Interview Survey (N = 2315), a statewide, random digit-dial telephone survey conducted simultaneously.Results: Smoking prevalence was significantly higher among community (33%) than among telephone survey (19%) Blacks, even after controlling for sample differences in demographics.Conclusion: Telephone surveys underestimate smoking among African-Americans and probably underestimate other health risk behaviors as well. Alternative methods are needed to obtain accurate data on African-American health behaviors and on the magnitude of racial disparities in them.

Adventures (and Misadventures) on the Road to Understand (and Reduce) Disparities in Stroke Mortality

Racial and geographic disparities in stroke mortality have existed for over a half-century, and between ages of 45 to 65 are among the largest for any disease. For much of this period, the causes of the disparities have been mysterious; however, investments by NINDS and NHLBI are now providing insights regarding the causes of these disparities. Diverse and complementary study designs provide information on different aspects of the disparities in stroke. Vital statistics data track temporal patterns in stroke mortality, perhaps the ultimate index of the success in overcoming the disparities. Surveillance studies allow assessment of the contributions of incidence versus case fatality to the disparities in vital statistics mortality data, a distinction critical to effort to reduce the disparities. Finally, cohort studies give insights to the contribution of specific risk factors to disparities in either incidence or case fatality, allowing targeted interventions to be effective. While deaths from stroke mortality declined by a third over the most recent nine year period, there has been a 35% increase in the black-white disparity and little change in geographic disparities. Surveillance studies suggest that the black-white disparity is primarily attributable to differences in incidence, and also have unmasked Hispanic-white differences in incidence that are not apparent in mortality trends. Longitudinal cohort studies are suggesting multiple targets for intervention such as a multi-dimensional impact of blood pressure on the black-white differences, and indications that diet may be contributing to geographic disparities. The vital statistics mortality data currently provide a mixed message, with falling stroke mortality for all groups, but a more rapid fall for whites contributing to an increase in the magnitude of racial disparities in stroke. After suffering these disparities over a half-century, information is now emerging to allow us to better understand the underpinnings of the disparities and potentially enter a new era of targeted interventions to reduce these disparities.

Racial disparities in cancer therapy

The purpose of this study was to determine whether racial disparities in cancer therapy had diminished since the time they were initially documented in the early 1990s. The authors identified a cohort of patients in the SEER-Medicare linked database who were ages 66 to 85 years and who had a primary diagnosis of colorectal, breast, lung, or prostate cancer during 1992 through 2002. The authors identified 7 stage-specific processes of cancer therapy by using Medicare claims. Candidate covariates in multivariate logistic regression included year, clinical, and sociodemographic characteristics, and physician access before cancer diagnosis. During the full study period, black patients were significantly less likely than white patients to receive therapy for cancers of the lung (surgical resection of early stage, 64.0% vs 78.5% for blacks and whites, respectively), breast (radiation after lumpectomy, 77.8% vs 85.8%), colon (adjuvant therapy for stage III, 52.1% vs 64.1%), and prostate (definitive therapy for early stage, 72.4% vs 77.2%, respectively). For both black and white patients, there was little or no improvement in the proportion of patients receiving therapy for most cancer therapies studied, and there was no decrease in the magnitude of any of these racial disparities between 1992 and 2002. Racial disparities persisted even after restricting the analysis to patients who had physician access before their diagnosis. There has been little improvement in either the overall proportion of Medicare beneficiaries receiving cancer therapies or the magnitude of racial disparity. Efforts in the last decade to mitigate cancer therapy disparities appear to have been unsuccessful.